Senate Majority Leader Mitch McConnell isn’t ready to return to health care, but he may have to. Photo: Carolyn Kaster / AP

Republicans have been asking themselves what they'll turn to next, after their tax overhaul wraps up. If they repeal the Affordable Care Act's individual mandate, there's a good chance the answer will be health care — whether they like it or not.

What they're saying: President Trump has said several times that he wants to take another crack at repeal-and-replace after the tax bill. GOP leaders in the House and Senate have not echoed that plan. But if Republicans do end up repealing the individual mandate, Insurance markets will begin to feel the effects quickly, leading to almost immediate nationwide upheaval that will be impossible to ignore — especially in an election year.

  • This year saw a lot of chaos — insurers pulling out of markets, coming back in, changing their premiums at the last minute — due in large part to changes that would pale in comparison to something on the scale of repealing the individual mandate.
  • "I think next year will be even crazier" if the coverage requirement goes away, the Kaiser Family Foundation's Larry Levitt says.

The timing: The disruption caused by repealing the individual mandate would start early next year and intensify again just before next year's midterm elections.

  • The Senate's tax bill would eliminate the ACA's penalty for being uninsured, starting on Jan. 1, 2019. That might seem like a long way away, but it's not.
  • Insurers will start deciding this coming spring whether they want to participate in the exchanges in 2019 — and if so, where. Without the mandate, insurers would likely begin to pull back from state marketplaces early next year, likely leaving many parts of the country with no insurance plans to choose from.
  • Insurers will then have to finalize their 2019 premiums next fall. Those rates would likely be substantially higher (10% higher, on average, according to the Congressional Budget Office) without the mandate in place — and that news would hit just before next year's midterms.

The bottom line: All this fallout would be impossible to ignore, putting more pressure on Congress to return to health policy whether it wants to or not — and reopening all the same internal divisions that have stymied every other health care bill.

Flashback: "You can make an argument that Obamacare is falling of its own weight — until we repeal the individual mandate," Sen. Lindsey Graham said two weeks ago. "Then there is absolutely no excuse for us not to replace Obamacare because we changed a fundamental principle of Obamacare. So I hope every Republican knows that when you pass repeal of the individual mandate, it's no longer their problem, it becomes your problem."

Go deeper

Updated 1 hour ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 3 a.m. ET: 31,605,656 — Total deaths: 970,934 Total recoveries: 21,747,491Map.
  2. U.S.: Total confirmed cases as of 3 a.m. ET: 6,897,432 — Total deaths: 200,814 — Total recoveries: 2,646,959 — Total tests: 96,612,436Map.
  3. Health: The U.S. reaches 200,000 coronavirus deaths — The CDC's crumbling reputation — America turns against coronavirus vaccine.
  4. Politics: Elected officials are failing us on much-needed stimulus.
  5. Business: Two-thirds of business leaders think pandemic will lead to permanent changes — Fed chair warns economy will feel the weight of expired stimulus.
  6. Sports: NFL fines maskless coaches.

Trump pushes to expand ban against anti-racism training to federal contractors

Trump speaking at Moon Township, Penns., on Sept. 22. Photo: Mandel Ngan/AFP via Getty Images

President Trump announced late Tuesday that the White House attempt to halt federal agencies' anti-racism training would be expanded to block federal contractors from "promoting radical ideologies that divide Americans by race or sex."

Why it matters: The executive order appears to give the government the ability to cancel contracts if anti-racist or diversity trainings focused on sexual identity or gender are organized. The memo applies to executive departments and agencies, the U.S. military, federal contractors and federal grant recipients.

Louisville declares state of emergency as Breonna Taylor decision looms

A demonstrator holds up a sign of Breonna Taylor during a protest in Louisville, Kentucky. Photo: Brandon Bell/Getty Images

Louisville Mayor Greg Fischer declared a state of emergency Tuesday "due to the potential for civil unrest" ahead of Kentucky Attorney General Daniel Cameron's expected announcement on the Breonna Taylor case.

Of note: Louisville has witnessed more than 115 days of protests over the police killing of Taylor, an unarmed Black woman, with calls for all the officers involved to be charged.

Get Axios AM in your inbox

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Please enter a valid email.

Subscription failed
Thank you for subscribing!