WASHINGTON — Senate Republican leaders are adding a provision to their tax bill that would undermine the Affordable Care Act, a major change of strategy as they now try to accomplish two of their top domestic priorities in a single piece of legislation.
Senate Majority Leader Mitch McConnell, R-Ky., said Tuesday the tax bill will now seek to repeal the Affordable Care Act’s individual mandate, a central piece of the health care law that compels most Americans to buy health insurance or pay a fine.
Repealing the mandate would free up more than $300 billion in government funding over the next decade that Republicans could use to finance their proposed tax cuts, but it would cause 13 million fewer people to have health insurance, according to projections from the nonpartisan Congressional Budget Office.
Attempting to use the tax bill to repeal the mandate marks an abrupt shift in strategy as Republicans attempt to use a slim Senate majority to pass a massive overhaul of the U.S. tax code. And it scrambles an already complicated calculus as Republican leaders look to assemble the 50 votes they’d need to turn their tax bill into law.
Using the bill to attack former president Barack Obama’s signature legislative achievement likely rules out the already slim possibility of support from Senate Democrats, and the prospect of adding millions to the ranks of the uninsured will likely trouble some of the same moderate Republicans who voted down previous repeal efforts.
"We’re optimistic that inserting the individual mandate repeal would be helpful" to the tax effort, McConnell said Tuesday after meeting with party members during a closed-door lunch.
President Donald Trump pressed Congress to include the repeal in their tax efforts in a Twitter post Nov. 1, but it was received cooly by GOP leaders who feared the same health care politics that had sunk their previous Affordable Care Act repeal attempts would torpedo their tax effort.
Sen. Susan Collins, R-Maine, one of the Republicans who opposed previous attempts to roll back the health care law, said she was concerned about including the mandate repeal while the Senate was still addressing a health care compromise negotiated by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash.
"I personally think that it complicates tax reform to put the repeal of the mandate in there, particularly if it’s done before the Alexander-Murray bill passes because of the impact on premiums," Collins said. "I’m going to see what the bill says."
Sen. John Thune, R-S.D., chairman of the Senate Republican Conference and a member of the finance committee that is drafting the tax bill, said repeal will allow the GOP to further cut taxes for middle-income families.
"It’ll be distributed in the form of middle-income tax relief," Thune said. "It will give us even more of an opportunity to really distribute the relief to those middle-income cohorts who could really benefit from it."
Sen. Minority Leader Charles Schumer said including a repeal of the mandate in the tax bill would torpedo Democratic support for the Murray-Alexander compromise.