The Republicans have passed their tax bill which means that they have killed one of the most
controversial provisions of the Affordable Care Act-the mandate. The mandate requires mostly everyone
to have some form of health insurance or pay a fine. The mandate was originally to urge young people to
purchase health insurance and was also a means of making sure people don’t wait until their sick to buy
health insurance. Insurance companies have said that without the mandate, they’ll have to raise premiums
and pass on other costs to people who do have health insurance
“Having young and healthy people as part of the insurance pool helps keep premiums manageable for everyone,”
a coalition of health and consumer groups, including the American Diabetes Association, the American Cancer
Society Cancer Action Network and the American Lung Association, said in a joint statement.
“People who buy their own coverage on the individual market and who have incomes above 400 percent of the
federal poverty level (about $48,200 for an individual and $98,400 for a family of four) — the threshold for ACA
premium subsidies — would face the brunt of the premium increase,” it said.
A major point of contention for Republicans trying to replace the ACA has been whether to help people pay for
their insurance coverage. The most conservative arm of the party is against these subsidies, saying they amount to
yet another entitlement program. Some Republicans have expressed concern over the millions of constituents who
could end up without coverage if they don’t have help to pay for it. Several earlier GOP replacement proposals,
including one championed by Health and Human Services Secretary Tom Price, called for age-based tax credits.
The House bill provides for credits that are based on age, but capped based on income, and raises the financial ceiling
for who would be eligible.
Changes to the ACA marketplaces and Medicaid will apply change other parts of the system, including employer-sponsored
insurance. It’s hard to know what exactly those changes will be, but the CBO estimates will be a helpful starting point.