White House officials have prepared an executive order that would weaken the Affordable Care Act’s requirement that taxpayers demonstrate proof of insurance, according to people briefed on the matter, suggesting they will issue it if congressional Republicans cannot achieve the same goal through the tax reform process.
President Trump supports abolishing the insurance requirement, called the individual mandate, but he cannot eliminate it unilaterally because it is enshrined in law. Given that several Republican bills aimed at unraveling the ACA have failed, Trump and his deputies are now seeking other ways to scale back the requirement for health-care coverage.
The renewed push underscores the extent to which health care — an issue Republicans had hoped to shelve to focus on tax legislation — refuses to fade away. Conservatives see rolling back the mandate as a way to cut federal spending while achieving a key policy priority, but it could complicate the tax bill’s prospects for passage.
The draft order would broaden the “hardship exemption” that the Obama administration established for those who face extraordinary circumstances, according to people familiar with the matter. These people spoke on the condition of anonymity because the order has not been issued yet, and they cautioned that the White House is continuing to press congressional leaders to change the requirement through legislation.
The Treasury Department, which enforces the mandate, has traditionally granted this exemption in cases such as the death of a family member, bankruptcy, a natural disaster, or when a taxpayer cannot afford to pay his or her utilities.
The Washington Examiner first reported on the draft executive order Monday.
Eliminating the individual mandate outright would spark a political firestorm among Democrats as well as some centrist Republicans, because it is seen as a powerful incentive to encourage healthier consumers to sign up for health insurance.
The current penalty for not having coverage is $695 per adult and $347.50 per child — up to $2,085 per family — or 2.5 percent of family income, whichever is greater. Roughly 6.5 million taxpayers paid a fine for being uninsured in 2015, according to the Internal Revenue Service, though the fine that year was $470 per adult.
The Congressional Budget Office projected in a December 2016 report that abolishing the individual mandate could leave an additional 15 million Americans uninsured by 2026, while saving the federal government $416 billion in subsidies to ACA consumers and Medicaid payments.
Last month, the White House signaled that it would look more favorably upon a bipartisan health bill in the Senate if the measure retroactively eliminated the individual mandate, as well as a requirement that employers with at least 50 employees provide coverage, for this year.
And in an interview on “Fox News Sunday,” House Speaker Paul D. Ryan (R-Wis.) said “a lot of members are suggesting” that the tax bill include a repeal of the individual mandate.
In a Monday telephone interview with The Washington Post, Rep. Tom Cole (R-Okla.), a close ally of House GOP leadership, said there were some potential upsides to including such a provision in the tax bill. “It just gives you a lot more flexibility,” said Cole, speaking as other elements of the plan have set off intense jockeying and negotiation.
Still, Cole was not convinced that it would be included. He said that while adding the repeal would not derail plans to pass the tax bill in the House, over in the Senate it “could cause problems.” And right now, Cole said, House GOP leaders are trying not to expose their bill to major complications in the upper chamber.
Cole said he expected that House GOP leaders would consult their Senate counterparts before making a final decision.
Sen. Tom Cotton (R-Ark.) has lobbied for the provision on the Senate side, and the Wall Street Journal editorial page endorsed the idea Monday, calling it “a winner politically and as fiscal and health policy.”
One influential Republican in frequent contact with lawmakers in both chambers said Monday that congressional GOP leaders have privately voiced concerns about losing votes for the tax plan if they did add a repeal of the individual mandate.
The Republican, who spoke candidly on the condition of anonymity, said top leaders eyeing the vote counts had voiced concerns about losing as many as a dozen GOP votes in the House and three or four in the Senate.
Sen. Susan Collins (R-Maine), who is seen as a key swing vote on taxes, warned Friday against including a repeal of the individual mandate in a sweeping reform bill.
“While I support replacing the individual mandate with an auto enrollment system that allows for a consumer to opt out, it would make it more difficult to pass a tax relief bill if it is combined with a repeal of the individual mandate,” Collins said in a statement.