Senate Republicans have approved the repeal of ObamaCare’s individual mandate as part of their tax-cut bill, a major step toward ending an unpopular part of the health-care law.
“Families ought to be able to make decisions about what they want to buy and what works for them — not the government,” Sen. John Barrasso (R-Wyo.) said, hailing the accomplishment.
“I believe if people don’t want to buy the ObamaCare insurance, they shouldn’t have to pay a tax penalty to the IRS.”
The Senate tax bill must still be reconciled with House legislation that does not include the mandate’s repeal. But that is unlikely to be a major issue, given support in the GOP conference for repealing the mandate.
No Democrats in either chamber voted for the GOP tax bills.
It’s unclear what repeal of the mandate will mean for ObamaCare.
Many experts and health-care groups warn that repeal will destabilize ObamaCare markets, leading to premium increases or insurers simply dropping out of certain areas. Without a financial penalty under the mandate for lacking health coverage, there is less incentive for healthy people to sign up and balance out the costs of the sick.
Some experts counter that the effects will not be as severe as others say, given that there are doubts the mandate had a strong effect on people to begin with.
Moderate Republicans are now pushing for bipartisan ObamaCare fixes to help stabilize insurance markets, setting up a showdown with conservatives.
The mandate’s repeal was not part of the original tax-reform measure released by the Senate Finance Committee, and Chairman Orrin Hatch (R-Utah) previously said he wanted to keep the divisive health-care issue separate from taxes.
But President Trump, along with Senate conservatives such as Sen. Tom Cotton (R-Ark.), made a vocal public push for its inclusion.
Repealing the mandate also saves $300 billion over ten years in subsidies that otherwise would have been spent on consumers, according to the Congressional Budget Office, providing savings for the tax cuts.
The CBO estimates that 13 million fewer people will have health insurance over the next decade without the mandate, and it projects that premiums will rise 10 percent. But it also projects markets will remain stable in “almost all areas of the country.”
While three Republican senators, John McCain (R-Ariz.), Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska) defeated an ObamaCare repeal bill over the summer that included mandate repeal, this time they put aside their concerns.
Murkowski wrote that repealing the mandate didn’t hurt the structure of the health-care law, but allowed people the “freedom” to choose whether to enroll.
Collins said she had won a commitment from Trump and Senate Majority Leader Mitch McConnell (R-Ky.) to pass two bipartisan ObamaCare fixes before the end of the year. She hopes those bills will counteract the increase in premiums from mandate repeal.
One of the bills, from Sens. Lamar Alexander (R-Tenn.) and Patty Murray(D-Wash.) funds key payments to insurers, while the other measure provides funding known as reinsurance to pay for some sick people’s claims and help bring down premiums.
The Alexander-Murray bill does not directly deal with the effects of repealing the mandate, and some experts argue there would have to be more reinsurance funding than currently proposed to make up for mandate repeal.
It’s unclear if either fix will actually become law, as House conservatives oppose the measures as propping up ObamaCare.
Rep. Fred Upton (R-Mich.), a member of the moderate Tuesday Group, said he supports passing Alexander-Murray to try to counteract the premium increases from mandate repeal. But he acknowledged conservatives oppose that move, meaning he thinks the initial House version of a government funding bill will not have the health fix attached.
He thinks the Senate will add it later, setting up a choice for the House.
“They’ll toss it back to us and either you take it like that or you shut the government down,” Upton said.
Trump appears eager to return to the full repeal-and-replace push after the final tax bill passes.
“We will Repeal & Replace and have great Healthcare soon after Tax Cuts!” he tweeted in late October.
GOP leaders have not committed to revisiting the issue in an election year, though Sen. John Kennedy (R-La.) said he thought mandate repeal brings full repeal and replacement a step closer.
“I think it’s going to make our third attempt at health-care reform easier,” Kennedy said.