Collins a 'yes' on tax overhaul; Alexander says ACA fix will be in stopgap spending bill

Sen. Susan Collins, R-Maine, delivers remarks on the Senate floor on Monday about the Republican tax overhaul bill.

With just a few days left in the legislative calendar this year, Congress is racing to pass two bills that could have big implications for the health insurance industry. And in both measures, Sen. Susan Collins plays a key role.

In remarks on the Senate floor on Monday, the Republican lawmaker from Maine offered her support for the GOP’s tax overhaul bill, which will repeal the Affordable Care Act’s individual mandate. That provision and others previously led Collins to demur on whether she would support the bill, so her move to a “yes” is a win for Republicans, which have only a slim majority in the Senate.

“While this legislation is by no means perfect, on balance, it will provide much-needed tax relief,” Collins said. “It will benefit lower- and middle-income families, while spurring the creation of good jobs and greater economic growth for our nation.”

Part of what won over Collins was the fact that Senate Majority Leader Mitch McConnell promised to pass two ACA stabilization bills by the end of the year that counteract the effects of repealing the individual mandate. One bill, drafted by Democratic Sen. Patty Murray and Republican Sen. Lamar Alexander, would fund cost-sharing reduction (CSR) payments for two years, while the other, co-authored by Collins and Democrat Bill Nelson, would set up state-based reinsurance programs.

RELATED: The GOP is getting closer to passing its tax bill. Here's what it could mean for health insurers

Alexander said Friday that his ACA stabilization measure will indeed be added to the year-end government spending bill, according to The Hill. Yet House conservatives aren’t likely to support such a measure, so it’s not a guarantee that it will make it into the final version of the legislation.

In addition, a prominent pro-life group called the Susan B. Anthony List has warned it will “vigorously oppose” any spending bill that includes funding for CSR payments that are not protected by the Hyde Amendment—which ensures federal funding doesn’t go to plans that cover abortions.

Some analysts have also raised doubts about whether passing the Alexander-Murray bill is now a good idea, since reinstating funding for CSRs might actually cause consumers to pay more for ACA exchange policies in 2019. As for the Collins-Nelson reinsurance bill, one analysis found that it might help stabilize the individual market, but those effects could be overshadowed by repealing the individual mandate, FierceHealthcare has reported.

Collins also noted that McConnell sent her a letter (PDF) in which he pledged to prevent an automatic $25 billion cut to Medicare that the GOP tax bill could inadvertently trigger. But that potential funding cut led the AARP to oppose the measure and urge Congress to “work in a bipartisan manner to enact tax legislation that better meets the needs of older Americans and the nation.”