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In January 2012, 27 senators sent the Supreme Court a 48-page legal brief.
The Supreme Court would soon hear a landmark case on the legality of the Affordable Care Act’s individual mandate. These senators wanted to warn the justices of grave consequences of repealing the requirement to carry health coverage.
“The individual mandate,” they wrote, “is at the heart of the PPACA. The remainder of the statute necessarily depends on its inclusion because without the mandate, the statute’s reforms cannot work as intended.”
The senators who wrote this letter were (and are) Republicans. Twenty-three of them still serve in Congress — and most have been supportive of a tax bill that would unleash these exact same consequences.
Senators have not developed a sudden case of amnesia — they have not forgotten the consequences of mandate repeal. Many spoke out against the idea of stand-alone repeal of the individual mandate this summer, when a bill known as “skinny repeal" was introduced.
That bill would have, like the tax bill, repealed the requirement to carry coverage — and senators harshly attacked it as a terrible policy.
“The skinny bill as policy is a disaster,” Sen. Lindsey Graham (R-NC) said at the time. “It is not a replacement in and of itself.”
But skinny repeal is essentially what Republicans have attached to their tax bill. And that provision runs the very real risk of causing disruption and possibly collapse in the Obamacare insurance marketplaces.
What to expect when you're expecting individual mandate repeal
In Wednesday's VoxCare, I wrote about the assumptions that economists have about what would happen if the individual mandate went away. You can read more about that here. The upshot is: Premiums go up and the number of Americans with coverage goes down.
The coverage loss looks similar to what you'd see under Senate health bills, as this graph from Vox's Alvin Chang shows:
Chart of the Day
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Kliff’s Notes
With research help from Caitlin Davis
Today's top news
- “Susan Collins, Lisa Murkowski defend opposition to individual mandate”: “Republican Sens. Susan Collins and Lisa Murkowski helped doom the GOP's efforts to repeal Obamacare over the summer by voting against a bill that would have repealed the law’s individual mandate. Now Alaska's Murkowski and Maine's Collins are backing a repeal of the mandate's penalties.” —Robert King, Washington Examiner
- “Charlottesville Residents Unite to Protest Likely Surge in Health-Insurance Premiums”: “Its county, Albemarle, will have the highest costs in the nation in 2018 for people on the Affordable Care Act’s exchanges. Hundreds of residents who buy their own insurance, but earn too much for federal help, have banded together in the past two weeks, trying to pressure Congress for some kind of relief.” —Stephanie Armour, Wall Street Journal
- “Millions of Poor Children Could Lose Health Care If Congress Doesn’t Act Soon”: “States from Oregon to Massachusetts are scrambling to help millions of poor families whose children could lose coverage if Congress fails to reinstate a health insurance program that was approved two decades ago with bipartisan support.” —Natasha Rausch, Bloomberg
Analysis and longer reads
- “Making Medicines Affordable: A National Imperative — A Review”: “The viewpoint of the committee about how the current U.S. biopharmaceutical system diverges from an ideal patient-centric marketplace alone is a major contribution to the national discussion. The report argues that product markets only function effectively when consumers have choices: they can switch to another product, or buy nothing.” —Rena Conti, Health Affairs
- “A Radical Move: Giving Up Income to Get Health Insurance”: “Between 5 and 7 percent of Americans with insurance — about 17.6 million — buy it on the individual market. Of those, 7.5 million, or nearly half, don’t get subsidies, according to Robert Laszewski, an insurance industry consultant. Many in this latter group are professionals who work for small companies or are self-employed.” —Rachel Bluth, New York Times
- “After WannaCry knocked it offline, UK's National Health Service banks on new security center to improve cybersecurity”: “The U.K. National Health Service recently launched a 20 million pound -- or about $27 million -- project on a new security operations center to help its hospital and health centers fend off cyberattacks.” —Jessica Davis, Healthcare Finance
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