Republicans in Congress say tax bill will include repeal of law requiring individuals to have health insurance; critics object

Senate Republicans' tax bill will include a repeal of the requirement that almost all Americans obtain health insurance, "a major change as they now try to accomplish two of their top domestic priorities in a single piece of legislation," The Washington Post reports. The House is expected to agree.

Lisa Des Jardins of PBS reports that the repeal "helps them with (conservative) critics demanding some kind of Obamacare repeal and, according to the Congressional Budget Office, the repeal would bring an additional $338 billion in savings, mainly because fewer people would sign up for Medicaid." The government exchanges for tax-subsidized Obamacare policies are also used to enroll in Medicaid.

The mandate in the 2010 Patient Protection and Affordable Care Act is tax-related, because failure to have coverage incurs a penalty on tax returns. The Supreme Court decision upholding the law turned largely on that point.

“We’re optimistic that inserting the individual mandate repeal would be helpful” to the effort to pass the tax bill, something Republicans badly want, Senate Majority Leader Mitch McConnell said. President Trump had promoted the idea, but "Republicans had resisted making the change, worried that injecting health care politics would imperil the tax bill," the Post reports.

Sens. McConnell and Paul (USA Today photo)

McConnell announced the change a few hours after his Kentucky seatmate, Republican Rand Paul, said he would offer an amendment to the tax bill to repeal the mandate and give a greater tax cut to middle-class families. Paul "suggested earlier in the day that Republicans should use the money to help taxpayers who would be impacted by the loss of the state and local tax deduction, which the Senate bill currently eliminates," NBC News reports.

As part of the deal, Republicans will allow a vote on the bipartisan Senate legislation aimed at stabilizing individual markets, Des Jardins reports. "It would fund the subsidies that President Donald Trump said he would end and Congress needed to resolve. Democrats love that bill and it could pass overwhelmingly. It also helps with a certain senator from Maine, Susan Collins, who was a key 'no' vote on the original health-care bill."

"The bills cannot be combined due to strictures imposed by the budget process Republicans are using to avoid a Democratic filibuster," the Post reports. Sen. John Thune of South Dakota, chair of the Senate Republican conference, "said he’s confident the votes are there," Des Jardins reports.

"Repealing the mandate would undermine other key parts of the Affordable Care Act," the Post reports. "The health-care law banned insurance companies from discriminating against people with pre-existing health conditions. But in order to prevent people from waiting to buy insurance until they got sick, the law also imposed financial penalties for individuals who did not maintain health insurance coverage. Health experts say eliminating the mandate would destabilize the individual insurances markets set up by the Affordable Care Act, as they would be full of people with high health care costs but have far fewer of the healthy people that insurance companies bank on. In response, insurance companies would likely either massively raise premiums or pull out of the marketplaces entirely. A powerful group of stakeholders, including the major health insurance and hospital insurance lobbies and two influential doctors’ groups, wrote a letter to leaders from both parties arguing that they should retain the individual mandate."

UPDATE, Nov. 19: After criticism of the idea, White House Budget Director Mick Mulvaney said, “If it becomes an impediment to getting the best tax bill we can, then we are okay with taking it out.” He said on CNN’s “State of the Union” that it was not an impediment now.