Doing so could jeopardize Obamacare’s already-shaky marketplaces, by reducing the number of healthier people who sign up for insurance.
The bill will “repeal Obamacare’s individual mandate tax, delivering relief to low- and middle-income Americans who have struggled under an unpopular and unworkable law,” the Kentucky Republican said in an emailed statement.” (A)

“Susan Collins believes, or claims to believe, that Paul Ryan can be trusted to protect Medicare. She thinks that seniors and Americans with disabilities who rely on the program’s benefits should trust him too. That requires ignoring everything that Ryan has ever said about Medicare…
Not only is Collins insisting that Ryan is to be trusted, and can deliver the votes, when it comes to protecting Medicare. She is showing the same gullibility — or hypocrisy — with respect to the health care of those not yet of Medicare age. The tax bill she voted for would repeal the individual mandate, an essential provision of the Affordable Care Act. That would result in 13 million people losing their insurance coverage. For those who still remain in the ACA marketplaces, premiums would go up by an average of ten percent.
But Collins claims that these harms will be mitigated because Congress will separately pass the Alexander-Murray agreement to stabilize the marketplaces. Why is she so sure they will pass it? McConnell and Ryan promised…and of course, they would never go back on their word. If they are so willing to pass it, why didn’t they do so already as part of the just-passed extension of the continuing resolution? A different vehicle will make passage even harder” (B)

“To assume that Collins was “duped” into voting for the tax bill requires thinking that she is profoundly stupid. She might be, but I don’t think she is. An alternate analysis is that Collins is not naive; that she knew all along that McConnell’s promises were worthless; and that she simply wanted a reason to justify (to constituents or to herself) voting for the tax bill. Vote for the bill, then perform disappointment when McConnell pulls the rug out from under you or the House refuses to even consider the “deal” you claim you were promised. Bada-bing, bada-boom….
Susan Collins is not an innocent bystander to the country’s destruction by her party, and it’s time for political commentators to stop treating her as such. Susan Collins is a centrist in today’s Republican Party, which is to say she surpasses the lowest possible bar for basic human decency that exists. Susan Collins is a moderate Republican in the same way that your Aunt Sue is your favorite aunt by default, because at least Aunt Sue doesn’t drink too much chardonnay and tell you the HPV vaccine is going to kill you.
If I had to bet, I’d say Susan Collins will vote for the final version of the tax bill, knowing full well that most of her constituents in Maine would detest it if they knew all its grisly details. I hope she proves me wrong.” (C)

“What happens if the Obamacare death spiral occurs?
The future of the health insurance market, and of President Obama’s signature legislation, is decidedly uncertain. If Republicans make no further changes during the remaining three years of President Trump’s term, the exchanges may limp along, and the Obamacare market may essentially become an expensive, high-risk pool in which insurers offer costly coverage and the government pays ever-increasing subsidies to cover rising premiums.
Or the death spiral may be used as a pretext to repeal the law entirely, throwing the insurance market into further chaos unless a replacement plan is put in place.
Those buying policies on the open market may wish to consider investing in a health savings account so they at least have pre-tax funds available to pay for healthcare expenditures in case the insurance market is upended and the disruption causes a temporary gap in coverage.” (D)

“A group of insurance experts is warning Congress against repealing ObamaCare’s individual mandate, saying the move would raise premiums and could cause insurers to drop out of the market.
The American Academy of Actuaries wrote to congressional leaders on Tuesday saying that “eliminating the individual mandate would lead to premium increases…
The insurance experts also say that a measure pushed by Sen. Susan Collins (R-Maine), intended to help offset the premium increases from repealing the mandate, would not be enough to make up the difference.
That bill, sponsored by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), would fund key ObamaCare payments known as cost-sharing reductions. The actuaries say the payments “would not offset premium increases due to an elimination of the mandate…”
“Insurers would likely reconsider their future participation in the market,” the actuaries write. “This could lead to severe market disruption and loss of coverage among individual market enrollees.” (E)

“House conservatives are launching a full-court press to preserve a key provision rolling back ObamaCare in the final tax-reform bill being crafted behind closed doors by congressional negotiators…
“ObamaCare’s coercive individual mandate represents perhaps the worst example of the federal government violating individual freedom and liberty — which is why we have repeatedly promised to repeal it,” Walker and 70 other committee members said in letter to lead negotiators Texas Rep. Kevin Brady and Utah Sen. Orrin Hatch. “We urge you to help fulfill our promise to the American people and include this language in a final conference package.”
Repealing the mandate would at least give Republicans a significant victory toward the larger goal of a full repeal-and-replace….
The president wants a final GOP tax plan on his desk before Christmas.” (F)

“Ms. Collins remained respectful and strained to convince the room of about a dozen skeptics that the promises that had been made to her were ironclad.
She defended her decision in the face of the group’s challenges that previous Republican promises for the tax bill had been broken, including a commitment to not add to the deficit and to not benefit the rich, and that written agreements are not law.
“I do not believe that I’ve given up leverage,” Ms. Collins said. “I’ve used my leverage to negotiate agreements that are promises to me.”” (G)

(A) GOP Tax Compromise Would Repeal Obamacare’s Individual Mandate, by Zachary Tracer, https://www.bloomberg.com/news/articles/2017-12-13/obamacare-coverage-requirement-undone-in-gop-tax-compromise
(B) Will Susan Collins Save Medicare?, https://www.huffingtonpost.com/entry/will-susan-collins-save-medicare_us_5a317543e4b06a512dd69cdf
(C) Susan Collins Isn’t Being Duped Into Anything, by Emma Roller, https://splinternews.com/susan-collins-isnt-being-duped-into-anything-1821188722
(D) What Is the Obamacare “Death Spiral” — and Can It Be Stopped?, http://www.foxbusiness.com/markets/2017/12/10/what-is-obamacare-death-spiral-and-can-it-be-stopped.html
(E) Actuaries warn of premium increases from repealing ObamaCare mandate, by PETER SULLIVAN, http://thehill.com/policy/healthcare/364514-actuaries-warn-of-premium-increases-from-repealing-obamacare-mandate
(F) Conservatives fight to keep ObamaCare mandate repeal in tax bill, by Joseph Weber, http://www.foxnews.com/politics/2017/12/12/conservatives-fight-to-keep-obamacare-mandate-repeal-in-tax-bill.html
(G) Last-Ditch Effort to Sway Senator on Tax Bill Involves Personal Pleas, by ALAN RAPPEPORT, https://www.nytimes.com/2017/12/14/us/politics/susan-collins-tax-bill.html?_r=0

Before she voted for the Senate version of the Republican tax bill, Sen. Susan Collins saw that Congress would soon be passing separate spending deals, and she had demands.
The Maine Republican laid out a series of conditions for her to support the final “conference committee” version of the tax proposal. Most notably, she wants Congress to pass two separate health care bills first….
It’s unclear how the separate health bills would become law before a final tax vote. Though Collins secured support from both President Donald Trump and Senate Majority Leader Mitch McConnell (R-Ky.), neither man controls the House of Representatives.
House Speaker Paul Ryan (R-Wis.) has suggested he doesn’t support the Collins demands, saying he wasn’t a party to her deal with McConnell. And Rep. Mark Walker (R-N.C.), leader of a group of lawmakers called the Republican Study Committee, said the conservative bloc had been promised by GOP leaders that the health bills would not be part of a must-pass spending package this month.
Collins wants Congress to pass the so-called Alexander-Murray deal — an agreement worked out between Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) that would provide for “Cost Sharing Reductions” for Obamacare insurers — and another bill providing $2.25 billion annually for states to offset the high insurance costs of some individuals.
Without those measures signed into law, McConnell could just invite Collins to become the one remaining “no” vote Senate Republicans can afford, since their tax bill passed with 51 votes last Saturday….
It would be difficult for Republican leaders to appease Collins without betraying House conservatives.
On Thursday, they went along with a stopgap spending bill under the conditions that there would be no Alexander-Murray provisions in any of the other upcoming measures to fund the government. Ryan and House Republicans could very well pass another short-term appropriations bill in two weeks, have the Senate change the bill — because, after all, McConnell needs Democratic votes to pass that bill in his chamber — and then force Ryan and House Republicans to pass the Senate version or shut down government.
But no matter the ultimate conclusion, Collins is already being asked to accept more things on faith than she was supposed to. Earlier in the week, the House Freedom Caucus nearly derailed a vote to begin merging the separate versions of the tax legislation until leaders agreed to “decouple” the tax bill from the other spending bills, with Freedom Caucus Chairman Mark Meadows (R-N.C.) telling reporters that the final tax bill would now likely come next week, days before Senators vote again on a spending bill.
If that’s the case, Collins will once again be asked to vote for legislation she believes is harmful to Americans with the promise that Congress will mitigate their actions in the future.
If Collins objects, any one other Republican senator — with Bob Corker (R-Tenn.) continuing to oppose the bill — could sink the tax legislation. And other senators may hold up the process until Collins receivers firmer commitments. Sen. John McCain (R-Ariz.), for example, could have a problem with McConnell going back on his word.” (A)

“But it should be clear at this point, to Collins and to House conservatives, that someone is going to get hoodwinked. At least one GOP leader is going to have to go back on his word. And it should be clear at this point that these commitments Republicans are making are a lot looser than members of Congress think…
Republican Sen. Susan Collins of Maine says she would consider removing her support from GOP tax plans, saying in an interview she could change her vote if her proposed amendments don’t make it in the final version.
“I would (consider changing my vote),” she told CNN affiliate CBS WABI5 on Thursday. “I’m going to look at what comes out of the conference committee meeting to reconcile the differences between the Senate and House bill. So I won’t make a final decision until I see what that package is.”…
Collins, a moderate Republican, voted for the GOP’s tax plan last week despite having helped kill the GOP’s Obamacare repeal efforts earlier this year. Several aides told CNN that Collins made clear to Senate Majority Leader Mitch McConnell that she wanted to get to “yes” on the tax legislation, unlike with health care.
“There’s a real fear that the tax bill is going to trigger a 4% cut in Medicare,” she told CBS WABI5 in the interview. “I am absolutely certain that 4% cut in Medicare that I mentioned will not occur. I have it in writing from both the speaker of the House, Paul Ryan, and also Senator Mitch McConnell.” (B)

Meanwhile, it looks as though funding for another cost-sharing reduction (CSR) payments won’t make it into the next spending bill, according to The Hill. Republican Study Committee chairman Rep. Mark Walker said House leaders made that promise during a meeting Tuesday.
That is likely unwelcome news for Sen. Susan Collins, R-Maine. She agreed to vote for the Senate’s tax bill—which repeals the ACA’s individual mandate—after striking a deal with Senate Majority Leader Mitch McConnell to pass a bill funding CSR payments and her reinsurance proposal. The idea is that those bills might mitigate the negative effects of repealing the individual mandate—though some analyses have disputed that notion.
Collins said Friday that she might change her vote on the GOP’s tax overhaul if party leaders don’t include her amendments to that measure, which are related property tax and medical expense deductions, the Associated Press reported. Collins also noted that House and Senate leaders promised her they would remove the threat of a 4% cut to Medicare. (C)

“Sen. Lisa Murkowski (R-Alaska) is pushing back on Democratic attacks that she is undercutting ObamaCare, saying opponents are simply using “scare tactics.”
In a question-and-answer video posted on her YouTube page, Murkowski defended her vote for tax reform this month. Murkowski backed a bill that includes language repealing ObamaCare’s individual mandate.
“I think it’s important that people really look to what is included in this bill when it relates to the Affordable Care Act and to get beyond the scare tactics and the rhetoric that is designed to just instill fear and paranoia in people,” Murkowski said.
She notes that the only provision in the tax bill related to ObamaCare is the repeal of the requirement to have coverage or pay a fine.
“What this bill does is says if you can’t afford health-care coverage, or if you don’t see that value in it, we’re not going to fine you,” she said. “It doesn’t impact the ACA in any other way. If you receive a subsidy for your health-care insurance before this tax bill passes you will still be able to receive a subsidy after.”
Murkowski was one of three Republican senators who voted down a Republican ObamaCare repeal attempt over the summer, which included repeal of the mandate. She has drawn sharp criticism from Democrats this time for voting for the repeal of the mandate.
Opponents of her move argue that eliminating the mandate will have wider impacts, and that it could lead to a spike in premiums or insurers dropping out of the market once an incentive for healthy people to enroll is removed.
The Congressional Budget Office finds that premiums will increase 10 percent and 13 million fewer people will have coverage over a decade if the mandate is repealed.
Murkowski argued that subsidies available under the health-care law will encourage many people to remain enrolled in ObamaCare.
She also touted a bipartisan bill from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) as one that would help stabilize the market by providing funds for key insurer payments.
“It is my understanding that as part of the negotiation, not only has the Senate leadership committed that we will advance Alexander-Murray, but the president has indicated that support as well, so prior to the end of this year, I think we can anticipate that we will see that piece inserted as well,” Murkowski said.
Many House Republicans, though, are opposed to the bill, raising questions on if it can pass that chamber.
Experts say that Alexander-Murray alone is also not enough to counteract the premium increases from repealing the mandate, and that additional funding would be needed to bring down premiums.” (D)

“Marc Short, the White House director of legislative affairs, said the change for state and local tax deductions is “certainly being discussed.” But he said “the biggest challenge is the pay-fors” — that is, how to cover the revenue that would be lost by offering a larger deduction….
By Monday, Cohn added, “we’ll have a pretty final tax bill here, and we’ll know where we’re going to be.”
Short predicted that two GOP senators who have cited specific concerns about the legislation — Marco Rubio of Florida and Susan Collins of Maine are “going to be fine” in the end….
Collins has said she wants to see separate legislation passed to shore up health-insurance marketplaces if the ultimate tax bill repeals the individual mandate that’s part of Obamacare. The measures will almost surely face rough sledding in the House, however.
On Thursday, the White House didn’t commit to supporting the health-care bills Collins wants. Short said Friday that “if those reach the president’s desk he will sign them, but there’s some elements of that as far as the lobbying and whipping of votes that is out of our control.”” (E)

“Sen. Susan Collins, the Maine Republican whose vote was pivotal in pushing the GOP tax bill forward last week, thought she had a deal to bolster health care protections in exchange for her support.
But it’s now unclear whether her strategy to shore up part of the Affordable Care Act will prevail or that it would produce the results she anticipates.
The tax bill repeals the ACA’s fines for the individual mandate, which requires most people to have health insurance or pay a fine. Collins says she would vote for it if Senate Republicans promised to allow a vote on two other health bills….
The tax bill is now the subject of final negotiations between the House and the Senate. First, even if the bills pass the Senate, there is little to suggest that the House Republicans would go along. On Tuesday, House Speaker Paul Ryan, R-Wis., reportedly told other House leaders he was not a party to Collins’ health care deal with McConnell. Ryan had previously expressed opposition to restoring the cost-sharing payments.
In response to Ryan, Collins on Thursday signaled that she might not vote for the tax bill’s final passage.
But would Collins’ changes offset the elimination of the mandate? Some analysts question whether the bill restoring the federal cost-sharing subsidy payments could actually do more harm than good.
“It’s a mess,” says insurance industry consultant Robert Laszewski. Many states allowed insurers to raise premiums to make up for the loss of the federal cost-sharing reduction payments. So passing the law now, at least for 2018, would require insurers to make refunds to individuals and the federal government for those overpayments….
The elimination of the mandate penalties is permanent, but Collins’ bill would fund the cost-sharing and reinsurance programs for only two years. Because of that, says Timothy Jost, a former law professor and expert on the health law, “I don’t think it’s going to be much of a carrot” to encourage insurers to stay in the individual market…..” (F)

Health insurance companies know that an insurance market without the requirement that everyone get coverage will be worse for them and their customers. They just aren’t sure how much worse.
HuffPost contacted dozens of health insurance companies to ask them to assess the impact that removing the so-called individual mandate ― which Republicans in Congress are on the verge of doing as part of their tax bill ― would have on their businesses and their customers.

Fifteen companies responded ― and all warned that eliminating the mandate would force them to further raise prices, and could drive some insurers to leave the market altogether. Both of those outcomes would lead to fewer Americans having health insurance and destabilize an insurance market already plagued with problems.
Let’s assume for a second that you eliminate the mandate and so those healthy people decide to sit out, whether they need a subsidy or not, the pool shrinks,” said Jim Havens, senior vice president of individual and senior markets for Mountlake Terrace, Washington-based Premera Blue Cross.
“That means that the people left are people who either intend to use it or think they will be using it, which is going to make it more expensive,” Havens said. Premera is the sole insurer offering individual policies in Alaska and also operates in Washington state.
The biggest losers would be middle-class people who don’t get health benefits from their employers and make too much money to receive subsidies for private insurance from a health insurance exchange. They will see fewer choices and higher prices in the future.
People who live in sparsely populated regions are at the greatest risk of extremely high premiums, and of having no insurers doing business where they live because rural areas already are the toughest locations to make a profit.” (G)

*Quote attributed to Warren Buffet

(A) Susan Collins Never Had An Actual Deal On Taxes, by Arthur Delaney and Matt Fuller, https://www.huffingtonpost.com/entry/collins-tax-vote_us_5a2ac0d1e4b0a290f050378a
(B) GOP Sen. Susan Collins says she would consider changing her tax plan vote over amendments, by Daniella Diaz, http://www.cnn.com/2017/12/08/politics/susan-collins-republican-gop-tax-plan-amendments/index.html
(C) GOP lawmakers mull health insurance tax delay, by Leslie Small, https://www.fiercehealthcare.com/regulatory/gop-lawmakers-mull-health-insurance-tax-delay
(D) Murkowski pushes back on ObamaCare ‘scare tactics’, by Peter Sullivan, http://thehill.com/policy/healthcare/363975-murkowski-pushes-back-on-obamacare-scare-tactics
(E) Trump Backs Keeping State Income Tax Break With Cap, Cohn Says, by Toluse Olorunnipa and Jonathan Ferro, https://www.bloomberg.com/news/articles/2017-12-08/trump-backs-keeping-state-income-tax-break-with-cap-cohn-says
(F) Doubts Rise About Sen. Collins’ Strategy To Shore Up Insurance Market, by Julie Rovner, http://www.wbur.org/npr/569421827/doubts-rise-about-sen-collins-strategy-to-shore-up-insurance-market
(G) Health Insurers See Higher Prices And A Big Mess Ahead Without The Obamacare Mandate, by Jeffrey Young, https://www.huffingtonpost.com/entry/health-insurers-higher-prices-obamacare-mandate-repeal_us_5a272277e4b0c2117626a077

“We’re going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit,” Ryan said during an appearance on Ross Kaminsky’s talk radio show. “… Frankly, it’s the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements — because that’s really where the problem lies, fiscally speaking.”…
Ryan’s remarks add to the growing signs that top Republicans aim to cut government spending next year. Republicans are close to passing a tax bill nonpartisan analysts say would increase the deficit by at least $1 trillion over a decade. Trump recently called on Congress to move to cut welfare spending after the tax bill, and Senate Republicans have cited the need to reduce the national deficit while growing the economy.” (A)

“Healthcare lobbyists are scrambling to win changes in congressional Republican tax legislation, as Senate and House GOP leaders race to merge their separate bills into something both chambers can pass on a party-line vote this month.
But provider, insurer and patient advocacy groups doubt they can convince Republicans to remove or soften the provisions they find most objectionable. They say GOP leaders are moving too fast and providing too little opportunity for healthcare stakeholders to provide input….
Some lobbyists hold out a faint hope that the Republicans’ tax cut effort could collapse as a result of intra-party differences, as did their drive to repeal and replace the Affordable Care Act.
One possibility is that Maine Sen. Susan Collins flips and votes no on the tax cut bill emerging from the conference committee if congressional Republicans fail to pass two bipartisan bills she favors to stabilize the individual insurance market….
Collins conceivably could be joined by Alaska Sen. Lisa Murkowski, who also said she wants to see the market stabilization bills passed. If Tennessee Sen. Bob Corker, who voted no on the tax cut bill over deficit concerns, remains opposed, those three GOP senators could sink the tax bill. “We’d all like to see Collins pull her vote,” Hobson said. “It was always clear that the deal she cut with McConnell won’t fly on the House side.”” (“It appears virtually certain that repeal of the law’s individual mandate to buy coverage will be included in a final tax bill. Two of the moderate senators most likely to defect over that issue — Collins and Lisa Murkowski of Alaska — are okay with getting rid of the mandate, arguing it has been less effective than expected and its associated penalty is paid chiefly by lower-income Americans.
The question is whether Republicans will also manage to pass the two bipartisan measures essentially infusing cash into marketplace plans — a move that analysts say will help insurers lower premiums, which have been spiking across the country.” (B)

“A measure from Alexander and Sen. Patty Murray (D-Wash.) would fund $7 billion in extra cost-sharing discounts; another one from Collins and Sen. Bill Nelson (D-Fla.) would provide $4.5 billion in reinsurance funding. If either one passes, it probably would be as part of a big spending measure.” (C)

“So how’s that working out for you, Senator Collins?
The latest bit of bad news for Collins comes from Avalere Health. According to an analysis the healthcare consulting company released this morning, the reforms sought by Collins, while helpful, are possibly “overshadowed” when the Senate tax bill’s repeal of the individual mandate is taken into account.
The basic problem is that according to the Congressional Budget Office, mandate repeal will cause premiums to spike. The two pieces of legislation that Collins is supporting would try to make up for this. One bill would give insurers $4.5 billion over the next two years to help compensate for the costs of covering sick – read expensive – patients, something known as reinsurance. The other bill would restore payments to insurers — which Trump had stopped — and which would cover the cost of insuring low income people, otherwise known as cost-sharing reductions, or CSRs.
Together, they are supposed to keep down premiums. Caroline Pearson, a senior vice president at Avalere, told The Hill that their study concludes that “From a premium point of view, we do think reinsurance and CSRs probably covers the mandate.”
But this remains unclear. Topher Spiro, a health policy analyst at the liberal Center for American Progress, points out that the analysis actually doesn’t support that conclusion, once you take account of the fact that Trump has already halted the CSRs; restoring them will merely return us to the previous status quo.
What’s more, a number of healthcare wonks recently told Vox that the second of these two bills will not do nearly enough to fix the spiking premium problem.
And finally, the actions sought by Collins only cover a two-year period, and Avalere’s own experts conclude that once they expire, they would do little to deal with spiking premiums. As Elizabeth Carpenter, a senior vice president at Avalere, put it: “Eliminating the requirement to purchase coverage would create additional uncertainty in the market. It is important not to overlook the negative impact of repealing the individual mandate on long-term market stability.” (D)

“Ed Kilgore, writing in New York magazine, said Collins “is an experienced, savvy legislator. She knew when she cut her deals with Trump and McConnell that they would be worthless if the House didn’t go along.”
“She could have demanded assurances from Ryan and conservative leaders, too — certainly she could have demanded the moon at the point where it appeared she might be the decisive vote in the tax bill.
“What this series of events shows is that Collins, like the other alleged ‘holdouts,’ really wanted to ‘get to yes,’ as we kept hearing last week. If that meant securing a promise written in vanishing ink, so be it,” Kilgore said.
Collins’ office released a copy of the agreement reached between McConnell and Collins. Both had signed it. On its face, the ink looks pretty permanent.
In any case, whether Collins got played will be clear within weeks as Congress moves to adopt both the tax bill and a budget measure that Collins expects to include the health care measures she wants.” (E)

“Ms. Collins has released a copy of her agreement with Mr. McConnell in which he pledged to support passage of the two measures before the end of the year. His signature was displayed prominently at the top of the first page. But the deal has landed with a thud in the House, where Republicans appear loath to support legislation that they view as propping up a health law that they have pledged to repeal.
“Our members wince at voting to sustain a system that none of them supported,” said Representative Tom Cole, Republican of Oklahoma.
The Senate could attach the Alexander-Murray legislation to a government funding measure, hoping that Republicans in the House would be willing to swallow it as part of a measure to avoid a government shutdown. But Mr. Cole said House Republicans would be “very offended” at such an approach.
“I don’t think we’re in the mood to be blackmailed by anybody,” he said.
Mr. Brat, a member of the conservative Freedom Caucus, assailed the deal with Ms. Collins as an example of horse trading that is characteristic of the Washington swamp that he said voters had repudiated.
Likewise, Representative Mark Walker of North Carolina, the chairman of the conservative Republican Study Committee, said of the Alexander-Murray bill, “There’s no appetite for that over here.”
Ms. Collins said on Wednesday that she believed the House would “take a serious look” at the two bills intended to hold down insurance premiums and that Mr. Trump, in several recent meetings, had assured her that he also supported those bills.
“I don’t think this effort is over by any means,” Ms. Collins said.” (F)

“…The open enrollment period for 2017 is significantly shorter this year compared to last. The Trump administration shrunk the sign-up stretch to six weeks instead of three months.
With the December 15 deadline fast approaching, the number of plan selections is well short of the more than 9 million people who signed up on the federal exchange last year….
Matthew Fiedler, a fellow at the Brookings Institution’s Center for Health Policy, said there are a lot of reasons for the enrollment drop-off — but not one that stands out above others.
“My view is that various administration actions — including the shorter enrollment period, the reduction in outreach funding, higher premiums for unsubsidized consumers due to policy uncertainty, and consumer confusion about the ACA’s future — have weighed on enrollment, but the size of each of those effects is uncertain,” Fiedler told Business Insider.
Fiedler said that the decrease in enrollment will likely be detrimental to people enrolled on the exchanges.
“In terms of what the effects of lower enrollment will be, a lower uninsured population will be damaging. The additional uninsured will have worse access to care and be less financially secure,” Fiedler told Business Insider. “Similarly, other individual market enrollees will face higher premiums since the lost enrollees are likely healthier than average, and health care providers will face higher uncompensated care costs.”…
Fiedler said that the Obamacare markets could still “muddle through” even with lower enrollment.
“While bad, enrollment declines are not an existential threat to the individual market,” he said. “The impact of enrollment declines on the risk pool are smaller than sometimes thought. Furthermore, the rate increases insurers implemented for 2018 appear to be large enough to accommodate the deterioration in the risk pool we are likely to see.”” (G)

“A reinsurance program funded with $10 billion or even $15 billion in annual spending could actually offset the price hikes expected to result from individual mandate repeal. But that, of course, costs more money. And again, it doesn’t address what happens after 2020 at all.
This is what experts predicted about the Collins bill. “The Collins-Nelson bill would help mitigate premium increases resulting from repeal of the individual mandate, but it would fall short of completely offsetting the hikes,” Larry Levitt at the Kaiser Family Foundation told Dylan last week.
And at the end of the day, a lot of this debate may be moot. The Collins plan needs 60 votes to move through the Senate (unlike the tax bill, which is being run through the reconciliation process and thus only requires 50 votes). Whether Democrats would want to work with Republicans to pass a bill like this — whether more conservative senators would even get on board — is a big open question.
My takeaway from the Avalere analysis is this: Repealing the individual mandate will cause uncertainty and confusion in the individual market. That much is certain. The Collins plan is a Band-Aid on a much larger problem caused by the Senate bill — one that it just can’t fix.” (H)

“After taking a beating for three years, health plans jacked up their rates for 2017, with the average premium on the most popular products rising more than 20 percent. That created sticker shock for many Obamacare customers while putting many insurers on pace to record profits this year for the first time, according to a POLITICO analysis of 31 regional Blue Cross Blue Shield plans, many of which dominate Obamacare markets in their states.
But the turnaround comes just as Republican efforts to dismantle the health care law are creating new threats to the viability of the marketplaces. That leaves the plans in a bewildering situation, trying to improve their margins while the GOP declares Obamacare a failure and mounts another push to dismantle the system, starting with rolling back the health care law’s individual mandate.
“The political narrative is over a market in crisis, and that’s just not how the market actually looks right now,” said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, a nonpartisan research group. “At this moment, the individual insurance market looks quite stable and most insurers have achieved profitability.” (I)

“The two core pieces of Obamacare are the subsidies that help middle-class families afford private insurance and the expansion of Medicaid for working-class families. The tax bill doesn’t get rid of either. Instead, it will likely repeal the individual mandate — the requirement that people buy health insurance. As a result, health-insurance markets will suffer some turmoil, and costs for some families will rise.
Most people who want health insurance will still be able to get it, though. And health care advocates can reduce the impact of the mandate’s repeal through public-information campaigns that encourage people to sign up. The elimination of the insurance subsidies and Medicaid expansion would be qualitatively worse.
Many big fights remain. The tax bill’s supporters have a clear vision, and they’ve been surprisingly up front about that vision. The first step is to cut taxes. The second is to cut government programs like Medicare, Social Security, Medicaid and much else.
But this tax bill itself doesn’t accomplish the second step (with the exception of some modest automatic cuts). Republicans will have to pass other bills to shrink programs that benefit the middle class. Democrats are already gearing up to have those debates, as they should be. A McClatchy news headline yesterday: “Dems warn GOP: We’re prepared for class war.” Debates over spending cuts are easier for Democrats to win than debates over tax policy.” (J)

“Sen. Susan Collins (R-Maine) said Thursday that she may change her vote on the final version of the GOP tax-reform bill if her proposed amendments are not included in its final version.
“I would. I’m going to look at what comes out of the conference committee meeting to reconcile the differences between the Senate and House Bill. So I won’t make a final decision until I see what that package is,” Collins told CBS WABI 5 when asked if she would consider changing her vote…
“There’s a real fear that the tax bill is going to trigger a 4 percent cut in Medicare,” Collins added. “I am absolutely certain that 4 percent cut in Medicare that I mentioned will not occur. I have it in writing from both the Speaker of the House Paul Ryan [R-Wis.] and also Sen. Mitch McConnell [R-Ky.].”
Collin expressed optimism that the final bill will adopt her amendments.” (K)

“For the moment, none of this appears to have shaken Collins’s support for the bill. But it has ensured that her second vote for the Trump tax cuts will be more politically painful than her first one. Beyond the collapse of her health-care “deal,” the Republican bill isn’t getting any less (historically) unpopular. And progressive activists in Maine are mobilizing in opposition.
If Collins were to lose her nerve — and Tennessee senator Bob Corker were to retain his opposition to the bill on deficit grounds — then McConnell would only have one vote to spare. Should one of the multiple elderly, Republican senators with ongoing medical problems fall ill — or, should Doug Jones win Alabama’s special Senate election next week — the Trump tax cuts could conceivably fall into jeopardy.” (L)

(A) Ryan says Republicans to target welfare, Medicare, Medicaid spending in 2018, 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=.5b3ab0175186
(B) Healthcare lobbyists not optimistic on changing GOP tax bill, By Harris Meyer, http://www.modernhealthcare.com/article/20171206/NEWS/171209899
(C) The Health 202: Senate GOP intensifies push to send more cash to Obamacare marketplaces, By Paige Winfield Cunningham, https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/12/07/the-health-202-senate-gop-intensifies-push-to-send-more-cash-to-obamacare-marketplaces/5a28164030fb0469e883fa53/?utm_term=.228c5c6f8672
(D) Susan Collins is getting played. Will she really vote for the tax bill in the end?, by Helaine Olen, https://www.washingtonpost.com/blogs/plum-line/wp/2017/12/06/susan-collins-is-getting-played-will-she-really-vote-for-the-tax-bill-in-the-end/?utm_term=.cb71725eaf59
(E) Despite criticism, Susan Collins is confident that GOP leaders will stand by their word, by Steve Collins, http://www.sunjournal.com/despite-criticism-susan-collins-is-confident-that-gop-leaders-will-stand-by-their-word/
(F) Tax Bill Is Likely to Undo Health Insurance Mandate, Republicans Say, By ROBERT PEAR and THOMAS KAPLAN, https://www.nytimes.com/2017/12/06/us/politics/tax-bill-obamacare-mandate-collins.html?_r=0
(G) It’s looking like Trump’s Obamacare meddling could cause serious problems for the healthcare market, by Bob Bryan, http://www.businessinsider.com/trump-obamacare-enrollment-insurance-market-2017-12
(H) Sen. Collins’s health proposal isn’t going to save Obamacare, by Sarah Kliff, vox.com. Dec 6, 2017
(I) POLITICO survey: Insurers finally making money on Obamacare, by PAUL DEMKO, https://www.politico.com/story/2017/12/07/obamacare-profits-health-care-285258
(J) The Republic Will Survive the Tax Bill, by David Leonhardt, https://www.nytimes.com/2017/12/06/opinion/republican-tax-bill.html
(K) Collins considers changing vote on tax bill over amendments, by JOSH DELK, http://thehill.com/blogs/blog-briefing-room/363891-collins-considers-changing-vote-on-tax-bill-over-amendments
(L) Senate Republicans Made a $300 Billion Mistake in Their Tax Bill, by Eric Levitz, http://nymag.com/daily/intelligencer/2017/12/the-senate-gop-made-a-usd300-billion-mistake-in-their-tax-bill.html

“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-

… 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

…who rely on the federal government for their health insurance.
The bill reaches into every major American health care program: Medicaid, Medicare, and the Obamacare marketplaces.
These are expected outcomes based on two key policy changes in the bill. First, the bill repeals the individual mandate, a key piece of Obamacare that requires most Americans get covered. Economists expect its elimination to reduce enrollment in both the Affordable Care Act’s private marketplaces and Medicaid by millions. The money saved will be pumped into tax cuts for the very wealthy.
The bill also includes tax cuts so large that they would trigger across-the-board spending cuts — including billions for Medicare. The last time Medicare was hit with cuts like this, patients lost access to critical services like chemotherapy treatment.
This tax bill deserves a broader name. Its policies will cause millions of vulnerable Americans to lose coverage, disrupt care for the elderly, and potentially change the health care system in other ways we can’t fully predict.” (A)

“Health care became intimately mired in the tax reform debate as Senate Republicans heeded President Trump’s call to tack on a repeal of Obamacare’s individual mandate, one of the health law’s most unpopular measures, into their plan. The mandate requires all Americans to carry insurance (subsidized for the vast majority of people buying individual health insurance plans) or pay a tax penalty.
Trump and the Congressional GOP have long aimed to nix that requirement. But they’ve been unsuccessful to date in part because the CBO has projected that repealing the mandate would lead to millions of fewer insured Americans relative to current law while also hiking rates. And while experts may quibble over the precise magnitude of those effects, the CBO hasn’t equivocated about the overall trend.
“There’s a lot of uncertainty around how effective the mandate has been,” Larry Levitt, senior vice president at the independent health care think tank Kaiser Family Foundation (KFF), told Fortune in an interview. “But CBO has said the direction of the effect is clear. Repealing the mandate would increase premiums, would increase the number of people who are uninsured.”
Just how big of an effect would a mandate repeal have? According to CBO, 13 million fewer people would be insured in 2027 compared with current law while premiums would spike 10%. That’s because, without the policy “stick” of a mandate, healthier and wealthier people would likely drop out of Obamacare’s marketplaces, in turn making individual insurance risk pools more costly by disproportionately leaving them with sicker Americans.” (B)

“President Trump at a closed-door meeting with GOP senators on Tuesday said he would support two proposals meant to stabilize ObamaCare’s insurance markets in exchange for a repeal of the law’s individual mandate, several Republicans in attendance said.
The two bills would fund key ObamaCare insurer payments, and provide billions to help states create reinsurance programs for high-cost patients.
Passage of the measures could prove crucial to winning support for the Senate tax bill, which includes repeal of ObamaCare’s mandate, from Sen. Susan Collins (R-Maine)….
Collins left the meeting feeling she’d been reassured by Trump that he’d support both bills.
“[Trump] said that he understood the need to have something to offset the premium increases and appeared very open” to signing the two bills into law, she said.” (C)

“Sen. Susan Collins (R-Maine) said early Thursday that she expects legislation to lower health-care premiums to pass Congress before senators take a final vote on a $1.5 trillion tax-reform bill that would repeal the Affordable Care Act’s individual mandate….
To mitigate the impact, GOP leaders plan to pass legislation negotiated by Senate Health Committee Chairman Lamar Alexander (R-Tenn.) and Sen. Patty Murray (Wash.) that would reinstate cost-sharing reduction payments to insurance companies.
It will be paired with legislation sponsored by Collins and Sen. Bill Nelson (D-Fla.) that would set up health reinsurance programs for older and sicker individuals.
The measures are likely to be attached to a government stopgap funding bill, Collins said.
“I have met with the president of the United States about this and have gotten his endorsement, I’ve met with the Republican leadership and with the members of the Finance Committee,” she said. “They are most likely to be on the continuing resolution.”
“Assuming the tax bill passes the Senate, we then turn to the CR and those two bills will be put on the CR,” she said.
“While the tax bill is in conference, the CR will presumably become law and then the tax bill come back from conference,” she said. “So I’m going to know whether those provisions made it and that matters hugely to me.”” (D)

“Larry Levitt, an Obamacare expert with the Kaiser Family Foundation, told CNBC that “Alexander-Murray, as it’s currently drafted, wouldn’t really do anything to mitigate the effects of repealing the individual mandate.”
But funding reinsurance programs “could offset any premium increase” resulting from repeal, Levitt said.
Totally offsetting such price hikes from repeal would require some additional funding, and extending reinsurance beyond the two-year span outlined in Collins’ bill, he said.
However, “it wouldn’t do anything to deal with the fact that more people are likely to be uninsured” as a result of the mandate’s repeal, Levitt said.
If the mandate is repealed, the CBO estimates that 13 million more people would become uninsured by 2027 than are currently projected.
“Most of the losses [in insurance coverage] are due to the fact that people are not getting pushed into getting coverage,” Levitt said.
Sen. Patty Murray, D-Wash., who co-authored the Alexander-Murray bill, told The Washington Examiner, “I support reinsurance, but it won’t solve the problem they created,” referring to the mandate repeal.
“The bill we designed has not been written to block the premiums they’re creating,” Murray said.
Republican lawmakers as a group are less likely to be concerned with the increase in the number of uninsured people.
“The premium increases on middle-class consumers is probably the most troubling part of repealing the individual mandate, particularly for Republicans,” Levitt said.
Many middle-income Americans earn too much to qualify for Obamacare subsidies that lower monthly premiums. That means those people bear the full brunt of premium increases.” (E)

“The Senate Republican plan to use tax legislation to repeal the federal requirement that Americans have health coverage threatens to derail insurance markets in conservative, rural swaths of the country, according to a Los Angeles Times data analysis.
That could leave consumers in these regions — including most or all of Alaska, Iowa, Missouri, Nebraska, Nevada and Wyoming, as well as parts of many other states — with either no options for coverage or health plans that are prohibitively expensive.
There are 454 counties nationwide with only one health insurer on the marketplace in 2018 and where the cheapest plan available to a 40-year-old consumer costs at least $500 a month. Markets in these places risk collapsing if Congress scraps the individual insurance mandate.
“It’s very, very concerning to us,” said Denise Burke, healthcare analyst at the Department of Insurance in Wyoming, where the cheapest plan for a 40-year-old consumer in most of the state will cost $586 a month next year.
The precise nationwide impact of the Senate GOP tax plan, which would eliminate the Affordable Care Act’s unpopular mandate penalty, is unclear, as many forces affect how much insurance costs and where insurers sell plans.
But the legislation is widely expected to cause insurers to raise prices or exit markets out of fear that fewer healthy people will buy plans if there is no longer a penalty for going without coverage.
The risk is greatest in places where health insurance is already very expensive and where there are few insurers.” (F)

“But the argument that getting rid of the mandate will improve people’s well-being by allowing them to opt out of coverage without a penalty is weaker than it first sounds, as per this analysis by Aviva Aron-Dine. She draws heavily on the Congressional Budget Office’s estimate that repealing the mandate will lead to 13 million fewer people with coverage and a 10 percent increase in premium costs.
First, the mandate isn’t in the Affordable Care Act just for fun. Health coverage plans with cost controls typically have some version of a mandate to avoid “adverse selection,” wherein the people who buy health coverage tend to be those who need it the most, making it too expensive for others. This undermines health insurance markets, which work through the healthy subsidizing the sick. If that sounds unfair, consider that at some point, you could be either one of those people (i.e., healthy or sick), but you can’t know now which one you’ll be. That’s the problem insurance solves.
Aron-Dine argues that because of this dynamic, “some of the coverage losses from repealing the mandate would not be ‘voluntary’ in any sense.” Instead, they’d be a function of higher premiums due to healthier people leaving the risk pool.
Next, consider that according to the CBO, about half of those budget savings come from fewer people on Medicaid. What’s up with that? After all, Medicaid recipients don’t pay premiums, so why would repealing the mandate affect them either way?
It’s because, as Aron-Dine notes, “the mandate also serves a critical outreach function, leading uninsured people who are unaware of their eligibility for marketplace subsidies or Medicaid to explore their available options and then enroll.” The CBO estimates that this ultimately will lead to 5 million fewer people with Medicaid coverage.
Then there’s the risk that people who don’t get coverage pose to themselves and, through negative spillovers, to the rest of us. Those who decide to forgo coverage are making a bet that they won’t get sick. But some will lose that bet, and when they do, these patients will receive “uncompensated care” because hospitals must treat the sick regardless of their insurance status. And you know who pays for such care, right? The rest of us.” (G)

“Throughout this decadelong healthcare debate, the organization I lead, the National Coalition on Health Care, has urged Congress to pursue bipartisan solutions in healthcare. We have called for reforms that improve our health system and reduce costs through evidence-based policy—but instead, Congress is pursuing across-the-board cuts hidden in a tax bill.
In the individual market today, bipartisan solutions would mean continuing cost-sharing reduction payments and stabilizing premiums—without pushing millions off health coverage. Instead, the Senate tax bill’s repeal of the individual mandate would increase the number of uninsured by 13 million and increase premiums in the nongroup market by about 10%, according to the Joint Committee on Taxation and the Congressional Budget Office.
In Medicaid today, bipartisan solutions would mean fostering state innovation, not shifting the cost burden onto states, beneficiaries or providers. States are already making efforts to transform their care delivery systems by helping beneficiaries remain independent in their homes and integrating care for lower income seniors and disabled individuals enrolled in both Medicare and Medicaid. Targeted federal policy has the ability to improve and expand upon these initiatives. Unfortunately, in this bill much of the savings attributed to the individual mandate repeal would come from a substantial reduction in federal support for state Medicaid programs. An analysis of the mandate repeal published recently by the CBO projected those Medicaid cuts would total $179 billion over 10 years.
In Medicare today, bipartisan solutions would mean improving the quality of care and reducing costs while avoiding indiscriminate cuts that harm beneficiaries. The Senate-passed CHRONIC Care Act is one example of such an effort, providing vital flexibilities to enable providers and health plans to deploy high-tech telehealth and high-touch personal support to improve care for the chronically ill.” (H)

“While the ACA is not perfect, it has provided an important pathway for moving from peril to progress in strengthening America’s health care system. It is important to remember that in 2008, prior to the ACA’s enactment, 82 percent of Americans wanted an overhaul of the U.S. health care system at a time when over 47 million people — or 18 percent of the U.S. population — lacked health insurance. The historic passage of the ACA signed into law by President Obama in 2010 represents the most significant and comprehensive health care legislation since the establishment of Medicare and Medicaid in 1965 and it has transformed the U.S. healthcare system. Through its reforms, the legislation has enabled 20.4 million people to gain insurance coverage by 2016. Medicaid expansion itself covered 11 million people, including nearly two million Americans in rural areas. Furthermore, the ACA’s coverage mandates protect the nearly 129 million Americans with pre-existing conditions — or one in two people — from being charged discriminatorily higher premiums or denied coverage. The ACA’s provisions also put into place payment reforms that incentivized quality care over quantity of medical services provided and fueled a prevention revolution through the provision of preventive services at no cost to consumers in their insurance plans, the establishment of a Prevention and Public Health Fund to support community prevention programs, and the creation of a National Prevention Strategy with the participation many governmental departments and numerous stakeholders.
This is not the time to sabotage the ACA legislation but rather the very moment to strengthen it. Since the establishment of the Affordable Care Act in 2010, much progress has been made to advance America’s health care system in communities, states and nationally. The significant achievements made since the law’s enactment highlight the importance of working together to safeguard, improve, and expand on the ACA’s progress to improve the health of all Americans now and in the years ahead.” (I)

“Gov.-elect Phil Murphy said Wednesday he plans to examine New York Gov. Andrew Cuomo’s efforts to preserve health insurance coverage for residents of his state as a model for New Jersey if parts of the Affordable Care Act are repealed under a new Republican tax bill in Congress….
In June, Cuomo issued emergency regulations requiring any private insurer to guarantee the 10 “essential health benefits” offered under Obamacare, and blocking any insurer that withdraws from New York’s health insurance exchange from participating in Medicaid or its children’s health plan.
But Murphy was adamant that his first priority should be to pressure Congress to preserve the individual mandate to buy health insurance that serves as the Affordable Care Act’s linchpin.
“Make no mistake,” said the governor-elect. “There’s almost nothing the state can do to replace the federal government.”
The current tax reform bill in the U.S. Senate also threatens to slash health insurance for the 900,000 New Jerseyans who’ve gained access to health care under Obamacare by scrapping the the individual mandate requiring people to buy health insurance through a Medicaid exchange or pay a penalty.” (J)

(A) Is it a tax bill or a health care bill?, by Sarah Kliff, VoxCare, November 30. 2017
(B) GOP Tax Plan Would Still Leave 13 Million Without Health Insurance, CBO Says, by Sy Mukherjee, http://fortune.com/2017/11/29/gop-tax-plan-obamacare-cbo/
(C) Trump backs bipartisan fixes to ObamaCare markets, by JESSIE HELLMANN, http://thehill.com/policy/healthcare/362168-trump-backs-bipartisan-fixes-to-obamacare-markets
(D) Collins: Health-care fix will pass before tax bill, by ALEXANDER BOLTON, http://thehill.com/homenews/senate/362537-collins-health-care-fix-will-pass-before-tax-bill
(E) Why a new GOP idea won’t solve biggest problem with repealing Obamacare’s mandate, by Dan Mangan, https://www.cnbc.com/2017/11/28/gop-idea-wont-solve-biggest-problem-with-repealing-obamacare-mandate.html
(F) Republicans’ latest plan to repeal Obamacare’s insurance requirement could wreak havoc in some very red states, by Noam N. Levey, http://www.latimes.com/politics/la-na-pol-insurance-mandate-repeal-20171127-story.html
(G) How the Republican tax cut plan goes after health care, by Jared Bernstein, https://www.washingtonpost.com/news/posteverything/wp/2017/11/27/how-the-republican-tax-cut-plan-goes-after-health-care/?utm_term=.23fcc55219d5
(H) Guest Commentary: Tax reform should mean improving the economy, but not at the expense of our healthcare system, by John Rother, http://www.modernhealthcare.com/article/20171129/NEWS/171129914
(I) Safeguarding America’s Health System from Sabotage, by Susan Blumenthal, M.D. and Alexis Boaz, https://www.huffingtonpost.com/entry/safeguarding-americas-health-system-from-sabotage_us_5a1ecf33e4b0e37da0447b66
(J) Murphy says he’d consider emergency action to save Obamacare for N.J., by By Claude Brodesser-Akner, http://www.nj.com/politics/index.ssf/2017/11/following_cuomo_murphy_will_consider_obamacare_exc.html#incart_river_home