A new insidious threat reared its head yesterday when a provision eliminating the individual mandate was added to the Senate version of the tax bill.
Fellow Mainers, please let Senator Collins know this is unacceptable.
As many of you know, the mandate works to bring everyone into the system. Without it, the CBO estimates 13 million fewer people would be covered and premiums would rise 10% over the baseline increase.
Note that the CBO analysis assumes all else being equal, we still have the threat of the changes encouraged by the Executive Order (Donald Trump’s Terrible Executive Order on Health Care).
For those needing a refresher, Paul Krugman provides this explanation of why the mandate is needed (remember the three-legged stool?):
"It starts by requiring that insurers offer the same plans, at the same prices, to everyone, regardless of medical history. This deals with the problem of pre-existing conditions. On its own, however, this would lead to a “death spiral”: healthy people would wait until they got sick to sign up, so those who did sign up would be relatively unhealthy, driving up premiums, which would in turn drive out more healthy people, and so on.
So insurance regulation has to be accompanied by the individual mandate, a requirement that people sign up for insurance, even if they’re currently healthy. And the insurance must meet minimum standards: Buying a cheap policy that barely covers anything is functionally the same as not buying insurance at all.
But what if people can’t afford insurance? The third leg of the stool is subsidies that limit the cost for those with lower incomes. For those with the lowest incomes, the subsidy is 100 percent, and takes the form of an expansion of Medicaid.
The key point is that all three legs of this stool are necessary. Take away any one of them, and the program can’t work."
Source: Three Legs Good, No Legs Bad
As you read about events, please don't be fooled by the bone being tossed of the Alexander Murray bill being approved in tandem with the tax bill. Given the way the premium subsidy changes played out, Alexander Murray would end up cutting subsidies for some and doing little to stabilize the markets. Senator Murray has already indicated that she would not support passage of her bill in light of the mandate being eliminated.
"But Ms. Murray rejected any suggestion that the mandate repeal could be paired with her legislation.
“That is the exact opposite of what we should be doing,” she said. “Americans have stood up and spoken loudly for the last year saying they do not want the markets destabilized, and their provision in the tax bill that they are talking about will really destabilize the marketplaces.”"
Source: Senate Plans to End Obamacare Mandate in Revised Tax Proposal
There are many reasons to object to the tax bill. Another one of relevance to the health care discussion is the CBO report yesterday that the GOP tax bill could spur $25 billion in Medicare cuts.
I don't usually include a call to action in my writings, I try and explain a situation as I understand it and leave the rest to you. But this time is different. Without trying to be hyperbolic, I believe that passage of the Senate tax bill would be the beginning of the end of the ACA as a functioning law.
If you are a fellow Mainer, please let Senator Collins know how you feel. And if you've found this piece helpful, please share.
