WASHINGTON – Senate Republican leaders said Tuesday that they would seek a repeal of the Affordable Care Act’s individual mandate through their tax bill, a major change of strategy as they try to accomplish two of their top domestic priorities in a single piece of legislation.
Repealing the mandate, which compels most Americans to buy health insurance or pay a fine, would free up more than $300 billion in government funding over the next decade that Republicans could use to finance their proposed tax cuts, but it would result in 13 million fewer people having health insurance, according to projections from the nonpartisan Congressional Budget Office.
The CBO has also projected that repealing the individual mandate would drive up insurance premiums for many Americans by roughly 10 percent.
The injection of health policy into the tax debate introduces a volatile variable into what was already a challenging political enterprise for Republicans. And it’s unclear whether it will help or hurt the bill’s chances.
By freeing up hundreds of billions of dollars, Senate leaders have more flexibility as they attempt to assuage the concerns of anxious members from across their caucus.
Senate GOP leadership has come under pressure to boost the tax plan’s benefits for the middle class as nonpartisan projections have shown that the wealthy and big corporations would benefit most. At the same time, leaders are struggling to ensure that the legislation does not add too much to the budget deficit in the long run, threatening the bill’s viability under the procedures they intend to use to pass it.
“We’re optimistic that inserting the individual mandate repeal would be helpful,” Senate Majority Leader Mitch McConnell, R-Ky., said Tuesday after meeting with party members during a closed-door lunch.
Eliminating the individual mandate and having far fewer people signed up for insurance saves money because many of those people receive federal subsidies to buy coverage.
But the elimination would cause substantial political problems of its own.
The attack on former president Barack Obama’s signature legislative achievement is likely to rule out the already slim possibility of support from Democrats, and the prospect of adding millions to the ranks of the uninsured could trouble moderate Republicans who voted down previous repeal efforts.
Sen. Susan Collins, R-Maine, one of the Republicans who opposed earlier attempts to roll back the health-care law, said Tuesday that including the repeal measure “complicates” the tax effort. But she suggested she might be able to support it if the Senate also passes a bipartisan bill to preserve other aspects of the Affordable Care Act.”
Sen. John McCain, R-Ariz., who along with Collins and Sen. Lisa Murkowski, R-Alaska, voted down an Affordable Care Act repeal effort this summer, declined to say whether he’d back a tax bill that included repeal.
“I want to look at the bill in its entirety before you start plucking out parts of it to see whether I support it or not,” he said Tuesday in the Capitol.
Republicans control 52 votes of the 100-seat Senate, so the defection of three members would imperil any changes to the bill. Republicans are trying to pass the tax-cut bill through a process known as reconciliation, which requires only 50 votes – plus a tiebreaking vote from Vice President Mike Pence – to pass the bill.
Pence praised the repeal effort Tuesday at a Wall Street Journal event in Washington, noting that President Donald Trump is a vocal supporter of the effort and saying that the mandate’s elimination would amount to a tax cut for the middle class.
Repealing the mandate would undermine the Affordable Care Act’s system for attempting to get low-income people and other individuals into private health insurance plans. The health-care law banned insurance companies from discriminating against people with preexisting health conditions. But to prevent people from waiting to buy insurance until they got sick, the law also imposed financial penalties for individuals who did not maintain coverage.
Health experts say eliminating the mandate would destabilize the individual insurance markets set up by the Affordable Care Act, as they would be full of people with high health-care costs but have far fewer of the healthy people insurance companies depend on to stay profitable. In response, insurance companies would probably massively raise premiums or pull out of the marketplaces entirely.
A powerful group of stakeholders, including the major health insurance and hospital insurance lobbies and two influential doctors’ groups, wrote a letter to leaders of both parties arguing that they should retain the individual mandate.
“There will be serious consequences if Congress simply repeals the mandate while leaving the insurance reforms in place: millions more will be uninsured or face higher premiums, challenging their ability to access the care they need,” the groups wrote.
Republicans appear to have divergent plans for how they would use the funding saved by repealing the mandate.
Senate Finance Committee Republicans met late Monday to see whether each member would agree to including the health-care language, and their support was unanimous.
They plan to use the savings to offset further tax cuts, including an even greater expansion of the child tax credit, a move Ivanka Trump and Sen. Marco Rubio, R-Fla., have called for.
The president has said the repeal should be focused on getting income tax rates down for the wealthy, with any leftover money going toward cutting taxes for the middle class.
Sen. Rand Paul, R-Ky., said Tuesday morning that he would introduce his own amendment to the tax bill that would repeal the individual mandate and use the savings to lower taxes for middle-class families.
Broadly, both the Senate bill and House bill would sharply cut the corporate tax rate and cut income tax rates for individuals, while seeking to finance those cuts by eliminating or scaling back some popular tax deductions. What the deduction rollbacks don’t cover would be financed by $1.5 trillion in deficit spending over a decade.
The House and Senate bills would lower taxes for many Americans, but nonpartisan analysts have concluded that the elimination of certain deductions would have millions pay higher taxes, particularly if they live in states such as New York, New Jersey or California.
The House and Senate must pass matching versions of the tax-cut bill for Trump to be able to sign them into law. The House bill does not include a repeal of the individual mandate.
House conservatives mounted a last-ditch effort Tuesday to include a repeal before the full chamber votes on the bill, scheduled for Thursday. Rep. Mark Walker, R-N.C., the leader of the Republican Study Committee, huddled in the office of House Speaker Paul Ryan, R-Wis., Tuesday afternoon with House Rules Committee Chairman Pete Sessions, R-Texas, whose panel will make any final changes to the bill Tuesday night before it heads to the floor.
But House GOP aides who were not authorized to speak publicly on the internal discussions said GOP leaders are loath to make such a major change to the bill at this late stage and prefer to see whether the Senate could pass a bill with the repeal provision before bringing the issue up in the House.
In the Senate, the sudden shift in the tax bill threatens to undermine a compromise health measure negotiated between Sens. Patty Murray, D-Wash., and Lamar Alexander, R-Tenn. The agreement would resume payments that help low-income Americans afford health insurance, which the Trump administration halted in October.
To win support for the updated tax bill, the Senate could take up the Alexander-Murray bill alongside it, according to Sens. John Thune, R-S.D., and Bob Corker, R-Tenn. The bills cannot be combined under the rules of reconciliation.
Senate Minority Leader Charles Schumer, D-N.Y., said including a repeal of the mandate in the tax bill would torpedo Democratic support for the Murray-Alexander compromise.
“We don’t need to trade it for a tax bill, and we won’t,” he said.
And Murray, D-Wash., the top Democrat on the Senate Health, Education, Labor and Pensions Committee, told reporters she was stunned that Republicans would again seek to undo the Affordable Care Act.
“The elections last week clearly showed that the American people are paying attention, and they don’t want their health care taken away,” Murray said, referencing a string of state-level elections in Virginia, New Jersey and elsewhere in which Democrats trounced Republicans. “I don’t think [Republicans are] listening.”
The Washington Post’s Carolyn Y. Johnson, Jenna Johnson and Ed O’Keefe contributed to this report.