“..Conference Committee “may not change a provision on which both houses agree, nor may they add anything that is not in one version or the other,”…

… according to the Congressional Research Service. The final product is a “conference report,” which is passed by the majority of the members in the conference committee and then sent to the full House and Senate floors. Both the House and Senate have to pass the conference report outright for it to be sent to the president’s desk. (A)

“Because the Senate was rewriting its bill till the last minute, only the dealmakers themselves knew what the chamber voted on. There will, no doubt, be many unpleasant surprises as both houses work to pass final legislation for President Trump to sign.
The votes for the bill by Susan Collins of Maine and John McCain and Jeff Flake of Arizona were particularly disheartening. Ms. Collins, who helped sink an effort to effectively repeal the A.C.A. in September, blithely voted for a tax bill that will leave a gaping hole in that law by repealing its requirement that most people have insurance or pay a penalty. She traded away her vote for an inadequate deduction for property taxes and empty promises from Mr. Trump and the majority leader, Mitch McConnell, that they would help shore up the A.C.A., which they have repeatedly tried to sabotage.” (B)

“Left more uncertain is the trade-off Republican leaders made in order to secure support from all but one Senate Republican. Sen. Susan Collins, R-Maine, who voted against GOP efforts to repeal parts of Obamacare this summer, came onboard for the tax plan after promises from leadership that the Senate would bring a bipartisan bill to the floor known as Alexander-Murray. Collins also was able to secure a pledge to bring a two-year, $5 billion-a-year reinsurance fund to the floor, a bill she introduced with Sen. Bill Nelson, D-Fla.
“After securing significant changes, as well as commitments to pass legislation to help lower health insurance premiums, I will cast my vote in support of the Senate tax reform bill,” Collins tweeted Friday.
But Democrats have repeatedly said that passing both bills would not negate the side effects of repealing the mandate. Insurers have warned that without the individual mandate they are likely to raise premiums for the country’s estimated 16 million Obamacare customers, or withdraw from the exchanges where some of these customers can purchase plans that are subsidized by the federal government.
Sen. Patty Murray, D-Wash., who helped author the bill that carries her name and that of Sen. Lamar Alexander, R-Tenn., said that her deal with Alexander wasn’t designed to mitigate mandate repeal.
“Our bill was designed to shore up the existing healthcare system and deal with problems that President Trump and Republicans have already created — not solve the new problems in this awful Republican tax bill,” Murray said on the Senate floor Friday.
Alexander-Murray makes cost-sharing reduction payments to insurers for two years. In exchange, states get more latitude to waive Obamacare insurer regulations. The payments reimburse insurers for a requirement to lower copays and deductibles for low-income Obamacare customers.
Trump ended the payments starting on Oct. 18. In response, many Obamacare insurers raised premiums to offset the costly requirement for lowering out-of-pocket costs for low-income customers.
Murray said the reinsurance bill sponsored by Collins and Nelson won’t offer relief.
“This bill is good policy on its own — but won’t stop the premium increases, coverage losses, and chaos that the Republican tax bill will cause,” she said Friday.” (C)

“Another argument – that the repeal of the individual mandate wouldn’t be the same as throwing people who already have insurance off insurance – is entirely specious. The individual mandate repeal unwinds the exchanges, allowing young and healthy people to stay out of the risk pools, making coverage more expensive and even unaffordable for those who remain. Surely, Collins and Murkowski know this to be the case from the Obamacare repeal debate. Simply put, as the Center on Budget and Policy Priorities found, “Pairing mandate repeal with the Collins-Nelson bill, or a similar approach . . . would not change the fact that repealing the mandate would drive up uninsured rates. That would weaken access to care, health, and financial security for millions of people. It would also substantially raise uncompensated care costs, which would ultimately be borne by providers, other health-care consumers and taxpayers.”
None of this addresses the damage that the bill may do to Medicaid and Medicare. Because of the deficits it creates (an issue that has thrown the entire legislative process into confusion), there may be a $25 billion sequester in Medicaid and Medicare funding in 2018 alone under the so-called pay-as-you-go (PAYGO) rules. Collins has said she’d oppose that, but her colleagues do not show the same concern.” (D)

“But let’s be clear: Repealing the individual mandate would be a big deal. The mandate is a valuable device for stopping free riders. Obamacare mandated that insurance companies offer insurance to everybody who wants it, with only minimal price discrimination based on age and smoking status. But if a healthy person knows they can buy insurance whenever they want for a given price, they may well decide to only purchase it after they get sick and need coverage.
This would be a big problem for insurance markets, as the pool of covered beneficiaries would be an unhealthy and expensive group. That’s why, for example, the CBO forecasts that repealing the individual mandate would cause premiums in nongroup markets to rise significantly.
Additionally, the mandate provides a hard nudge to people on the fence about getting enrolled in health insurance, including those in nongroup markets but also those who have Medicaid or employer-sponsored insurance. The CBO estimates that of the 13 million people who would lose coverage if the mandate is repealed, seven million are dropping out of Medicaid and employer-sponsored plans. In short, the mandate is a very efficient tool for keeping premium increases in check and increasing enrollment in all types of coverage.
Finally, while the individual mandate repeal is the only plank of the tax bill that directly attacks the ACA, Republicans have made no secret of the fact that after this bill passes, they will point at the resulting deficits to justify cuts in Medicaid and Medicare. This is not idle speculation; the House and Senate passed a budget resolution last month with $1.8 trillion in cuts to both of these programs. The battle over health care won’t end with this tax bill—or anytime soon.” (E)

“High-ranking Republicans are hinting that, after their tax overhaul, the party intends to look at cutting spending on welfare, entitlement programs such as Social Security and Medicare, and other parts of the social safety net.
“House Speaker Paul D. Ryan (R-Wis.) said recently that he wants Republicans to focus in 2018 on reducing spending on government programs. Last month, President Trump said welfare reform will “take place right after taxes, very soon, very shortly after taxes.”
As Republicans advocate spending cuts, they have frequently cited a need to reduce the national deficit while growing the economy.
“You also have to bring spending under control. And not discretionary spending. That isn’t the driver of our debt. The driver of our debt is the structure of Social Security and Medicare for future beneficiaries,” Sen. Marco Rubio (R-Fla.) said this week.
While whipping votes for a GOP tax bill on Thursday, Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) attacked “liberal programs” for the poor and said Congress needed to stop wasting Americans’ money.
“We’re spending ourselves into bankruptcy,” Hatch said. “Now, let’s just be honest about it: We’re in trouble. This country is in deep debt. You don’t help the poor by not solving the problems of debt, and you don’t help the poor by continually pushing more and more liberal programs through.”
The GOP tax bill currently under consideration in the Senate would increase the federal deficit by nearly $1.5 trillion over a decade, according to Congress’s official tax analysts and multiple other nonpartisan analysts. When economic growth the measure could create is included in the analysis, Congress’s official tax scorekeeper predicted the bill would add $1 trillion to the deficit over 10 years.
Trump has not clarified which specific programs would be affected by the proposed “welfare reform.”
During the presidential campaign, Trump vowed that there would be “no cuts” to Social Security, Medicare or Medicaid, although the president has reversed many of his economic campaign promises since taking office.” (F)

“In the hours before the Senate’s final vote on the tax overhaul package, McConnell and House Speaker Paul D. Ryan (R-Wis.) sought to tamp down fears of such cuts, issuing a joint statement in which they accused Democrats of “misleading claims” and promised to “work to ensure these spending cuts are prevented.”
The bill itself does not avert them, however. Separate action would be required later and — unlike the parliamentary maneuvers used to adopt the tax plan with only GOP votes — would require support from some Democrats. Republican leaders predict that Democrats would cooperate rather than bear blame for harming health-care funding.
The leaders’ joint statement has its skeptics. “We are aware they say they will waive the paygo, but we have little comfort that they can do this,” said Georges S. Benjamin, executive director of the American Public Health Association. “Why did they not write the bill to address this in the first place?”
The cuts, if they happen, would decrease federal spending on Medicare by 4 percent — amounting to about $25 billion next year, the Congressional Budget Office forecast. Because paygo rules do not allow Medicare benefits to be touched, the funding loss would be spread among payments to doctors, hospitals and others that provide care to the program’s 56 million older and disabled Americans.
Those rules focus only on the mandatory spending within the federal budget and would leave untouched some health-care programs that provide help to low-income Americans, such as Medicaid and the Children’s Health Insurance Program. But it could eliminate nearly $1 billion a year for a Prevention and Public Health Fund, created under the ACA, that now represents 12 percent of the Centers for Disease Control and Prevention’s budget.” (G)

“There are some timing issues that could impact this process. Collins told reporters Tuesday that if she is going to vote on the Senate’s tax bill, she wants to see two Obamacare stabilizations bills passed before the conference report comes out.” (A)

(A) Senate Republicans pass a tax bill giving corporations a massive tax cut and cutting health care. By Tara Golshan, https://www.vox.com/policy-and-politics/2017/12/2/16720052/senate-republicans-pass-tax-bill
(B) A Historic Tax Heist, https://www.nytimes.com/2017/12/02/opinion/editorials/a-historic-tax-heist.html?_r=0
(C) Republicans send Obamacare individual mandate repeal to conference, by Robert King and Kimberly Leonard, http://www.washingtonexaminer.com/republicans-send-obamacare-individual-mandate-repeal-to-conference/article/2642364
(D) Two senators’ inexplicable flip-flop on health care, by Jennifer Rubin, http://www.sfgate.com/opinion/article/Two-senators-inexplicable-flip-flop-on-health-12398430.php
(E) Commentary: The Hidden Victim of Trump’s Tax Plan: Your Health Insurance, by Josh Bivens, http://fortune.com/2017/12/01/trump-senate-tax-bill-vote-individual-mandate/
(F) GOP eyes post-tax-cut changes to welfare, Medicare and Social Security, by Jeff Stein, https://www.washingtonpost.com/news/wonk/wp/2017/12/01/gop-eyes-post-tax-cut-changes-to-welfare-medicare-and-social-security/?utm_term=.7430216da035
(G) Senate’s huge tax bill would have potent ripple effects for health-care system, by Amy Goldstein, https://www.washingtonpost.com/national/health-science/senates-massive-tax-bill-would-have-potent-ripple-effects-for-health-care-system/2017/12/02/8e1701b2-d6c3-11e7-a986-d0a9770d9a3e_story.html?utm_term=.ab7093963f

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