“ the move is a winner for Republicans, who.. would otherwise have little to show for 7 years of…repeated efforts to kill Obamacare..”

“With the bill finally headed to a vote this coming week, taxpayers are scrambling to determine whether the legislation renders them winners or losers.
PRESIDENT TRUMP AND HIS FAMILY. Numerous industries will benefit from the Republican tax overhaul, but perhaps none as dramatically as the industry where Mr. Trump earned his riches: commercial real estate. Mr. Trump, along with his son-in-law Jared Kushner, who is part owner of his own real estate firm, will benefit from lower taxes on so-called “pass through” income, which is money earned by partnerships and other types of businesses whose income is passed through to its owner and taxed at the individual tax rate. Mr. Trump and Mr. Kushner benefit since they own properties through limited liability companies and other similar vehicles.
PEOPLE BUYING HEALTH INSURANCE. With the repeal of the individual mandate, some people who currently buy health insurance because they are required by law to do so are expected to go without coverage. According to the Congressional Budget Office, healthier people are more likely to drop their insurance, leaving insurers stuck with more people who are older and ailing. This is expected to make average insurance premiums on the individual market go up by about 10 percent. All told, 13 million fewer Americans are projected to have health coverage, according to the Congressional Budget Office.” (A)

“The tax bill barreling toward a final vote in Congress guts the most unpopular “Obamacare” provision, its requirement that virtually all Americans carry health insurance or face fines.
Politically, the move is a winner for Republicans, who otherwise would have little to show for seven years of rhetoric and repeated legislative efforts to kill the Affordable Care Act.
But if estimates by the nonpartisan Congressional Budget Office are right, it will lead to more uninsured people and higher premiums for those buying individual health insurance policies.
Congress may then find itself considering other ways to nudge people to get health insurance.
Other popular parts of the Affordable Care Act would remain in place, including subsidized premiums, “essential” benefits and protections for people with pre-existing medical conditions.” (B)

“The severity of the impact is a matter of debate among health policy experts.
The Congressional Budget Office predicts that four million fewer people would be covered in the first year the repeal would take effect. That number would rise to 13 million by 2027, as compared to current law. Meanwhile, premiums would rise by about 10% in most years of the decade.
But the agency also said it is reviewing its methodology. Others say fewer people would be left uninsured. S&P Global Ratings, for instance, projects that only three to five million more consumers would lack coverage over a decade because the mandate is not a key driver for obtaining insurance.
Still, many experts feel that removing the mandate would cause the individual market to tilt even more towards sicker and older consumers. That’s because the mandate serves as a stick to prod some younger and healthier Americans to sign up for coverage.
That shift may prompt some insurers to drop out of the market, especially since they would still be required to cover those with pre-existing conditions but would not be able to charge them more based on their medical history.
If a wave of insurers exit Obamacare, some consumers could be left without any providers on their exchanges in 2019. Already, 29% of current enrollees on the federal exchange have only one option in 2018, according to federal data. Residents in eight states — Alaska, Delaware, Iowa, Mississippi, Nebraska, Oklahoma, South Carolina and Wyoming — have only one insurer next year.” (C)

“The nongroup market refers to people who buy their own health insurance. Most Americans are covered by an employer. Many are covered by Medicare or Medicaid, a few get military health benefits and the so-called Obamacare markets were meant to help the rest get “nongroup” health insurance.
Health insurance premiums in this nongroup market will go up by 10 percent, the CBO predicted.
This will hit one group in particular, according to the Commonwealth Fund, which conducts studies in health policy and released a report Thursday on the Affordable Care Act.
“People who buy their own coverage on the individual market and who have incomes above 400 percent of the federal poverty level (about $48,200 for an individual and $98,400 for a family of four) — the threshold for ACA premium subsidies — would face the brunt of the premium increase,” it said.
A 40-year-old customer buying health insurance on one of the federal exchanges would pay $556 more in premiums in North Dakota and $1,264 more in Nebraska, the group calculated.” (D)

“The election of Doug Jones as the first Democratic senator from Alabama in a generation did many things: It opened a realistic, although still difficult, path for Democrats to capture a Senate majority in 2018, it deepened the divide between the GOP establishment and the self-styled insurgents led by Stephen K. Bannon, the former White House strategist.
And it probably ended GOP hopes of repealing the Affordable Care Act…
Throughout the past year, the Trump administration has taken one swing after another at the healthcare law, and seemingly each one has generated a chorus of predictions about the “death of Obamacare.”
That hasn’t happened….
The latest data on sign-ups came as a new study from the Commonwealth Fund, comparing data across states, showed that the law has, indeed, helped patients get to the doctor and pay their medical bills, contrary to the assertions from President Trump and others in his administration that the law was providing coverage that didn’t actually help people….
The only way to truly undo what the law has accomplished would be to cut off the billions of dollars that currently go to help more than 20 million people pay medical bills. Republicans tried repeatedly this year to cut back on that flow of funds with their various efforts to repeal Obamacare. They were poised to repeat that effort in 2018. But Jones’ upset victory now will likely put that prospect out of reach in the Senate.
Jones made healthcare a top issue in his campaign and explicitly told voters he would oppose repeal. “Repeal and replace is a political slogan,” he would say. “It’s not something that’s workable.” (E)

“But won’t the entire Obamacare system collapse without the mandate? Not if the states step into the breach. They’ve got the power to patch the hole that repeal of the mandate would leave in the ACA. The most ambitious states could even take steps to strengthen the law.
Massachusetts had an individual mandate well before the US did.
For starters, the states can adopt their own individual mandates to replace the one that Congress repeals. There’s nothing stopping them. Before the ACA existed, Massachusetts had a mandate; it’s still on the books. And, as Vox’s Sarah Kliff reported last week, a number of states — including California, Maryland, and Washington, as well as the District of Columbia— are toying with creating their own mandates.
Adopting mandates at the state level would help stabilize insurance markets, thereby keeping premiums in check and forestalling coverage losses. It would also provide a welcome source of revenue: Some people will still prefer to pay a penalty than buy insurance. Plus, the states don’t need to stick with the precise terms of the federal mandate, which has been reviled (from different quarters) both for heavy-handedness and its ineffectuality. Stiffer state-level penalties would still be unpopular, but at least they’d work better.” (F)

“Health economist Gail Wilensky said repealing the mandate might take some of the political steam out of the health care debate. It may even point to a path for lawmakers of both major parties to consider measures that would help stabilize insurance markets for people who don’t get coverage on the job.
It “may be enough to take away what has been the single most hated part of the ACA for both Republicans and Democrats,” said Wilensky, who served in a previous Republican administration.
But that won’t solve the problem of providing affordable coverage for people who don’t qualify for subsidies through “Obamacare.”
President Donald Trump’s administration is working on another track: regulations that would allow broader sale of lower-cost plans with limited benefits.
How much consumer appeal that alternative will have remains to be seen.” (G)

“Sen. Susan Collins said Thursday she isn’t concerned that House Republicans didn’t include Obamacare stabilization bills in its short-term funding bill, saying GOP leadership will add them to the Senate version.
The House GOP released a short-term continuing resolution Wednesday that funds the government until Jan. 19. It does not include two bills that the centrist Maine Republican has been pushing to stabilize Obamacare’s exchanges in return for her vote for tax legislation that includes a repeal of Obamacare’s individual mandate penalties.
Collins shrugged off the House snub, saying it didn’t matter if the House passes a spending bill that doesn’t include the legislation.
“That has never been the plan,” she told reporters. “The plan is for the majority leader to add [the bills] in the Senate.”…
Collins said Thursday that the plan is still to pass the bills by the end of the year, and the new continuing resolution would be the only opportunity left.” (H)

(A) The Winners and Losers in the Tax Bill, By JESSE DRUCKER and ALAN RAPPEPORT, https://www.nytimes.com/2017/12/16/business/the-winners-and-losers-in-the-tax-bill.html
(B) Tax Bill Guts Unpopular ‘Obamacare’ Insurance Mandate, https://www.nytimes.com/aponline/2017/12/16/us/politics/ap-us-taxes-health-care.html
(C) Will Obamacare survive the tax bill?, by Tami Luhby, http://money.cnn.com/2017/12/15/news/economy/obamacare-individual-mandate-tax/index.html
(D) Tax bill kills health insurance mandate. Who will pay more?, by MAGGIE FOX, https://www.nbcnews.com/health/health-care/tax-bill-kills-health-insurance-mandate-who-will-pay-more-n829846
(E) How Alabama saved Obamacare and other effects of an upset, by David Lauter, http://www.latimes.com/politics/la-pol-essential-politics-20171215-story.html
(F) The tax bill destroys an important part of Obamacare. The states can save it., by Nicholas Bagley, https://www.vox.com/the-big-idea/2017/12/14/16773294/obamacare-aca-states-protect-coverage-after-tax-bill
(G) Tax Bill Guts Unpopular ‘Obamacare’ Insurance Mandate, by RICARDO ALONSO-ZALDIVAR, https://www.usnews.com/news/politics/articles/2017-12-16/tax-bill-guts-unpopular-obamacare-insurance-mandate
(H) Susan Collins: Senate eyes adding Obamacare bills to short-term funding deal, by Robert King, http://www.washingtonexaminer.com/susan-collins-senate-eyes-adding-obamacare-bills-to-short-term-funding-deal/article/2643551

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