“…House and Senate Republicans will likely scrap Obamacare’s individual mandate in their final tax bill.”

“Economist Larry Summers said Monday that roughly 10,000 more Americans will die each year if Republican tax-reform legislation passes and includes a repeal of the ObamaCare individual mandate.
“When people lose health insurance, they’re less likely to get preventive care, they’re more likely to defer health care they need, and ultimately they’re more likely to die.”
The Senate passed its tax-reform legislation early Saturday morning. The upper chamber’s bill includes a repeal of the individual mandate, while the House’s tax-reform bill does not.
Summers’s estimate is based on a Congressional Budget Office report that 13 million Americans would opt out of ObamaCare if the individual mandate is repealed.
Summers, who served as former President Clinton’s Treasury secretary and former President Obama’s National Economic Council director, said it’s hard to quantify the number of deaths precisely, but called an estimate that thousands will die because of the bill “very conservative.” (A)

“One clear effect of the GOP tax bill is the provision that medical groups object to most: the repeal of the individual mandate to buy health insurance.
Both the House and the Senate versions of the bill include a repeal of the mandate, which calls for a tax on people who don’t buy health coverage to help make up the cost of care for the uninsured.
While the mandate is unpopular among voters, it was a must-have for health insurance companies. They demanded such a mandate to even take part in the health insurance exchanges set up by the 2010 Affordable Care Act, and without it, many more can be expected to hike premiums or drop out altogether from the Obamacare markets, experts predict.
“If the requirement to carry adequate health insurance disappears, so will the health care coverage of many Americans,” American Heart Association CEO Nancy Brown said in a statement.
“As insurance rolls decrease, premiums will rise an average of 10 percent,” Brown said. “Paying more for health insurance will be a heavy weight to carry if you have a pre-existing condition like heart disease or stroke. We fervently believe this provision should be rejected and removed from the final legislation.”
The Congressional Budget Office (CBO) estimated that repealing the mandate would result in 13 million fewer people being covered by health insurance and would cause insurance companies to raise premiums by 10 percent a year.
“The repeal of the individual insurance mandate destabilizes an essential pillar of the ACA by removing incentives for young and healthy people to purchase insurance,” a coalition of health and consumer groups, including the American Diabetes Association, the American Cancer Society Cancer Action Network and the American Lung Association.” (B)

“Within a year or two of elimination of the mandate, the individual insurance market will resemble the failed pre-Obamacare days when pre-existing conditions and high premiums made access impossible. The difference is that the government will foot a large part of the cost through subsidies. Before the A.C.A., lower-income people who didn’t qualify for Medicaid were priced out of the individual market, but with subsidies, they can now purchase lower-cost plans. If the individual mandate is eliminated, it will be middle-income people without subsidies who lose access.
The continuing high enrollment this fall supports the idea that most people still see the subsidized insurance offerings on the exchanges as a good deal. As a result, the demand side of this unusual market will stay strong for the subsidized customers.
How will the insurance companies react? They will see high demand for subsidized insurance as a tempting market in spite of past and future chaos. The problem for them is that these customers are sicker and less predictable in their needs, which makes it difficult to set a price. This is precisely why the number of insurers this year has dropped so severely. But managing uncertainty is at the core of this business. Any risk is acceptable if the compensation is high enough….
However, the timing of a mandate repeal is central. Eliminating the individual mandate will make little difference to insurers in 2018 if the mandate expires in 2019. But Congress may decide to eliminate the individual mandate immediately. Then insurers, who priced their plans assuming continuation of the same historical enrollee pool, will lose their shirts as healthier enrollees drop out. Changing the rules halfway through the game is not something insurance company C.E.O.s. can anticipate, but it is their biggest challenge now….
Yet as long as the subsidies continue, health plans will offer their policies on the exchanges with very high premiums. While this may allow access for some who otherwise would be left out, the grand purpose of the A.C.A. — to allow affordable care for all — will slip away. Is this any way to do health policy?” (C)

“With one simple move, the tax reform bill passed by Senate Republicans Saturday could herald the beginning of the end of former President Barack Obama’s Affordable Care Act, better known as Obamacare.
The new bill repeals Obamacare’s key requirement that all Americans obtain health insurance. Policy experts say that removing the mandate will force insurance premiums to rise, as young and healthy Americans opt out, leaving millions of Americans without healthcare.”
“It’s going to take a bunch of healthy people out of the insurance market,” Craig Garthwaite , director of the healthcare program at Northwestern University’s Kellogg School of Management, told Reuters.
Obamacare “is going to collapse even more now,” he said.” (D)

“Members of a joint congressional committee will now meet to resolve those differences, conflicts that pit all sorts of special interests against one another. But Republicans are so eager to pass a tax bill — and claim a so-far elusive big win in President Donald Trump’s first year — that compromise is not expected to be too difficult.
Health care mandate: The Senate bill would repeal the requirement in the 2010 Affordable Care Act that most people pay a penalty if they don’t purchase health insurance.
The provision isn’t in the House bill, but is popular among House conservatives. Yet those same conservatives are opposed to health care provisions that would be considered as a result of including the repeal, which might be necessary to delivering critical votes in the Senate.
Sen. Susan Collins, R-Maine, said she expects legislation that would reinstate cost-sharing payments to insurance companies to pass before the tax bill is complete. The provision, authored by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., would help lower health insurance premiums, she said.” (E)

“Sen. Susan Collins (R-Maine) has doubled the amount of money she’s requesting in her ObamaCare stabilization bill in exchange for her vote on the GOP’s tax-reform plan.
Collins, a key vote on tax reform, is pushing for the passage of two ObamaCare bills in an attempt to mitigate the effects of the tax bill’s repeal of the individual insurance mandate.
One of those bills — sponsored by her and Sen. Bill Nelson (D-Fla.) — would provide states with $10 billion over two years to establish high-risk pools or reinsurance programs to lower premiums.
That’s more than double the $4.5 billion originally requested in her bill, which she introduced in September.
Senate Majority Leader Mitch McConnell (R-Ky.) said he would support passage of both bills, which could be added to the end-of-year spending deal.” (F)

“In Maine, an estimated 50,000 fewer people could have health coverage by 2025. That’s because insurance rates would rise if, as expected, many healthy young people exercised their option to go without insurance — leaving the pool of insured people older and sicker. And as those rates rise, even more people would be priced out, including some who qualify for subsidies. The budget office estimates that average premiums in the individual market would rise about 10 percent a year for the next decade as a result of repeal. That would be on top of unrelated premium increases….
In 2017, some 79,400 Mainers were covered by individual plans purchased on the state’s insurance marketplace. That an Affordable Care Act provision that allows consumers to make apples-to-apples comparisons between available plans. The majority of the plans purchased in Maine qualified for a premium subsidy, available to enrollees who earn up to 400 percent of the federal poverty limit. That’s about $48,424 for an individual and $98,400 for a family of four. The subsidy takes the form of a tax credit.
In 2015, the most recent year for which information is available, 38,560 taxpayers in Maine qualified for that credit, at a total subsidy value of $184.3 million, according to the Internal Revenue Service. Of those taxpayers, 15,460 had household incomes of between $10,000 to $25,000. Another 13,340 had household incomes between $25,000 to $50,000.
Collins, who earlier this year helped defeat efforts to end the Affordable Care Act, initially said that repealing the individual mandate would destabilize health insurance markets. But in the days leading up to the vote, Collins said she was reassured by Trump’s assertion that other steps will be taken to offset any negative impacts of repeal.” (G)

“But one expert says such efforts are inadequate. Aviva Aron-Dine, senior fellow and senior counselor at the Center on Budget and Policy Priorities, warns that temporary underfunded reinsurance programs are not enough to reverse the impact of the individual mandate’s repeal.
“As a result, it will not meaningfully reduce the risk that insurers will leave the market. Even a much larger reinsurance program would leave insurers in doubt about how to price their insurance products for the state of the overall risk pool: what they should assume, for example, about how many people will leave the market, how much healthier this group is than average, and how quickly the full effects of mandate repeal would be felt,” Aron-Dine wrote.” (H)

CMS Chief Seema Verma:
“Well, first start by saying, I’m not sure that the individual mandate has really been effective. If we look at what’s gone on since Obamacare was implemented, we’ve seen rates go up by over 100%. In some areas of the country, it’s over 200%. While prices have gone up, if we look at the types of plans that are being offered, in many states, right now we have eight states that have only one insurance company. That means that people may not have the choice of doctor. One third of our folks that are using the exchanges will only have one insurer, so our choices are going down.
We’re also hearing from people that the plans that are being offered in and of themselves are high deductible plans or they’re narrow networks. Folks are looking at this and saying, “It’s very expensive, there’s a high deductible, and I don’t want this. I would rather pay the penalty.” If we look at the number of people that are paying the penalty, it’s over seven million people. Out of that seven million, 5.2 million are earning less than $50,000 a year. This is really a tax on low income people, low income people that may not be able to afford coverage and then on top of it they’re paying a penalty. That’s one area of the law, I don’t think that, that in and of itself, is going to address the underlying issues.
From our standpoint, we’re trying to do what we can, making things more flexible, more market friendly, and trying to create more choices, but ultimately, there’s only so much we can do. We need a Congressional, a comprehensive Congressional solution, that’s not only going to provide flexibility for states and empower states, but it’s going to address the underlying reasons of why costs are going up so much.” (I)

“Republicans are also facing the possibility that the $1 trillion tax bill will trigger deep, automatic cuts to Medicare next year unless Congress stops it from happening.
Majority Leader Mitch McConnell (R-Ky.) promised Sen. Susan Collins (R-Maine) that the cuts required by the “pay-as-you-go” or “pay-go” budgetary rule won’t happen.
Collins was a key holdout, and she said the personal promise from McConnell helped win her support for the legislation.
McConnell on Friday issued a joint statement with Speaker Paul Ryan (R-Wis.) saying the pay-go cuts won’t happen.
“Congress has readily available methods to waive this law, which has never been enforced since its enactment. There is no reason to believe that Congress would not act again to prevent a sequester, and we will work to ensure these spending cuts are prevented,” McConnell and Ryan said.
Lawmakers have voted numerous times in the past to waive the rule, but they need the support of Democrats, who have so far been reluctant to offer it.” (J)

“Speaker Paul Ryan’s (R-Wis.) office told a meeting of congressional leadership offices on Monday that the Speaker is not part of a deal to get ObamaCare fixes passed before the end of the year, according to a source familiar with the meeting.
Senate Majority Leader Mitch McConnell (R-Ky.) made a commitment to Sen. Susan Collins (R-Maine) that he would support passage of two bipartisan ObamaCare bills before the end of the year, a promise that helped win her vote for tax reform.
However, Ryan’s office told a meeting of staff from the four top congressional leadership offices on Monday that he has not made that same commitment, raising further questions about whether the ObamaCare bills, already opposed by House conservatives, can pass the House.
Ryan’s office did not go so far as to say it opposed the bipartisan bills, the source said, and it is still possible the measures could pass before the end of the year. The Senate is expected to add the measures to a government funding bill later this month, which would put pressure on the House to accept it or else risk a government shutdown.” (K)

“The top House tax writer said Tuesday that House and Senate Republicans will likely scrap Obamacare’s individual mandate in their final tax bill.
“Yeah, I believe we will,” House Ways and Means Committee Chairman Rep. Kevin Brady, R-Texas, said when asked if the joint plan would get rid of the provision requiring most Americans to have health insurance or pay a penalty.
Brady’s statement appears to resolve one of the key differences between the separate tax legislation passed by the House and Senate. The Senate bill would effectively repeal the mandate, while the House proposal would not.” (L)

“Republicans appear to be on the brink of striking down the Affordable Care Act’s health-insurance requirement, an ardently sought goal of the law’s opponents. But the fate of a bipartisan bill that centrist Republicans hoped would offset some of the fallout remains uncertain. Some key GOP centrists supported a Senate tax overhaul that repeals the requirement that most people have health insurance, a move experts say will likely drive up premiums, on the condition that it be swiftly accompanied by a bipartisan measure that aims to lower premiums.” (M)

“Repealing the individual mandate means fewer people will sign up for health insurance—13 million according to the Congressional Budget Office (CBO)—and the government will pay out less in premium support. The calculus is clear—tax cuts for the wealthiest Americans will be paid for by providing less support for working families to buy health insurance. Indirectly, however, people who need insurance the most—older, less healthy Americans—will subsidize tax cuts via higher premiums.
Without a mandate, the exchange population will trend older and sicker. Without a balanced risk pool, premiums will spike—at least 10% in most years according to the CBO. Importantly, the ACA’s subsidies will mitigate financial hardship for Americans making under 400% of the federal poverty level, about $98,400 for a family of four. But families above that threshold—who are by no means poor, but certainly not rich—will be thrown to the wolves. Although they will not necessarily be paying higher taxes to support corporate tax cuts, they will be stuck paying higher premiums as a result of the mandate repeal. In many cases, families will be priced out of the insurance market entirely—people can’t choose to buy what they can’t afford.
The GOP tax bill is a bomb lobbed in to the heart of the U.S. health care system. It willingly ignores the dynamics of insurance markets. Under the flag of free markets and consumer choice, the bill guts choice for millions of middle-class Americans to pay for regressive tax cuts.” (N)

“This week, Sen. Orrin Hatch (R-UT) helped push a tax bill through the Senate that will cost about $1 trillion. At the same time, he lamented the difficulties of finding the money to fund the Children’s Health Insurance Program (CHIP), which pays for health care for 9 million children and costs about $14 billion a year — a program Hatch helped create.
A Sunday-morning tweet from MSNBC’s Joe Scarborough quoting Hatch kicked off a dustup on Twitter over the Utah Republican’s take on CHIP. Funding for the program — which was created as a joint effort between Hatch and Democratic Sen. Edward Kennedy in 1997 — expired at the end of September; Congress has yet to reauthorize it. That puts health care for millions of American children at risk.
On Thursday evening, as the Senate debated the Republican tax plan, Sen. Sherrod Brown (D-OH) asked whether there’s “something we can do to get the children’s health insurance program done.”
Hatch’s response, in a nutshell: Yes, we’ll fund the program, but we’re really short on money.
“We’re going to do CHIP; there’s no question about it in my mind. And it’s got to be done the right way,” Hatch said. “But the reason CHIP’s having trouble is because we don’t have money anymore, and to just add more and more spending and more and more spending, and you can look at the rest of the bill for the more and more spending.”” (O)

(A) Economist Larry Summers: 10,000 people will die annually from GOP tax bill, by BRETT SAMUELS, http://thehill.com/policy/healthcare/363152-larry-summers-10000-people-will-die-annually-from-gop-tax-bill
(B) Repeal of health insurance mandate in GOP tax bill could have big effects, by MAGGIE FOX, https://www.nbcnews.com/health/health-care/repeal-health-insurance-mandate-gop-tax-bill-could-have-big-n826441
(C) How the G.O.P. Tax Bill Will Ruin Obamacare, by J. B. SILVERS, https://www.nytimes.com/2017/12/04/opinion/gop-tax-bill-obamacare.html
(D) HOW DONALD TRUMP SHOT DOWN OBAMACARE WITH THE SENATE TAX REFORM BILL, by TOM PORTER, http://www.newsweek.com/senate-tax-reform-bill-could-spell-beginning-end-obamacare-729328
(E) With Senate tax bill passed, deal-making with House to begin, by Ron Johnson, https://www.ohio.com/akron/news/breaking-news-news/with-senate-tax-bill-passed-deal-making-with-house-to-begin
(F) Collins doubles funding ask for ObamaCare bill, by JESSIE HELLMANN, http://thehill.com/policy/healthcare/363130-collins-doubles-funding-ask-for-obamacare-bill
(G) What repealing Obamacare mandate would mean for Maine, by Meg Haskell, https://bangordailynews.com/2017/12/02/health/what-repealing-obamacare-mandate-would-mean-for-maine/
(H) Senate passes tax bill that repeals individual mandate, by David Lim, https://www.healthcaredive.com/news/senate-passes-tax-bill-that-repeals-individual-mandate/512125/
(I) CMS Chief Seema Verma Speaks About Her Top Health Care Policy Priorities, by Avik Roy, https://www.forbes.com/sites/theapothecary/2017/12/05/cms-chief-seema-verma-speaks-about-her-top-health-care-policy-priorities/3/#6eda9c236100
(J) Tax bill could fuel push for Medicare, Social Security cuts, by NATHANIEL WEIXEL, http://thehill.com/policy/healthcare/362866-tax-bill-could-fuel-push-for-medicare-social-security-cuts/
(K) Ryan’s office warning he wasn’t part of deal on ObamaCare, by PETER SULLIVAN, http://thehill.com/policy/healthcare/363306-ryans-office-warning-he-wasnt-part-of-deal-on-obamacare-source
(L) Final GOP tax bill will likely scrap Obamacare individual mandate, top House tax writer Brady says, by Jacob Pramuk, https://www.cnbc.com/2017/12/05/kevin-brady-expects-tax-bill-to-repeal-obamacare-individual-mandate.html
(M) Support Wavers for Senate Bill to Shore Up Health-Insurance Markets, by Stephanie Armour and Kristina Peterson, https://www.wsj.com/articles/support-wavers-for-senate-bill-to-shore-up-health-insurance-markets-1512490052
(N) Obamacare Architect: How Is Trump Paying for Wealthy Tax Cuts? By Kicking People Off Their Health Insurance, by Ezekiel J. Emanuel and Aaron Glickman, http://fortune.com/2017/12/04/tax-reform-bill-2017-explained-obamacare-individual-mandate/
(O) GOP senator says it’s hard to fund $14 billion children’s health care program — then advocates for $1 trillion tax cut, by Emily Stewart, https://www.vox.com/2017/12/3/16730496/orrin-hatch-

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