Obamacare Repeal Is Back—in the Republican Tax Bill

 In U.S.
Updated on November 14 at 5:09 p.m. ET

Republicans are taking another run at the Affordable Care Act as part of their overhaul of the tax code.

Bowing to pressure from President Trump, Senate leaders announced on Tuesday afternoon that they would add the repeal of Obamacare’s individual insurance mandate to the far-reaching tax bill they unveiled last week. It’s a high-risk, high-reward maneuver for the GOP, which has struck out in its previous attempts to dismantle the health law. If successful, the move could be a two-for-the-price-of-one policy victory for a party desperate to energize its voters heading into a difficult campaign year. But GOP leaders have previously warned that it could backfire, jeopardizing complicated negotiations over a tax bill and compounding what is already a heavy political lift.

Even as he confirmed the effort on Tuesday, Senate Majority Leader Mitch McConnell seemed less than assured it would succeed. “We’re optimistic that inserting the individual mandate repeal would be helpful,” he told reporters after Republicans senators discussed the issue over lunch.

The main argument for scrapping the insurance requirement as part of the tax bill is to solve a math problem. As currently written, the Senate bill costs the government too much money and couldn’t pass under the budget reconciliation rules Republicans are using to skirt a Democratic filibuster. While repealing the mandate technically reduces taxes on Americans who choose to pay a penalty rather than buy health insurance, the Congressional Budget Office has projected that zeroing out the penalty would actually boost federal revenues by $338 billion over a decade. That would help Republicans pay for their tax cuts—a point made by Trump in a tweet touting the move on Monday.

But the political risk to the GOP lies in the reason why repealing the mandate would save money: According to the CBO, 13 million fewer people would have health insurance as a result, including many who would have received government subsidies. And millions more could eventually face higher premiums, since removing the requirement that people buy coverage would shrink the insurance pool and force insurers to raise prices. Inserting that provision would put immense pressure on the three Republicans who torpedoed the party’s effort to pass a “skinny” repeal over the summer, Senators Susan Collins of Maine, Lisa Murkowski of Alaska, and John McCain of Arizona, along with others who opposed efforts to dismantle the health law without simultaneously replacing it.

“Make no mistake, repealing the individual mandate is tantamount to repealing the Affordable Care Act,” said Brad Woodhouse, campaign director for Protect Our Care, an advocacy group supportive of the ACA. “And as such it would be wise for those few Republicans in the House and Senate who said ‘no’ to previous efforts at repeal to say ‘hell no’ to this one.”

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