Senate Passes Tax Reform Bill in 51-49 Vote. Health coverage imperiled as Obamacare’s individual mandate traded for $338 billion in tax cuts.

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The News:

By a vote of 51-49, the Senate passed a tax overhaul bill early Saturday morning that included a repeal of the Affordable Care Act’s (ACA) individual mandate, which requires people to buy a health insurance policy or pay a penalty.

The vote was mostly along party lines; only Sen. Bob Corker (R-TN) crossed over to vote with the Democrats against the measure. The Senate bill must now be reconciled with a tax bill passed by the House on November 16, 2017; that bill does not include the ACA mandate repeal.

Most of the Senate floor debate on the bill revolved around its tax provisions, but there was also some vigorous discussion of its effect on healthcare, according to MedPage Today.

Sen. Amy Klobuchar (D-MN) said that repealing the mandate “would kick 13 million people off of their health insurance by 2027, and increase individual market premiums by 10%,” numbers that were released by the Congressional Budget Office in its analysis of the repeal’s effects. “We should be helping with premiums, not increasing them. [These increases] mean less money in the pockets of middle class Americans, less money for retirement, and less money for college.”

Instead of passing this provision in the tax bill, “the American people want us to work together to fix the ACA,” Klobuchar said. She referred to the bill sponsored by Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA), which would restore the law’s cost-sharing reduction payments and give states more flexibility in their ACA implementation, as an example of a good bipartisan effort to improve the ACA.

“Alexander and Murray held hearings on common-sense solutions; they had the governors come in,” said Klobuchar. “It’s a model for how you can put a bill together. But instead of that kind of bipartisan approach, this tax bill not only repeals the [individual mandate], but would cut hundreds of billions from Medicare and Medicaid.”

Sen. Susan Collins (R-ME) said she expected that before there was a final vote in both chambers on the tax bill, Congress would first pass the Alexander-Murray bill, along with a bill by Collins and Sen. Bill Nelson (D-FL) that would provide health insurers with reinsurance for high-cost patients.

But a group of conservative House Republicans said they would oppose such a plan, according to media reports. Collins also tweeted that she had received assurances from Senate Majority Leader Mitch McConnell (R-KY) that the bill would not result in Medicare cuts.

Even if those other bills were passed, “[they] won’t stop the premium increases, coverage losses, and chaos this bill will cause,” argued Murray. “Hiding behind these bipartisan bills might seem like a good partisan talking point…but political cover doesn’t pay bills or give them coverage back. It doesn’t help people with preexisting conditions who might get priced out of the market.” She urged Senate Republicans to “step back from the brink, and work with Democrats on healthcare and taxes in ways that help, not hurt, the people you’re supposed to be here to serve.”

The next step is to forge a version of the Senate bill that satisfies members of both the Senate and the House, which passed its own tax bill November 16, 2017. As mentioned earlier, the latter didn’t include the ACA mandate repeal, among numerous other disparities.

Steve’s Take:

Looking back over the past nine years and the state of our present Congressional leadership, I can’t resist citing one of my favorite Yogi-isms: “It’s like déjà vu all over again.”

It’s worth remembering that Republicans were for the individual mandate before they were against it. From 1993 to 2008, they sold it with the argument that individual responsibility, not government intervention in markets, should be at the heart of any healthcare reform.

That all changed in 2009 when newly elected President Obama, who had opposed a mandate during the previous year’s Democratic primaries, decided that it should be part of his plan. Once Obama was for it, Republicans decided they had to be against it, USA Today points out.

Their original position was the correct one. The mandate, which the Supreme Court upheld, is essential to ensure the sustainability of insurance markets where individuals can purchase coverage.

Because issuers would still be required to cover pre-existing conditions and children up to age 26, what insurance company in touch with reality would offer policies if consumers could wait until they got sick to buy? Carriers would either pull out of individual markets or boost their premiums.

If the mandate is ended, the non-partisan Congressional Budget Office estimates that the number of people with health insurance would drop by 4 million in 2019. By 2027, CBO says, 13 million fewer people would have coverage–more than the population of Pennsylvania. Average premiums would increase by about 10%.

Some of the 13 million would be “young invincibles,” members of the US population between the ages of 18 and 29 who believe they don’t need coverage. But many would be people who want insurance but can’t afford it or can’t buy it, at any price.

Bottom Line:

The main purpose of terminating the mandate is to find $338 billion to partially offset tax cuts. That is not found money. It is $338 billion in subsidies that healthcare providers won’t get when some of the 13 million uninsured begin turning up in emergency rooms. Treating those people raises prices for all of us fortunate enough to have coverage.

Steve's Take: Repeal of #individualmandate is all about funding $338 billion in #taxcuts Click To Tweet

Oh, I almost forgot that the Senate GOP tax plan will also increase the deficit by more than $1.4 trillion over a decade, according to the CBO. To address that not minor problem, the GOP will shrug and say they have no choice but to cut Medicare and Medicaid benefits. Just you watch.

Wouldn’t it make more sense for Republicans to go back to their origins. This would include support for international trade and balanced budgets, and a lower tolerance for a president who brags about groping women and getting away with it. And it should include a personal responsibility agenda when it comes to health coverage. Recall that?

I’ll close with a final observation of the legislative modus operandi the GOP in Congress and Mr. Trump are employing. It’s inspired once again by the incomparable Yogi Berra: “When you come to a fork in the road, take it,”–especially when it leads to big dollars raining down on you from your corporate and wealthy individual campaign backers.

So what if millions of Americans are uninsured. That may sound unfair, but…we’re certainly not like those Canadians.