WASHINGTON -- By a vote of 51-49, the Senate passed a tax overhaul bill early Saturday morning that included a repeal of the Affordable Care Act's (ACA) individual mandate, which requires people to buy a health insurance policy or pay a penalty.
The vote was mostly along party lines; only Sen. Bob Corker (R-Tenn.) crossed over to vote with the Democrats against the measure. The Senate bill must now be reconciled with a tax bill passed by the House on Nov. 16th; that bill does not include the mandate repeal.
Most of the Senate floor debate on the bill revolved around its tax provisions, but there was also some vigorous discussion of its effect on healthcare. Sen. Amy Klobuchar (D-Minn.) said that repealing the mandate "would kick 13 million people off of their health insurance by 2027, and increase individual market premiums by 10%," numbers that were released by the Congressional Budget Office in its analysis of the repeal's effects.
"We should be helping with premiums, not increasing them. [These increases] mean less money in the pockets of middle class Americans, less money for retirement, and less money for college."
Instead of passing this provision in the tax bill, "the American people want us to work together to fix the ACA," Klobuchar said. She referred to the bill sponsored by senators Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), which would restore the law's cost-sharing reduction payments and give states more flexibility in their ACA implementation, as an example of a good bipartisan effort to improve the ACA.
"Alexander and Murray held hearings on common-sense solutions; they had the governors come in," said Klobuchar. "It's a model for how you can put a bill together. But instead of that kind of bipartisan approach, this tax bill not only repeals the [individual mandate], but would cut hundreds of billions from Medicare and Medicaid ... [rural hospitals] are just hanging on the edge as it is, and what do we do? We sock them with this."
Sen. Susan Collins (R-Maine) said she expected that before there was a final vote in both chambers on the tax bill, Congress would first pass the Alexander-Murray bill, along with a bill by Collins and Sen. Bill Nelson (D-Fla.) that would provide health insurers with reinsurance for high-cost patients. But a group of conservative House Republicans said they would oppose such a plan, according to media reports. Collins also tweeted that she had received assurances from Senate Majority Leader Mitch McConnell (R-Ky.) that the bill would not result in Medicare cuts.
Even if those other bills were passed, "[they] won't stop the premium increases, coverage losses, and chaos this bill will cause," argued Murray. "Hiding behind these bipartisan bills might seem like a good partisan talking point ... but political cover doesn't pay bills or give them coverage back. It doesn't help people with preexisting conditions who might get priced out of the market." She urged Senate Republicans to "step back from the brink, and work with Democrats on healthcare and taxes in ways that help, not hurt, the people you're supposed to be here to serve."
The provision to repeal the individual mandate (found on p. 94 of the bill) "would also be a dagger in the heart of the ACA, causing millions to lose their coverage and raising costs for millions more by gutting the personal responsibility portion of the ACA," said Sen. Ron Wyden (D-Ore.). "This legislation is going to take America back to the days when healthcare was for the healthy and wealthy because it will greenlight discriminating against those with preexisting conditions .... and will trigger a new wave of health insurance scams and ripoffs that are going to harm our people."
Sen. Pat Toomey (R-Pa.) said that Wyden's comment "is a damning indictment that it only works if people are forced to buy the product ... It's so badly designed that people won't buy it voluntarily, despite huge subsidies." The tax bill doesn't change anything else about the ACA, such as the level of subsidies, he added. "We change one thing: if you decide it's not worth it for you to buy this plan, if you opt out, you won't be punished."
Several health-related amendments proposed by the Democrats and independents went down to defeat, including a proposal by Sen. Bernie Sanders (I-Vt.) that would have raised the number of votes required to pass any measures that would cut funding for Social Security, Medicare, or Medicaid to 67. "If you don't want to cut Social Security, Medicare, and Medicaid to give tax breaks to billionaires, support this amendment," he said.
Sen. Mike Enzi (R–Wyo.) said the amendment was "non-germane" and "would gut this legislation," adding that the tax bill doesn't cut Social Security, Medicare, or Medicaid. "I would be delighted to gut and destroy this legislation," Sanders replied.
Another defeated amendment, offered by Sen. Robert Menendez (D-N.J.), would have restored deductions for state and local income taxes; those deductions were removed in the tax reform bill. "The American Medical Association and the American Hospital Association oppose [removing the deductions] because people will lose access to healthcare," said Menendez. "We can't afford to roll the dice and risk these investments in the middle class."
Sen. Bill Cassidy, MD (R-La.), said Democrats were missing one of the benefits of the bill when it came to healthcare. "There's a dirty little secret according to people who run Medicare and Social Security -- those trust funds are going bankrupt," he said.
"What can we do to try and rescue these programs that are so significant, so important to senior citizens? Well, what about economic growth? I did an analysis with another man that showed that if we just returned to 3.5% [gross domestic product] growth per year, we would fully fund the Medicare and Social Security trust funds ... That is the answer that has eluded the other side."
Washington Correspondent Shannon Firth contributed to this story.