Nov 6, 2017

How Trump could push GOP to tackle the ACA in tax overhaul

Some Republicans want to repeal the individual mandate in their tax overhaul. Photo: Evan Vucci/AP

President Trump has prepared an executive order weakening the Affordable Care Act's individual mandate but is holding off in case Republicans want to repeal that mandate in their tax overhaul, an unnamed Republican senator told the Washington Examiner.

Between the lines: A handful of Republican senators have an obvious incentive to create a sense of urgency around repealing the individual mandate. And the threat here seems to be that if Congress doesn't use those savings soon, Trump could, in effect, steal them.

Threat level: There's no direct conflict between these two actions: Trump signing an executive order weakening the mandate would not make it any harder for Congress to fully repeal the policy.

  • Some conservatives want to repeal the individual mandate in the GOP's tax bill, in part, because it would save some $380 billion over a decade, according to the Congressional Budget Office. That would go a long way toward helping to pay for new tax cuts.
  • Industry officials and policy analysts have expected to see an executive order on the individual mandate for a while now.
  • Trump could substantially weaken the policy through executive actions — largely by broadening exemptions and weakening enforcement — but he couldn't get rid of it entirely.

So, what bearing would the threat of an executive order have on congressional Republicans' decisions about whether to repeal the mandate?

  • It's all about CBO. If Trump substantially weakens the mandate, and if CBO builds those changes into its assumptions about how the individual mandate works, then a bill to fully repeal the mandate might not save as much money, and the tax overhaul would be harder to pay for.
  • That's a lot of ifs. It's not clear how much Trump could do on his own, at least without sparking legal challenges, to weaken the mandate. It's also not clear how CBO would respond.

Be smart: Attaching a repeal of the individual mandate to the tax overhaul would make that bill much harder to pass. It should be clear by now that Republicans are not on the same page when it comes to health care, and repealing the individual mandate would wreak havoc on insurance markets.

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