Daily on Healthcare: Goodbye mandate: House sends final tax bill to President Trump

Goodbye mandate: House sends final tax bill to President Trump. The House on Wednesday passed the final tax bill, which includes a repeal of Obamacare’s individual mandate penalties. It will now be sent to President Trump, who is expected to sign it into law. Wednesday’s vote was merely a formality, with all the drama already having played out Tuesday afternoon, when Speaker Paul Ryan first proved he had the votes to pass the $1.5 trillion tax cut. A re-vote was required because several small provisions of the bill were stripped out to accord with Senate rules just before the upper chamber voted for passage in the early hours of Wednesday morning. But formality or not, the legislation will have significant ramifications for tax and healthcare policy. Starting in 2019, Americans will no longer be subject to penalties if they decline to buy health insurance. The mandate has been the white whale for Republicans, who have spent more than seven years trying to bring it down and came close. In the 1990s, the mandate had been part of a Republican alternative to Hillary Clinton’s healthcare plan, which had an employer mandate. It was later adopted as part of the Massachusetts healthcare law signed by Gov. Mitt Romney in 2006. But as President Barack Obama and Democrats moved to impose it on the federal level, the requirement immediately became emblematic to conservatives of the encroachment on liberty, as for the first time, lawmakers were requiring individuals to purchase a product, and one that met specifications established by the central government. The mandate became one of the most unpopular aspects of Obamacare, and its constitutionality was challenged all the way to the Supreme Court, which, in a narrow ruling, said it was lawful only on the grounds that it was a tax. That ruling established that people who went uninsured were in compliance with the law as long as they paid penalties, which helped set the stage for Republicans to reduce the penalties to $0 in their tax bill, giving it the effect of repealing the mandate. The mandate has been seen as key to making Obamacare functional, because it is aimed at compelling younger and healthier individuals to buy insurance to offset the costs of covering older and sicker enrollees that insurers are forced to cover under Obamacare. Without it, studies conclude, fewer people would purchase insurance and premiums would spike even higher than they already have. However, some have made the argument, supported by research, that the mandate has not been very effective in convincing unsubsidized individuals to purchase insurance. Soon, we’ll get a real world experiment on the importance of the mandate.

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With zero Democratic votes, GOP tax overhaul risks future challenges. Republicans’ tax overhaul bill is set for final passage with no Democratic votes in the Senate or House, raising the risk that Democrats would undo parts of the legislation if and when they return to power. In that respect, this week’s passage of the GOP tax bill parallels former President Barack Obama’s enactment of healthcare legislation in 2010, which garnered no Republican votes in the final version. The partisan bill helped create the Tea Party and gave rise to the Republican majority in Congress. With Tuesday’s vote, the GOP is now poised to undo a major part of Obamacare by zeroing out its individual mandate. By pushing the tax bill through in a partisan, rushed process, Republicans “have guaranteed significant instability in U.S. tax policy for many, many years to come,” said Oregon’s Ron Wyden, the top Democrat on the Senate Finance Committee. Sen. Chris Van Hollen, D-Md., warned that the bill would create tax cuts for big corporations while raising taxes on the middle class. “We don’t want to see that happen,” he said. “We’ll have to change some things.” Speaking right after the House voted to pass the tax bill, House Speaker Paul Ryan, R-Wis., rejected the possibility that the measure could come under siege the way Obamacare did. “I think the comparison’s a non sequitur, because the Affordable Care Act proved to be extremely unpopular,” he said. “The Affordable Care Act proved to reduce healthcare choices, to raise premiums, to make healthcare unaffordable. This is going to do the opposite. This is going to grow the economy, it’s going to increase paychecks, it’s going to increase take-home pay, and that, I believe, will be very popular.”

Republicans scramble for spending deal by Friday. House Republicans late Tuesday had little time to celebrate their pending victory on tax reform, and instead were scrambling to come up with a bill to keep the government open past Friday’s deadline. The House is expected to vote on legislation as early as Wednesday that would keep the government funded fully through Jan. 19 and would include full fiscal 2018 funding for defense. Lawmakers in the upper chamber plan on stripping out the year-long defense spending and tacking on a measure to fund Obamacare subsidies. But that legislation can’t pass the House with only GOP votes and, according to leadership aides, won’t even get floor consideration. That conflict between what can pass the House and what can pass the Senate is leaving Republicans in a bind. Republican leaders in a closed-door meeting Tuesday told the GOP the House should not pass the Senate’s cost-sharing subsidies, which they said would prop up a flawed and failing Obamacare law. As a result, House lawmakers will have to come up with a new bill and send that back to the Senate. But no one knows what that bill will look like. The House bill includes a five-year reauthorization of the Children’s Health Insurance Program but Democrats oppose the funding, which they say depletes other health programs. Republican leaders pledged there will be no partial government shutdown. But Democrats say Republicans need to work with them on a bipartisan deal.

Susan Collins accuses media of being sexist in coverage of tax bill. Sen. Susan Collins called the media sexist in how it covered her support for the tax overhaul bill slated for passage in the Senate Tuesday night. The Maine Republican was asked by reporters about her support for the bill, including her reaction to GOP House members balking at passing two measures she negotiated that are intended to stabilize the exchanges and lower premiums. “I believe that the coverage has been unbelievably sexist, and I cannot believe that the press would have treated another senator with 20 years of experience as they have treated me,” she told reporters in the Capitol, according to several reports. “They’ve ignored everything that I’ve gotten and written story after story about how I’m duped. How am I duped when all your amendments get accepted?”

Co-sponsors of Obamacare overhaul bill met to discuss strategy. GOP Sens. Lindsey Graham of South Carolina, Bill Cassidy of Louisiana, Dean Heller of Nevada and Ron Johnson of Wisconsin met Tuesday to discuss details about their Obamacare overhaul bill and how to resuscitate it in 2018. Johnson told the Washington Examiner of the planned meeting. Sen. John Thune, the third-ranking Republican, said that would be the likely avenue. “My guess is that if we are able to move forward, if we can find 50 votes for something, it will probably be along the lines of a Graham-Cassidy approach. That is something that most of our members found a lot of merit in and to be a fairly workable solution,” he told reporters Tuesday. “But again, when I say ‘a lot of our members,’ whether that’s 50 or not remains to be seen. But I know Lindsey and Bill Cassidy are still working it hard.”

Bill would reduce premium increases from individual mandate, report finds. A bill sponsored by Collins would offset the estimated premium hikes from repealing the law’s individual mandate that everyone buy insurance, according to a report from the Council for Affordable Health Coverage. Collins and Sen. Bill Nelson, D-Fla., sponsored legislation to give states $10 billion in 2019 and 2020 to set up a reinsurance program. Reinsurance pays an insurer for the highest medical claims, which in turn would reduce premiums for everyone else. It also includes $500 million to help states develop and implement federal 1332 waivers for reinsurance programs. The waivers give states a way to tailor their own programs. The nonpartisan Congressional Budget Office estimates that eliminating the mandate would increase premiums on the law’s exchanges by 10 percent and reduce the number of uninsured by 13 million over the next decade. The council, which is an advocacy group comprised of insurers, pharmacists, drug manufacturers, and patient groups, estimates that the Collins-Nelson measure would lead to a 9 to 11 percent decline in premiums in 2019 and 2020. But the results could differ based on how the states use the funding.

Democrats urge repeal or suspension of medical device tax in spending bill. Democratic Sens. Joe Donnelly of Indiana and Amy Klobuchar of Minnesota, who previously introduced legislation to permanently repeal the medical device tax, are imploring Senate leaders not to allow it to go into effect in 2018. “We write to urge you to include relief from the medical device tax — such as long-term suspension or full repeal — before the end of the year,” they wrote in a letter. Some members have proposed repealing the tax retroactively, a move the industry opposes because they say it will still incur costs they won’t recuperate and cause operational difficulties.

Save my Care hits Collins, Murkowski for tax vote. Pro-Obamacare group Save my Care is slamming Collins and Sen. Lisa Murkowski, R-Alaska, for supporting the overhaul of the tax code in a new round of digital ads. Save My Care accused the senators of voting for “sneaky repeal” of Obamacare and urge them to resist further efforts to unravel the law. “She could’ve stood up for healthcare, but she decided it was more important to stand with Donald Trump, Mitch McConnell and corporate lobbyists,” each of the ads say.

Arizona Gov: McCain said to be ‘up and at ‘em and is bossing everyone around.’ Arizona Gov. Doug Ducey is optimistic about the health of Sen. John McCain, R-Ariz., after talking with his wife, Cindy, several days ago. “This weekend, I talked with Cindy, I got a really good report from her,” Ducey, a Republican, said during a radio interview with KTAR-FM on Tuesday. “She said the senator is up and at ’em, and is bossing everyone around, so very much back in his element. So, I’m rooting for him.” The senator, who is 81 years old and was diagnosed in July with a primary glioblastoma, was hospitalized last week. After he missed votes on Monday and Tuesday, it was revealed he was “receiving treatment at Walter Reed Medical Center for normal side effects of his ongoing cancer therapy,” according to a statement from his office. Cindy McCain revealed on Monday she and her husband had traveled back to Arizona for Christmas. The family said in a statement that the senator would be undergoing physical therapy and rehabilitation and that they anticipate he will return to Washington in January.

Paul Ryan denies House will pivot to Medicare cuts in 2018. Ryan ruled out cuts for Medicare beneficiaries next year despite previously calling for reforming healthcare entitlements. Ryan said on ABC’s “Good Morning America” Wednesday there could be some Medicare provider issues the Republican-led Congress could address in 2018. “Some providers in the Medicare field are getting overpaid,” he said. “As far as you talk about beneficiaries, we are not focused on that.” Ryan said this month on the Ross Kaminsky radio show the House was going to work on healthcare entitlement reform next year because that would tackle debt and the deficit. However, Ryan on Wednesday denied that reform would involve Medicare cuts. “The kinds of the entitlement reform that we are going to be pursuing are the kinds to get people on welfare to work,” he said.

RUNDOWN

Axios Repealing the individual mandate won’t affect employer coverage

Politico Ryan and McConnell head for clash over Obamacare

NPR First gene therapy for inherited disease gets FDA approval

Kaiser Health News Doing more harm than good? Epidemic of screening burdens nations older patients

Bloomberg Cornyn says tax bill mandate repeal makes Obamacare ‘unworkable’

New York Times A federal ban on making lethal viruses is lifted

STAT News Experts call for use of Sanofi’s Dengue virus to be halted in most cases

Calendar

WEDNESDAY | Dec. 20

1 p.m. White House. President Trump to hold a news conference on tax bill.

FRIDAY | Dec. 22

Deadline to pass government spending bill before funding runs out.