To pass a tax overhaul bill, the U.S. Senate needs to sway key Republicans who have been on the fence — including U.S. Sen. Susan Collins of Maine.
Collins has expressed reservations about the bill, in part because it would eliminate the Affordable Care Act’s individual mandate. But after a meeting with President Donald Trump on Tuesday, Collins indicated that she could support ending the mandate if Congress takes action to mitigate the effect on premiums.
As Collins appears to be looking more favorably on GOP tax reform, including its provision that would end the individual mandate, some physicians, like Dr. Hani Jarawan of Portland, are worried.
“This tax bill is bad for my patients, it’s bad for the country. Repealing the individual mandate and cutting federal health care dollars at a time when Mainers and Americans are screaming for more health care, and not less, is a moral abomination,” he says.
The Congressional Budget Office projects that eliminating the mandate would result in 13 million people losing coverage over the next decade, and hike premiums about 10 percent most of those years. The Center for American Progress calculates that in Maine, that means about 50,000 people would lose coverage.
“Then you have the 10 percent premium increase, which will cost Mainers another $2,350,” says senior policy advisor Sam Berger.
Collins has been leery of repealing the individual mandate because she's concerned it would increase costs for Mainers. But after meeting with President Trump on Tuesday, Collins seemed open to the idea.
Trump reportedly promised to support two health care bills that Collins said in a written statement would “mitigate the impact on premiums” if the mandate is repealed. One of those bills is co-sponsored by Collins with Democratic U.S. Sen. Bill Nelson of Florida.
“So Collins-Nelson is a way to add reinsurance for the individual marketplace of the ACA,” says Mitchell Stein, a Maine-based health policy consultant. “What reinsurance is — it’s a way to reimburse insurers for large losses.”
If the individual mandate is repealed, insurers likely would face losses because younger, healthier people would presumably forgo insurance, leaving an older, sicker population that wants coverage. The Collins-Nelson bill would allocate funding for states to set up reinsurance programs, which provide money for insurance companies to cover these sicker, more expensive customers.
It’s a good idea in theory, Stein says, but he points to a couple of problems with Collins’ proposal.
“The first one is the level of funding,” he says.
The Collins-Nelson bill would allocate about $2 billion a year for reinsurance programs. The Center on Budget and Policy Priorities projects the amount that’s actually needed is $10 billion a year.
“Collins-Nelson provides not enough money for not enough time,” says Steve Butterfield of Consumers for Affordable Health Care.
Butterfield says the other problem with the Collins-Nelson bill is it’s temporary.
“Repealing the individual mandate is forever. Collins-Nelson is two years. So what happens in two years?” he says.
And Butterfield doesn’t see any saving grace in the Senate bill sponsored by Republican U.S. Sen. Lamar Alexander of Tennessee and Democratic U.S. Sen. Patty Murray of Washington, either. It would fund cost-sharing reduction subsidies, which are federal payments recently ended by President Trump that helped insurance companies lower the cost of plans.
Butterfield says that deals with a separate issue, and the harm has already been done.
“Now that that damage has taken place, walking it back is not enough to go back to square one and say all of a sudden now it makes any sense to repeal the individual mandate. It doesn’t,” he says.
In a letter issued Wednesday, the Congressional Budget Office also concluded that if the individual mandate is repealed, the Murray-Alexander bill would have little impact on premiums and coverage.
The Democratic co-sponsors of the two health bills are also rejecting the notion that the bills sufficiently mitigate the damage the GOP tax reform bill does to health policy.
Murray tweeted, “It’s like trying to put out a fire with penicillin. It will not do anything to help.”
Nelson told CNN that the bill he co-sponsored with Collins is not an even trade for repealing the individual mandate.
Collins told reporters Wednesday that she has a commitment from Republican Senate Majority Leader Mitch McConnell that both Alexander-Murray and Collins-Nelson bills are “must-pass” bills this year.
Collins says she’s a “yes” on the motion to proceed with the GOP tax bill.
This story was originally published Nov. 29, 2017 at 5:24 p.m. ET.
