After years of trying, Republicans took the first real swipe at Obamacare in their tax-cut bill this week — but far from slaking their thirst, the move has left them all the more eager to root out the rest of the health insurance law.
The new bill repeals Obamacare’s individual mandate requiring Americans to hold insurance or pay a hefty tax penalty. Republicans say it won’t force anyone to give up coverage, but rather frees them to make that decision on their own.
But GOP leaders say the rest of the 2010 law, with new standards for coverage, and hundreds of billions of dollars in taxpayer cash to prop up the system, remains intact — and an even juicier target now.
“Arguably, doing away with the individual mandate makes the Affordable Care Act unworkable — not that it was particularly great beforehand,” said Senate Majority Whip John Cornyn, Texas Republican. “Hopefully this will precipitate the bipartisan negotiation on what we need to do as an alternative.”
At the White House, President Trump said Wednesday that he wants to make sure Republicans fulfill both ends of their repeal-and-replace campaign mantra, dating back to their 2010 “Pledge to America.”
“We have essentially repealed Obamacare, and we will come up with something much better,” Mr. Trump said.
While the mandate is gone, much of the 2010 law is still on the books. Dozens of states expanded Medicaid under the law, and consumers can buy insurance on web-based exchanges with the help of taxpayer-funded subsidies.
Consumer protections that require insurers to charge healthy and sick people the same and cover a slate of “essential” services also remain, and large employers still are required to provide coverage or pay crippling fines.
Some Republicans say the GOP can ax some of those remaining provisions using “reconciliation” procedures from the 2019 budget. They used the same reconciliation tools from the 2018 budget to pass the tax bill.
Rep. Mark Meadows, North Carolina Republican, said the process would allow them to target the employer mandate and other provisions in the law, while some Senate Republicans want to revive a bill that replaces the law with state block grants, placing red states that refused to expand Medicaid on equal footing with those that grabbed up Obamacare dollars.
Mr. Trump pointed to the block-grant measure as a viable option during a Cabinet meeting Wednesday, and a spokesman for Sen. Lindsey Graham, South Carolina Republican and chief sponsor, said he “remains committed” to the bill.
Other Republicans, though, say it would be fine to let the program stew for a while.
“It’s already imploding, it’s going to implode a little faster,” said Rep. Chris Collins, New York Republican. “We’re going to move into welfare reform, especially for able-bodied adults, we’re going to move into infrastructure. There’s a lot of other things. We’ll let the American public have a hue and cry, a year from now, for us to step in and fix Obamacare with a final repeal and replace [bill]. They’re not ready for it yet.”
The Congressional Budget Office says repealing the “individual mandate,” without another spur to get people into the markets, will cause 13 million people to drop coverage by 2027, mainly from the individual market and Medicaid.
Yet scorekeepers say the markets should remain stable in “almost all areas” during the coming decade, primarily because subsidies will rise with rates, blunting the cost for low- and moderate-income customers.
The chief pain would be felt by those who enroll in the markets on their own without subsidies, who will see rate increases projected to average 10 percent in most years, as healthy people drop out of the markets first.
“Today’s repeal of the individual mandate without a replacement sets the stage toward transforming the individual insurance market into essentially little more than a high-risk pool complete with rising costs and few choices,” said Chris Hansen, president of the American Cancer Society Cancer Action Network.
Senate Republicans say they want to smooth over the fallout by passing bipartisan measures that restore “cost-sharing” payments to insurers and $10 billion dollars in reinsurance funding to blunt the cost of particularly pricey customers over the next two years.
But those plans appear to be put on hold until January as a final agreement proved elusive.
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