Republicans in Congress are not finished with the effort to replace Obamacare. Senate Republicans have announced a plan to include a repeal of the individual mandate to their version of the tax cut proposal. It would end up saving the government billions of dollars and make it easier for lawmakers to pay for tax cuts. Analysts say it would mean millions more Americans without insurance and could undermine the foundation of the affordable care act. Jerry welcome to the program. There were 2 major efforts to repeal and replace the affordable care act and both failed is his plan to eliminate the individual mandate similar to either of those proposals?It is similar only in the sense that one of the features of the other proposals was to eliminate the individual, they would have had a much more damaging impact overall as they would've taken away more benefits.What would happen if the individual mandate goes away but the rest of Obamacare stays in place?I think what will happen is the Congressional Budget Office estimates that immediately try to million people would decide not to get insurance because they are relatively healthy and they will no longer have to pay a penalty if they don't have insurance. People will sit on the sidelines and it is estimated 4 million immediately. What that means is that the pool of people that will be left in the insurance market will probably be on average sicker and more expensive and that just drives up premiums and that is not good for anyone.Another consequence of that is that the government saves money because not as many people are signing up for health insurance.That is what the projected tax savings are all about. If the government is not providing subsidies for 13 million people that produces savings. There is an offsetting clause because Affordable Care Act is not fully repealed. People remaining in the marketplace will have subsidies increase and that will offset some of the savings.How has the individual mandate been working out? If you don't get health insurance under the provisions of the individual mandate you are subject to a fine, have those worked to get people enrolled?There is some debate among analysts about how important this individual mandate has been versus the actual subsidies themselves. I am one of those people who think the mandate did have an impact and believe it was substantial. There is some research that suggests people when it comes to taxes don't want to be viewed as cheating so the mandate is an important potential and a way of moving people into the insurance market. There are several million people who have been paying the penalty and remaining uninsured. It has not compelled everyone to go into the marketplace. I think it has been an important factor based on their estimates and suggests a substantial number are responding.This move by Senate Republicans comes at a time when a bipartisan group of senators are working on a plan to stabilize the country's health insurance markets. What are they proposing?It would provide restoration of cost-sharing reduction that President Donald Trump has eliminated and these are the subsidies that go directly to insurance companies to lower the out-of-pocket expenses for people who purchase silver plans and whose incomes are below 250% of the federal poverty level. It would restore something that was phased out at the end of 2016 which were subsidies for the insurance companies to cover really expensive cases, that fund would be restored under these new rules.It seems that some Republicans are talking about passing both of these bills together. Do we know how they might interact with each other?They kind of have offsetting effects and it is hard to say which one would have the biggest effect. My guess is that the repeal of the mandate may have a larger effect because you can be assured even though the president has two funding for advertising for this year's open enrollment season that his administration would make it widely known that the mandate had been repealed giving people permission to drop their insurance coverage knowing they would no longer have to pay a penalty. My guess is that there be a heavy advertising campaign to let people know they no longer need to purchase health insurance because the mandate is repeal. That may offset some of those efforts.Despite the Trump administration pulling money from advertising it is being reported Obamacare re-enrollments are surging despite the turmoil of its future. Do you think that boost might send a message to lawmakers?Our elected members of Congress were responsible for the messages coming from the majority of the public but it does not seem like that is happening now. I think the good news here is despite efforts by our government to sabotage the Affordable Care Act there are lots of other mechanisms out there for people to get the message and to sign up for benefits that are still there that Congress has been unable to repeal.I have been speaking with Gerald Kaminski director of the UCLA for health policy and research. Thank you very much.It was my pleasure.
Senate Republicans are intent on scrapping the Affordable Care Act's requirement that Americans get health insurance, targeting a repeal of the individual mandate to help finance deep tax cuts in their tax overhaul.
Sen. Orrin Hatch, chairman of the Finance Committee, confirmed late Tuesday he was revising the bill to include repeal of the insurance mandate "to help provide additional relief to low- and middle-income families."
The surprise renewal of the failed effort to scrap the law's mandate came a day after President Donald Trump renewed pressure on GOP lawmakers to include the repeal in their tax legislation. It has sharp political stakes for Trump, who lacks a major legislative achievement after nearly 10 months in office.
The move by Republicans on the Senate Finance Committee upended the debate over the tax measure just as it was inching closer to passage following months of fine-tuning and compromise. It turned the debate into an angry partisan referendum on health care and President Barack Obama's signature law.
Republican efforts to dismantle the law collapsed this past summer as moderate Republicans joined with Democrats in rejecting the repeal — a bitter disappointment for Trump, who lashed out at the Senate GOP for failing. Adding the repeal of the mandate to the tax measure would combine two of Trump's legislative priorities.
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Beyond Trump's prodding, the repeal move also was dictated by the Republicans' need to find revenue sources for the massive tax-cut bill, which calls for steep reductions in the corporate tax rate and elimination of some popular tax breaks.
"We are optimistic that inserting the individual mandate repeal would be helpful; that's obviously the view of the Senate Finance Committee Republicans," Majority Leader Mitch McConnell, R-Ky., told reporters.
The "Obamacare" mandate requires most people to buy health insurance coverage or face a fine. Without being forced to get coverage, fewer people would sign up for Medicaid or buy federally subsidized private insurance. Targeting the mandate in the tax legislation would save an estimated $338 billion over a decade, which could be used to help pay for the deep cuts.
The Congressional Budget Office has estimated repealing the requirement that people buy health coverage would mean 4 million additional uninsured people by 2019 and 13 million more by 2027.
It "will cause millions to lose their health care and millions more to lose their premiums," Sen. Ron Wyden of Oregon, the senior Democrat on the Finance Committee, angrily insisted when the panel reconvened to work on the tax bill and word came of the Republicans' move on the mandate.
Feeling ambushed without advance notice, minority Democrats exploded in anger.
The completed House tax bill, pointed toward a vote in that chamber Thursday, does not currently include repeal of the health insurance mandate. Trump plans an in-person appeal to House Republicans before the vote.
To win over moderate Senate Republicans to the tax legislation, the Senate may take up at the same time a bipartisan compromise to shore up health care subsidies, Sen. John Thune, R-S.D., indicated Tuesday. Thune is a member of the Finance panel.
Hatch's revised version also doubles the child tax credit to $2,000 from the current $1,000 — a change that presidential daughter Ivanka Trump has pushed for. The credit would rise to $1,600 under the House bill.
Also, Hatch's revision makes slight reductions in individual tax rates for three moderate income brackets, numbers three, four and five of a total seven. The rates are reduced from the original Senate bill and the current system. The new rates would be 10, 12, 22.5, 25, 32.5, 35 and 38.5 percent.
The House bill shrinks the current seven brackets to four: 12, 25, 35 and 39.6 percent.
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Outside Congress, as word spread of the Senate Republicans' intention, major organizations representing insurers, doctors and hospitals urged lawmakers to keep Obamacare's unpopular requirement that most Americans have health insurance — at least for now.
Ending the "individual mandate" would prompt healthy people to leave the insurance market in droves, driving up premiums, the groups argued in a letter Tuesday to congressional leaders.
Republican Sens. Rand Paul of Kentucky and Tom Cotton of Arkansas had pushed for the repeal in the tax bill just months after GOP efforts to dismantle the 2010 health care law had collapsed in the Senate.
"Repealing the mandate pays for more tax cuts for working families and protects them from being fined by the IRS for not being able to afford insurance that Obamacare made unaffordable in the first place," Cotton said in a statement.
Congressional Republicans projected confidence earlier in the day about delivering the legislation.
"This bill will make things better for hard-working Americans," House Speaker Paul Ryan, R-Wis., told reporters.
House GOP leaders rallied support with the rank-and-file at a closed-door meeting.
Earlier in the Senate panel's work on the bill, the Democrats complained that the bill would enable U.S. corporations with foreign operations and wealthy individuals and families to exploit loopholes to skirt millions in taxes.
On Monday, a nonpartisan analysis of the Senate bill showed it would increase taxes for some 13.8 million moderate-income American households.
Promoted as needed relief for the middle class, the House and Senate bills would deeply cut corporate taxes, double the standard deduction used by most Americans and limit or repeal completely the federal deduction for state and local property, income and sales taxes. Republican leaders in Congress view passage of the first major tax revamp in 30 years as imperative for the GOP to preserve its majorities in next year's elections.
