Individual mandate repeal, Medicare cuts loom large in debate over GOP tax bill

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A CBO analysis from earlier this month said the GOP tax bill could trigger $25 billion in cuts to Medicare in 2018.

With the Senate preparing to vote on the GOP’s tax bill, concerns continue to mount about the measure’s implications for both public payers and private insurance markets. 

One of the biggest issues is a provision in the bill that would repeal the Affordable Care Act’s individual mandate, which the Congressional Budget Office estimates would increase the number of uninsured by 13 million and increase premiums by 10% over the next decade.

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In an effort to lessen Republican Sen. Susan Collins’ concern about those effects, GOP leaders assured her they would likely attach two bipartisan ACA stabilization bills to their year-end spending bill, The Hill reported.

But that deal has two big issues. For one, the CBO said that one of those bills—the Alexander-Murray measure—wouldn’t alter its predictions about the negative effects of the individual mandate repeal. In addition, some prominent House conservatives said they wouldn’t support attaching those bills to the year-end spending bill, per The Hill article.

For her part, Collins said Friday that she is still undecided on the tax bill, according to another article from the publication. As of press time, senators were voting on Democratic amendments to the bill.

Meanwhile, the bill’s potential effect on entitlement programs is also in the spotlight. A CBO analysis from earlier this month said the tax bill could trigger $25 billion in cuts to Medicare in 2018. The reason is that “pay-as-you-go” rules trigger automatic spending cuts if a bill increases the deficit beyond a set threshold. 

The CBO’s prediction of Medicare cuts got the attention of the AARP, which sent a letter to Senate leaders on Thursday to express its opposition to the bill. The organization also noted that it opposes the repeal of the individual mandate. 

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“We urge Congress to work in a bipartisan manner to enact tax legislation that better meets the needs of older Americans and the nation, and we stand ready to work with you toward that end,” the AARP wrote

Collins told reporters Thursday that Senate Majority Leader Mitch McConnell promised her he’d try to avert those cuts to Medicare by waiving the “pay-as-you-go” rules as Congress has done previously, according to Talking Points Memo. 

“If the Medicare cuts were going to occur, “I would not even be considering voting for this [tax] bill,” she said. However, McConnell can’t control whether Democrats would support waiving those rules, the article noted.