Including the individual mandate in tax reform is the wrong approach

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The latest negotiations on the Senate tax bill have led them back to a proposal to eliminate the individual mandate under the Affordable Care Act. The lure of more than $300 billion in tax savings as calculated by the nonpartisan Congressional Budget Office is too big a number for them to ignore. That same CBO predicts that the repeal would lead to 13 million fewer Americans with health insurance by 2027 and a 10% increase in premiums.

I am not an actuary, but really?

Clearly, the individual mandate is ineffective since, according to Gallup-Sharecare Well-Being Index, 11.7% of Americans were uninsured in the second quarter of 2017. Most of those who do have coverage receive subsidies through the ACA exchanges, their employers or a government entitlement program. I would guess that most of the others have coverage because they have a medical condition and need it. That’s why premiums on the individual marketplace have soared. So, I am not so sure that the ranks of insured would drop as precipitously as the CBO expects.

Some may call this good news for employers since some may experience a drop off in enrollment; employees would no longer face a penalty if they opt out of employer coverage. We didn’t really see much change with the mandate in place, so I would expect this impact to be minor.

Higher costs
As for the 10% premium increase — that, I believe. Insurance companies will clearly use this as an excuse to increase premiums as much as they can — if they even stay in the game. The cards continue to get stacked against the insurance companies in the individual market. If I were at the table, I would fold.

Combining budget and healthcare is a big gamble for the GOP. The balancing act gets wobblier as the plates stack up. Remember, with the Alabama Senate seat still in play, the Republican majority is tenuous. The Trump effect may well wreak havoc in the midterm elections, and then, who knows?

Although only a small percentage of Americans are impacted by this healthcare chess game, the stakes are high. On Tuesday, Senate Republicans indicated that they would not support a bipartisan effort at incremental change. Call your Republican Senators and ask, why not? It’s time for stability.

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