The Health 202: House Republicans Are Divided Over Individual Mandate Push In Tax Plan

(c) 2017, The Washington Post.

House Republicans are a "heck, yeah" on repealing Obamacare's individual mandate but still a "maybe" on funding its extra cost-sharing discounts for low-income Americans.

At least that's what I heard on Capitol Hill Thursday, as Republicans headed into meeting with President Donald Trump shortly before passing their tax overhaul. House conservatives were predictably thrilled at the possibility of ultimately repealing the individual mandate in a final tax bill. Even some moderates said they're also in favor of ditching the mandate and its accompanying penalty for remaining uninsured.

"Let's remember the mandate was called a tax by the Supreme Court," said Rep. Tom MacArthur, R-N.J., who let's remember was ousted as chairman of the moderate Tuesday Group after helping Trump and the Freedom Caucus craft a deal on Obamacare repeal. "Eighty percent of the people who pay that tax make less than 50,000 a year, so if we can eliminate one of the most punitive and regressive taxes in our generation, I'm open to that."

Freedom Caucus Chairman Mark Meadows, R-N.C., summed up why he dislikes the mandate, in a tweet.

Meadows tweeted "Pleased to see the Senate include a repeal of the #Obamacare individual mandate in their #TaxReform proposal--Americans shouldn't be forced to buy a high-cost, low-quality product that they may not want or need. "

These are the two looming Obamacare-related questions on Capitol Hill as Republicans hurtle toward the end of the year. Will lawmakers repeal the individual mandate within their tax overhaul? And will they fund the cost-sharing discounts, known as CSRs, in a separate bill to keep the government running?

While the two priorities can't be combined into a single piece of legislation, they're being viewed as a dual way to appease GOP conservatives and moderates, who have so often been at odds this year over how to treat the Affordable Care Act. The party as a whole is still clearly unsettled about how to approach the law, torn between trying to dismantle it or making efforts to improve its marketplaces.

Rep. Mia Love, R-Utah, appeared pragmatic. She said Congress needs to fund the CSRs - which would help insurers lower premiums for consumers - until Republicans get their health-care act together. And while she'd also like to repeal the mandate, she's mostly concerned that the Senate passes some kind of tax overhaul so the whole effort doesn't get mired down in partisan gridlock.

"If they're not passing something, it was for nothing," Love told reporters. "If they are able to get their voters in line and actually work for the American people, I'll be satisfied with that."

House members acknowledged adding mandate repeal into a tax overhaul - as Senate Republicans have done - injects political risk into the overall debate. And it's infuriated Senate Democrats, who agreed to support a bipartisan plan to fund the CSRs but are now steaming that Republicans still haven't abandoned their repeal efforts.

"Republicans who think they'll be able to jam through a partisan bill that spikes health-care premiums and then make it all better by pointing to our bipartisan bill to reduce health costs are either fooling themselves or trying to fool their constituents," Sen. Patty Murray, D-Wash., said in a statement Thursday.

Murray has struck a deal with Sen. Lamar Alexander, R-Tenn., to fund the CSR payments for two years in a measure seeking overall to stabilize the ACA marketplaces. Alexander has said he'll vote for repeal of the mandate -- even though it could jeopardize his working relationship with Murray.

My colleague Mike DeBonis tweeted "Spoke to @SenAlexander, who basically lays out a 'repeal then replace' type of scenario. Says he will support individual mandate repeal in tax bill, then dare Democrats to oppose Alexander-Murray."

Even though it's completely unclear whether House moderates will ultimately support repealing the ACA's individual mandate, it's also been unclear whether conservatives would agree to fund the CSRs, which they've long termed a "bailout" for insurers. House Speaker Paul Ryan, R-Wis., has previously said he wouldn't bring such a measure to the floor, and his office didn't respond Thursday to questions about where he currently stands on the matter.

"We shouldn't be bailing out insurance companies," Rep. Raul Labrador, R-Idaho, a House Freedom Caucus member, told me. "They were the ones that wanted Obamacare, and we shouldn't be then bailing them out because Obamacare didn't work."

Yet some conservatives aren't entirely ruling out such a deal, saying it depends on what a total year-end spending package looks like. Rep. Phil Roe, R-Tenn., said he would need to see the "totality" of a bill but that CSR payments wouldn't necessarily be a "stopper" for him.

"I'm a conservative, but I also realize there's a greater picture out there," Roe said.


Quick, cover your ears, Republicans. More than six in 10 Americans say you now own the U.S. health-care system, Obamacare and all. And majorities of Democrats, Republicans and independents favor the idea of letting more people buy into Medicare -- an idea proposed by several Democrats. Here are some of the topline findings from a Kaiser Family Foundation poll released Friday morning:

--Half of respondents said if Obamacare enrollment is down this year, it's mainly the Trump administration's fault. There's a significant partisan divide on this question; while 78 percent of Democrats said they'd blame reduced enrollment on the administration, 73 percent of Republicans said it would be because Democrats designed a flawed law. Independents were more likely to blame Trump's actions (48 percent) than Democrats who wrote the law (36 percent).

--Sixty-one percent of all respondents view Trump and Republicans as now responsible for any future ACA problems, since they control the White House and Congress. Just four in 10 respondents said Democrats are responsible for problems.

--Public opinion about the ACA remains divided, with 50 percent viewing the law favorably and 46 percent viewing it unfavorably.

--Which political party you belong to hugely affects how much you trust Trump on health care (shocker). Eight in 10 Republicans said they trust Trump at least a fair amount, while just four in 10 independents and one in 10 Democrats said they trust the president.

--Democrat or Republican, Americans love Medicare. Eighty percent of respondents said they're fans of the program for seniors.

--Majorities of voters in both parties also like an idea advanced by some Democrats of allowing younger Americans to participate in Medicare, although there's slightly higher support for expanding it only to people between ages 50 and 64 (77 percent support) than expanding it to everyone (72 percent support).

--A significant portion of the public has seen ads this month for marketplace coverage from insurance companies trying to sell plans (41 percent said they've seen these types of ads) or from another source trying to educate them about coverage opportunities (32 percent).


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