Senate Republicans are still moving ahead with their tax overhaul, but the bill’s health care components —namely, repealing the individual mandate — got thornier yesterday.
On the Senate side: GOP leaders told Sen. Susan Collins they would agree to pass two health care measures to offset the damage from repealing the mandate: the ACA stabilization bill from Sens. Lamar Alexander and Patty Murray, and Collins’ proposal to establish a new reinsurance program with about $5 billion in federal money.
- Alexander-Murray would not have much effect at all, the Congressional Budget Office said yesterday. CBO still expects repealing the mandate to produce about 13 million newly uninsured Americans and premium hikes of about 10%, on average.
- As it did in its initial score of the Alexander-Murray legislation, CBO assumed the ACA’s cost-sharing payments were still being made, even though they are not. This is weird, and it does produce more conservative estimates of the bill’s impacts. But it’s not new, and GOP leaders on the Senate Budget Committee have some input into CBO’s assumptions on this front.
- As for reinsurance, Majority Leader Mitch McConnell has told Collins he’s on board.
The other side: The House is not on board. Rep. Mark Meadows, the influential chairman of the House Freedom Caucus, said yesterday that he opposes new reinsurance funding, according to The Hill. It’s not entirely clear whether Alexander-Murray could pass the House outside of a larger package, either.
Don’t forget about entitlements. Sen. Bob Corker’s colleagues are not wild about his idea for a “trigger” that would automatically raise taxes if these tax cuts don’t end up paying for themselves. Some are talking instead about a “trigger” that would cut spending — including spending on Medicare and Medicaid.
- A similar trigger already exists: As it stands, the tax bill would already prompt some $25 billion in Medicare cuts, thanks to existing rules that call for automatic spending cuts to counteract new laws that add to the deficit — which the tax bill would. An ACA payment program for insurers would also be cut substantially under those automatic reductions.
- The New York Times has a good visualization of these automatic spending cuts.