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Obamacare mandate’s fate in hands of the Senate. Republicans on the Senate Finance Committee voted Thursday night to send their tax bill to the Senate floor, planning to amend it there to shore up support among their members to keep tax reform on track for passage this year. With the committee approval, President Trump and congressional Republicans are speeding toward enacting major tax legislation, as the committee vote followed shortly after the House passed its version of the Tax Cuts and Jobs Act. “I’m personally proud of what we’ve accomplished here on behalf of the middle class,” said committee Chairman Orrin Hatch, R-Utah, right before passage. “I won’t count any proverbial chickens before they’re hatched — no pun intended — but I think we’ve produced a bill that can and will pass both chambers.” The biggest question looming over the bill is whether it can pass while including a repeal of Obamacare’s individual mandate’s penalties, a provision that Republicans added to the bill Tuesday night as one of several major late changes. Keeping the individual mandate repeal in the legislation could endanger the votes of Republican centrists such as Maine’s Susan Collins, who said she was wary of changing a system as complex as healthcare in a tax bill. More generally, Republicans risk replaying the Obamacare replacement effort, which was a loser for them. “We’ve been socializing that a lot,” said John Thune, the No. 3 Republican in the Senate, acknowledging that repealing the mandate is an uncertain political proposition. “But frankly, the individual mandate is a tax issue.”
S&P breaks with CBO: Mandate repeal would reduce coverage by less, save less money. Repealing Obamacare’s individual mandate would cause three to five million people to go without insurance and save only up to $80 billion over the next decade, according to an analysis from Standard & Poor’s. The analysis released Friday is drastically different than one from the Congressional Budget Office, which estimated a repeal would save $338 billion over a decade but would lead to 13 million people going without insurance. The numbers are critical as Senate Republicans included mandate repeal in their tax reform legislation and hope to use the savings to fund some tax cuts. A major difference between the dueling estimates is the S&P report’s impact on Medicaid and the individual market, which includes Obamacare’s exchanges and is used by people who don’t have insurance through a job or the government. “Our estimates are lower because we believe that it is not the mandate penalty, but the intrinsic financial incentives available to most eligible enrollees that drive enrollment in these two markets,” said credit analyst Deep Banerjee. While S&P says there would be some drop-offs in the individual market, repealing the mandate would “not stop the majority of this population from re-enrolling. This is also why we expect limited savings from the federal government from the mandate repeal.”
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Poll: Half of Americans would blame Trump for poor Obamacare signups. A new poll found that half of Americans would place blame on low Obamacare enrollment squarely on Trump. The poll from the health research firm Kaiser Family Foundation also found that 61 percent of Americans think Trump and congressional Republicans are responsible for Obamacare’s future. However, assigning blame for low enrollment fell sharply along partisan lines. Kaiser found 78 percent of Democrats believe lower signups are Trump’s fault, while 73 percent of Republicans think that it is because Obamacare is flawed. Nearly half of independents surveyed, 48 percent, would blame the Trump administration rather than the law itself. Opinions on Obamacare remain bitterly divided; 50 percent had a favorable view and 46 percent were unfavorable. There is also a wide partisan split on the law, as 80 percent of Democrats have a favorable opinion and 81 percent of Republicans feel the opposite.
Nearly 30 million still without health insurance. In the first six months of 2017, 28.8 million Americans had no health insurance, about 19.8 million fewer than before Obamacare was signed. The report from the National Center for Health Statistics notes that there wasn’t a significant difference in the number of uninsured compared to the same period in 2016, when 28.6 million people lacked coverage. The coverage estimates come as Congress debates whether to roll back Obamacare. The federal data shows that 19.8 million more people had insurance in the first six months of 2017 than in 2010, when Obamacare was signed in to law.
How Republican lawmakers voted on tax, healthcare bills. The Tax Cuts and Jobs Act passed largely along party lines Thursday, with all Democrats voting against it and 13 Republicans voting for it. The final tally was 227-205. The tax bill had a larger margin of support than the healthcare bill Republicans passed in May, which would have repealed and replaced portions of Obamacare. That bill, the American Health Care Act, narrowly passed with a 217-213 vote and then failed in the Senate. Obamacare’s repeal and the overhaul of the tax code are two of Trump’s biggest priorities. Here is how Republican lawmakers differed when voting on the tax bill versus on the healthcare bill.
Ron Wyden: Adding Obamacare repeal to tax bill would create more opposition. Sen. Ron Wyden said Thursday that Republican plans to repeal Obamacare’s individual mandate penalty in the tax reform bill is already creating more opposition to the tax bill around the country. “Now that they have made this a healthcare issue, I can tell you we are hearing from grassroots groups all over this country,” the Oregon Democrat told reporters Thursday. Wyden spoke after the House passed its tax bill. The Senate is working on its own version of tax reform that, unlike the House version, includes repeal of Obamacare’s individual mandate penalty. Wyden argued that any tax break that the middle class would get from the Senate tax bill would be nullifiedby increases in premiums from repealing Obamacare’s mandate that everybody buy health insurance.
The hidden tax provision that worries hospitals. The House tax bill contains a provision that is really worrying hospitals. While the individual mandate and medical expense deduction have received a lot of attention, a little-publicized change to the tax status on municipal bonds has hospital groups spooked. The House bill would eliminate tax-exempt financing on certain municipal bonds that are a major source of funding for nonprofit hospitals. The Senate version does not include eliminating that provision. The Joint Committee on Taxation estimated that eliminating the provision could save $39 billion over the next decade. However, PricewaterhouseCoopers said in an analysis that it is not clear if the provision will be included in the final bill. “Many not-for-profit hospitals use these vehicles – private activity bonds — to finance capital projects at significantly lower interest rates than they would otherwise be able to,” the research and consulting firm said.
Senate prepares hearing for HHS pick. The Senate Health, Education, Labor and Pensions Committee will hold a hearing Nov. 29 on the confirmation of Alex Azar, Trump’s pick for Health and Human Services secretary. His nomination has ignited criticism from Democrats that the former Eli Lilly executive wouldn’t do enough to fight high drug prices because of his history in the pharmaceutical industry. Democrats are also expected to bring up how he would handle Obamacare after criticism that the Trump administration is sabotaging the law.
CMS proposes rule that would loosen regulations on Medicare Advantage plans. The Centers for Medicare and Medicaid Services is providing flexibility for plans to design their benefits so that they can address specific medical needs. “This administration has been committed, from the beginning, to making sure that our seniors have more choices and lower premiums in their Medicare Advantage plans. To that end, we are adding new flexibilities that will allow seniors to choose plans that are tailor-made to their unique needs, with lower out-of-pocket costs,” CMS Administrator Seema Verma said. About one-third of Medicare beneficiaries have a Medicare Advantage plan.
RUNDOWN
Axios How the individual mandate scrambles the Senate’s tax cuts
Bloomberg Texas lawsuit claims this drugmaker pushed antipsychotic to kids
Kaiser Health News Despite ACA cost projections, most adolescents skip regular checkups
Associated Press Pope to lawmakers: Protect all people with healthcare laws
Wall Street Journal Discord threatens federal role at Indian hospitals
Washington Post Where are the most expensive health plans in America? Charlottesville
Roll Call Murkowski tax vote contingent on stabilizing the individual market
The Hill National ad targets Republicans on ‘sneaky repeal’ of Obamacare in tax plan
Calendar
FRIDAY | Nov. 17
Nov. 16-17. National Academies of Sciences, Engineering and Medicine colloquium on the Science of Science Communication. Details.
MONDAY | Nov. 20
9 a.m. 1789 Massachusetts Ave. NW. American Enterprise Institute event on “The future of delivery system reform.” Details.
Congress is out all week.
