CBO: Funding CSRs won’t mitigate impact from repealing individual mandate

The Congressional Budget Office (CBO) said passing an Affordable Care Act (ACA) stabilization measure after getting rid of the ACA’s individual mandate would still leave 13 million fewer people insured by 2027 and cause premiums increase by an average of 10 percent over the same time period.

These were the same results from mandate repeal alone—meaning stabilization measures like funding the ACA’s cost-sharing reduction subsidies won’t offset its impact.

Sen. Patty Murray, D-Washington, cosponsor of the stabilization bill known as Alexander-Murray and ranking Democrat on the Senate health committee, had asked for the CBO report after mandate repeal was included in Senate Republicans’ tax plan.

“There is no reason—absolutely no reason—that this has to include a healthcare provision that would lead to 13 million more people without insurance, showing up in emergency rooms, and increasing premiums for everyone else,” Murray said after the report was released.

Chances for passage of the Senate’s tax plan improved when Sen. John McCain, R-Arizona—who dramatically voted “no” on ACA repeal back in July—announced he’d support the tax cut legislation. Several other Republicans appear to be swing votes, such as Sen. Susan Collins, R-Maine, pointing to the mandate repeal’s impact as a reason for their concerns. Collins has introduced a proposal with Sen. Bill Nelson, D-Florida, to offset the damage to the risk pool by healthier customers leaving the individual market without penalty with $4.5 billion in reinsurance funding.

Collins told reporters on Nov. 30 she expected those bills to be included in a continuing resolution (CR) to keep the federal government operating which the Senate would take up passing the tax bill, which would have to be altered in conference with the House and then passed by both chambers before going to President Donald Trump.

“While the tax bill is in conference, the CR will presumably become law and then the tax bill come back from conference,” she said according to The Hill. “So I’m going to know whether those provisions made it and that matters hugely to me.”

Democrats doubt this strategy will work. A Democratic spokesperson for the Senate health committee said there are several hurdles which could trip up the healthcare bills, including House Democrats voting against it in an effect to secure protections for undocumented immigrants brought to the U.S. as kids and opposition from Republicans in the House Freedom Caucus.

“Any Republican Senator who points to Alexander-Murray and reinsurance as a reason for them being OK with voting to gut health care in this tax bill is pointing only to a vote they can take, not to anything that will actually get signed into law,” the spokesperson said in an e-mail to HealthExec.

Saving the individual mandate, however, has different political consequences than the earlier fights against ACA repeal. While the Republican bills introduced earlier in the year were unpopular, so is the mandate. In a POLITICO/Morning Consult poll conducted in November, 52 percent of respondents either somewhat or strongly disapproved of the penalty for not buying health insurance, compared to only 35 percent in support. Among Republicans, the split is 65-26 disapproval. Democratic respondents were less enthusiastic about defending the mandate, with a 50 percent somewhat or strongly approving of it and 41 percent disapproving.