Senate Republicans are including the repeal of ObamaCare’s individual mandate in their tax-reform bill, a risky play that meets President Trump’s demands but could cost the measure support from centrists.
Repealing the mandate gives Republicans more money to offset the cost of tax cuts, and would fulfill a long-standing GOP promise to eliminate a core part of former President Obama’s health-care law.
Republicans can afford only two defections in the Senate and pass the tax bill if all Democrats oppose it, but Sen. John Thune (R-S.D.) expressed confidence that Republicans have the votes after a count.
At the same time, Republicans acknowledged after a conference lunch that the decision to add the mandate’s repeal to the tax bill was not unanimous, suggesting uncertainty that the GOP has 52 votes. Sen. Susan Collins (Maine), one of three GOP senators who voted against the Republican ObamaCare repeal bill earlier this year, said she still had concerns about repealing the mandate after the lunch.
She said her concerns would be heightened if the Senate moved to eliminate the mandate without first approving legislation sponsored by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) aimed at stabilizing insurance markets. Republicans have refused to bring up that bipartisan deal.
“I personally think that it complicates tax reform to put the repeal of the individual mandate in there, particularly if it's done before the Alexander-Murray bill passes, because of the impact on premiums,” Collins said.
Thune said the Alexander-Murray bill would be brought up separately. It funds key payments to insurers for two years in exchange for more flexibility for states to change ObamaCare rules.
Sen. John McCain (R-Ariz.), another “no” vote on health care, did not take a position on the mandate repeal Tuesday, saying he wanted to wait to look at the whole tax bill.
Sen. Lisa Murkowski (R-Alaska), the third previous “no” vote, sidestepped a question regarding the bill.
Senators who have been pressing for leadership to include the repeal hailed the decision.
“I’m pleased the Senate Finance Committee has accepted my proposal to repeal the ObamaCare individual mandate in the tax legislation,” Sen. Tom Cotton (R-Ark.) said in a statement.
The decision is also likely to be popular with House conservatives, who had been pressing their leadership to include the mandate’s repeal in a tax-reform bill scheduled for a Thursday vote.
Republicans are under enormous pressure to get a legislative victory on tax reform after a year in which they have struggled to post wins.
While the House passed an ObamaCare repeal bill this spring, the Senate repeatedly failed to do so.
Off-year election losses in Virginia and New Jersey last week only intensified the pressure Republicans are feeling to pass tax reform.
If a tax bill also were to repeal the ObamaCare mandate, it would deepen the GOP victory, allowing the party to cast the legislation as a win on taxes and health care.
The Congressional Budget Office (CBO) has found that repealing the mandate would save $338 billion over 10 years, a major source of appeal for Republicans searching for ways to fund tax cuts.
But the CBO also pointed to some risks for Republicans.
It found that 13 million more people would be uninsured over a decade and premiums would rise by about 10 percent without the mandate.
Fears that ObamaCare repeal would take away health benefits for millions contributed to the GOP defeats earlier this year, and could now raise tensions over tax reform.
It’s also possible it could lead to a backlash at the polls. Health care was a leading issue mentioned by voters in Virginia last week who delivered victories to Democrats up-and-down the ballot.
A coalition of leading health-care groups, including America’s Health Insurance Plans and the American Medical Association, on Tuesday wrote a letter to Congress urging lawmakers to maintain the individual mandate.
“Eliminating the individual mandate by itself likely will result in a significant increase in premiums, which would in turn substantially increase the number of uninsured Americans,” the groups wrote.
Senate Finance Committee Republicans met about including the mandate repeal of their tax bill on Monday night and resumed conference-wide discussions at Tuesday’s lunch.
Sen. John Kennedy (R-La.) said that while the decision wasn’t unanimous, no one threatened to vote against tax reform because the mandate repeal was in the bill.
“This is totally different from health care,” Kennedy said. “Nobody was standing up saying ‘If you do this, I'm not going to vote for the bill.’ There's none of that. Everybody wants to get to yes.”
Larry Levitt, a health policy expert at the Kaiser Family Foundation, warned that insurers could drop out of the market if the mandate is repealed, which would remove an incentive for healthy people to enroll and balance out the costs of the sick.
“What matters is whether insurers would be willing to participate in a market that guarantees coverage for pre-existing conditions with no mandate,” Levitt wrote on Twitter. “I'm doubtful.”
Democrats are already seizing on the inclusion of the mandate to increase their attacks on the tax bill.
“Republicans just can’t help themselves,” Senate Minority Leader Charles Schumer (D-N.Y.) said in a statement. “They’re so determined to provide tax giveaways to the rich that they’re willing to raise premiums on millions of middle-class Americans and kick 13 million people off their health care.”
“If the American people weren’t already outraged by this bill, injecting health care into it will certainly do the trick,” Schumer added.
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