Sen. Susan Collins (R-Maine) has taken a whole lot of heat for her vote in favor of the GOP Senate tax bill, in particular because it includes repeal of the individual mandate. She has argued that two other pieces of legislation she is backing make up for the increase in costs likely to flow from repeal of the mandate. She did so again on Sunday on “Face the Nation“:
JOHN DICKERSON: There is one critique of that, though, that your legislation helped the condition before this tax bill, which has removal of that individual mandate, and that basically these fixes won’t be enough for those people who will see higher premium increases.
COLLINS: We have a brand-new study that just came out last week by Avalere, a respected consulting firm, that says it will more than offset the repeal of the individual mandate. And keep in mind that the individual mandate fines fall disproportionately on low- and middle-income families. Eighty percent of those fines are paid by families who make less than $50,000 a year.
As part of the debate over tax reform, Congress is discussing a proposal put forth by Senator Collins that would provide 2 years of reinsurance funding at $5B per year. Avalere estimates that level of reinsurance would reduce 2019 premiums by 4% and increase enrollment by 180,000 people (Table 1). According to Avalere, reinsurance helps protect insurers from high cost claims and, as a result, lowers premiums.
In addition to the reinsurance funding, Congress may vote on the legislation previously proposed by Senators Alexander and Murray, which would fund the CSRs. In combination, CSR funding and $5B in annual reinsurance could lower 2019 premiums by 18% and increase enrollment by 1.3M people.
Moreover, Avalere President Dan Mendelson reminds me that Collins’s fixes are only for two years “and when the money runs out, so does the salient effect.”
A spokeswoman for Collins told me: “According to the CBO, repealing the individual mandate would increase premiums by 10 percent. According to Avalere, passing Collins- Nelson and Alexander-Murray would decrease premiums by 18 percent.” She added, “Consequently, even with greater market uncertainty, it’s reasonable to conclude that passage of those two bills would offset the premium increase and may decrease the cost of health insurance premiums.” But that doesn’t account for what happens after 2020.
The Center on Budget and Public Policy Priorities has echoed that criticism and underscored the fact that Collins’s fix is only for two years:
The Alexander-Murray bill would reverse only the premium increases resulting from the Administration’s decision not to pay CSRs, and only for 2019. In contrast, repealing the individual mandate would increase premiums in 2019 and beyond, and for all individual market plans, not just silver plans. Without the individual mandate, fewer healthy people would sign up for individual market coverage, increasing average costs. CBO estimates this would raise premiums by about 10 percent, while some major insurers have said they would have to raise premiums across the board by about 15 percent if the individual mandate were repealed or no longer enforced. The premium increase would wipe out much of the 2019 silver plan premium reduction from passing the Alexander-Murray bill, while the Alexander-Murray bill would address none of the premium increases for other plans or in other years.
The bigger problem for Collins — and for Republicans seeking to pass the tax bill — is that House Republicans so far are disinclined to go along with Collins’s fixes. If they hold firm and decide to adopt the Senate’s individual mandate repeal, Collins would have to decide whether she would vote for the tax bill anyway. That would be a complete reversal from her votes on the Obamacare repeal measures.
Collins’s support for the two measures, she would argue, mitigates some of the damage from repeal of the individual mandate. However, “some” is not “all,” and she has not attempted any fix beyond 2020. Andy Slavitt, former acting head of the Centers for Medicare and Medicaid Services, tells me, “Even the study Senator Collins cited shows that the policies she’s proposing would undo only a small fraction of the coverage losses from mandate repeal and would have only temporary benefits. On the small chance that Paul Ryan decides to keep in Senator Collins’s amendments, this deal would not accomplish what she had hoped it would.”
And that brings us back to the original issue: Why allow Senate Republicans to wreck the individual exchanges under the guise of tax reform? (Someone should point out to Sen. John McCain that he voted against this once before, correctly pointing out that the lack of regular order and bipartisan buy-in made the Obamacare repeal effort untenable.) Given how thin the margin is here, Republicans are desperate to save the Alabama Senate seat — even at the price of putting an alleged sexual predator in the Senate.
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