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The GOP tax bill deals a blow to the Affordable Care Act. Here’s how

The sweeping tax bill passed by Congress on Wednesday extends beyond what you file with the IRS. It also affects American health care by repealing Obamacare's so-called individual mandate. John Yang learns more from Julie Rovner of Kaiser Health News about that and other health care matters on Congress’ agenda.

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  • Judy Woodruff:

    We return to the tax bill that Congress voted to pass along party lines today.

    The reach of the measure extends beyond what you file with the IRS to health care.

    John Yang has more on that.

  • John Yang:

    Judy, the bill repeals the penalties levied on individuals if they do not have health insurance coverage, the so-called individual mandate. That takes effect in 2019.

    President Trump says that repeals the Affordable Care Act.

  • President Donald Trump:

    So, in this bill, not only do we have massive tax cuts and tax reform. We have essentially repealed Obamacare, and we will come up with something that will be much better, whether it's block grants or whether it's taking what we have and doing something terrific, but Obamacare has been repealed in this bill.

  • John Yang:

    Here to discuss this and other health care issues facing Congress is Julie Rovner. She's chief Washington correspondent for Kaiser Health News, which, we should note, is not affiliated with Kaiser Permanente.

    Julie, you heard what the president said. Is he right? Is this effectively repealing the Affordable Care Act?

  • Julie Rovner:

    Not really.

    I think, you know, he's been saying this. He's been saying that it's dead. And most of my colleagues have been describing it as bruised, battered, beaten up, but not dead yet.

    The individual mandate was important, but is not the only piece of the law, nor I think these days people are saying it's not even the most important piece of the law. That may well be the requirement for insurers to cover people with preexisting conditions or the expansion of Medicaid. That's where most of the enrollment growth has come from.

  • John Yang:

    Well, we have got a graphic.

    The Congressional Budget Office estimates that 13 million more people will be without insurance over the next 10 years because of this, what Congress did, and that premiums will go up 10 percent or more in most years.

    Now, what's the connection between those two things?

  • Julie Rovner:

    Well, the concern has been from the insurance companies that if people aren't — healthy people aren't required, have some sort of requirement to have coverage, that they will wait until they get sick to sign up, so that only sick people will have insurance

    We're talking now about the individual market, the market where people buy their own coverage. It's somewhere around 17 million people total. And the insurers said that that's why they needed this individual mandate.

    So, without the individual mandate, they say, we will have only sick people. They will be required basically to raise their premiums, or else lose money, and that's where that comes in.

    So what the CBO says is there will be a combination of people who will no longer have coverage. Some of them will be the ones that the Republicans talk about, the people who were only buying coverage because they were required to, or else face a fine.

    Some of them, says the CBO, will be people who will now be priced out of coverage because the insurers are going to raise their premiums. And, finally, some of them will be people who live in areas where there won't be any more insurers. Those will likely be rural areas, where there are more Republicans than Democrats.

  • John Yang:

    You seem to be describing a body blow to the Affordable Care Act.

  • Julie Rovner:

    Oh, yes, it's something that's serious. It's just — it's not necessarily a complete repeal or even a fully taking apart of the law.

    What the CBO has said is that they expect, in most parts of the country, even without the requirement, most individual insurers' markets would remain what they call stable.

  • John Yang:

    Now, there have been two bills moving through really the Senate to try to stabilize the individual market under the Affordable Care Act.

    One would fund the plan's cost-sharing reduction payments. The other would create a pool of money to help insurance companies pay claims to the sickest policy holders.

    Just this afternoon, they said these are not going to go — not going to be acted on before they go home for Christmas. What's the future for these two bills?

  • Julie Rovner:

    Well, it's still pretty unclear.

    Senator Susan Collins rather famously said that she would vote for the tax bill only if they did these two bills, which it now looks like they're not going to do, at least not this year.

    One of them, actually the second one, what's called the reinsurance bill that would give insurers more money to help pay for their sickest patients, that one, most analysts think, would be fairly significant, although there's not a whole lot of money in that bill. But if they actually did it right, that could contain premiums from going up.

    The other bill is a little more complicated. This will restore these subsidies that the president cut off in October. But, really, since then, a combination of state regulators and the insurance companies have figured out ways most that people are being held harmless. Insurance companies are being paid back.

    The only people who are really being hit by this are people who don't get help for paying for their subsidies. Those people are paying higher premiums. But even then, some of them have been protected if they buy the right kind of plan.

  • John Yang:

    The Senate majority leader has promised a vote on these, but the speaker of the House has not.

    Is this — are they trying to have this collapse of its own weight, the Affordable Care Act?

  • Julie Rovner:

    Well, the House — the Republicans in the House have said all along they don't want to do anything that stabilizes this. They want the Affordable Care Act to fall apart, so why would they want to vote for something that could make this less of a body blow?

    They wanted to do this because they wanted it to be a body blow.

  • John Yang:

    Quickly to the Children's Health Insurance Program, CHIP, very popular program, bipartisan support. Funding ran out at the end of September, and they still have not reauthorized it.

    There's a study out today from the Georgetown University Health Policy Initiative saying that about two million children are at risk of losing coverage by the end of January, another one million by the end of February.

    Why is Congress having such a hard time keeping this going?

  • Julie Rovner:

    They agree that it should be renewed for five years. They disagree on how to fund it.

    The Republicans say this needs to be paid for. They want to take the money out of the Affordable Care Act and out of Medicare. Democrats don't want to do that. This is purely, how are we going to fund this? They have not resolved it.

    They said it was OK to wait until December. But now, as you point out, if they end up waiting until January, kids are going to start being taken off the program.

  • John Yang:

    So, this is all part of the funding problems that they face with the government funding running out on Friday, and they look like they are going to do a short-term until January.

  • Julie Rovner:

    That's what it sounds like. But that could have serious ramifications for CHIP, which they have been saying, oh, nobody's going to lose coverage, states have plenty of money left over.

    Well, they're quickly spending up all the money that was left over.

  • John Yang:

    Julie Rovner of Kaiser Health News, thanks for being with us.

  • Julie Rovner:

    My pleasure.

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