Tierney Sneed contributed reporting.
No matter how many times the full or partial repeal of Obamacare has died in Congress this year, it continues to claw its way back from the grave.
The latest incarnation, blessed on Tuesday by Senate GOP leadership, is an amendment to Republicans’ long-awaited tax overhaul bill that would repeal Obamacare’s individual mandate. Such a policy change would save the government more than $300 billion but cost about 13 million people their health insurance coverage, and drastically hike premiums for those who remain in the individual market, experts say.
Pursuing such a health policy in tandem with tax cuts for the wealthy and corporations is politically risky—and powerful medical organizations are already mobilizing in opposition to the bill.
Though hard-right members of Congress and President Trump have been agitating for weeks for the repeal’s inclusion in the tax package, GOP leaders have been hesitant, concerned that mixing controversial health policy into an already politically dicey tax debate could sink the bill entirely. Despite pressure from the Freedom Caucus, the House decided not to include the mandate repeal in its tax bill, which could pass as early as Thursday.
But late Tuesday night, the Senate took the plunge, inserting that provision during a markup in the Senate Finance Committee.
“I think it’s looking more and more doable,” a smiling Sen. Roger Wicker (R-MS) told reporters. “It just makes the overall bill a lot more possible.”
Sen. John Kennedy (R-LA), acknowledging that support for the idea is “not unanimous,” said he thinks they can include it without alienating the handful of moderate lawmakers whose votes they desperately need. “My gut tells me we will reach a consensus on doing that,” he said. “It’s $338 billion, and that’s a lot of money.”
Asked what the money could be used for, Kennedy suggested moving up the planned corporate tax cut, which the Senate bill had originally delayed for one year.
The non-partisan Congressional Budget Office recently reported that repealing the mandate would result in hundreds of billions of federal savings because at least 13 million people would lose their health insurance and no longer draw government subsidies. The CBO found that some of those people would be dropping their insurance voluntarily, but many of those who remain would be priced out of the market.
“They’re going to shrink the risk pool of healthy people,” Sen. Ron Wyden (D-OR) explained. “Which means you have mostly sick people left. This will be, for an enormous number of people, a huge increase in their health insurance premiums.”
In interviews this week in the halls of the Capitol, GOP lawmakers were enthusiastic about the prospect of gutting a pillar of the Affordable Care Act after failing to do so in nine months of controlling every branch of the federal government.
Yet a handful seemed uncomfortable with the idea. Sen. Susan Collins (R-ME), whose vote was crucial in defeating multiple ACA repeal bills earlier this year, told reporters she worries about the political and policy repercussions of gutting the mandate.
“I personally think that it complicates tax reform to put the repeal of the individual mandate in there, particularly if it’s done before the Alexander-Murray bill passes, because of the impact on premiums,” she said.
To assuage the concerns of Collins and those who share her concerns, Republican leaders have floated the idea of passing the tax bill with the individual mandate repeal in tandem with a promised vote on the bipartisan bill introduced earlier this fall that would restore cost-sharing payments to insurance companies and restore tens of billions of dollars for Obamacare outreach that President Trump cut earlier this year.
“By putting it in there we would have a better chance of moving forward with something that is along the lines of what Senator Alexander has been talking about, Sen. Rob Portman (R-OH), told reporters. “Those I think complement one another.”
But Democrats say such an offer is a non-starter.
“They should put our bipartisan health care bill on the floor as quickly as possible, without any attempts to sabotage it or use it as political cover to jam legislation through that would be devastating for patients and families,” Sen. Patty Murray (D-WA), co-author of Alexander-Murray, said in a statement Tuesday night.
“It would make absolutely no sense to stabilize health care with one hand while devastating it with the other,” she added.
Still, Republicans insist that unlike their repeated face-plants on health care earlier this year, the overriding desire among Republicans to pass a massive tax cut is so strong that even a controversial mandate repeal provision can’t derail it.
“This is totally different from health care,” Kennedy said after meeting with his fellow Republicans. “Nobody is standing up and saying, ‘If you do this, I’m not going to vote for the bill.’ Everyone is trying to get to yes.”