The House voted 227 to 203 Tuesday to pass a tax reform bill that eliminates in 2019 the individual mandate to buy health insurance coverage.
The bill moved to the Senate where around 1 a.m. this morning, members voted along party lines to pass the bill. However, before it goes to President Donald Trump's desk for his signature, the bill goes back to the House today for another vote due to procedural reasons. The president is expected to sign the bill, marking a legislative victory and the first time in 31 years Congress has passed tax reform.
Insurers have spoken out against the end of the individual mandate that requires individuals to have health insurance or face a tax penalty. The mandate stabilizes the Affordable Care Act market, insurers have said. Without the necessity to buy coverage, healthy Americans will opt out, leaving the individual market with the sickest and costliest enrolled, leading to higher premiums.
The Association for Community Affiliated Plans sent a letter Tuesday morning to the House and Senate.
"The repeal of the individual mandate and the modifications to the state and local taxes combined with the stated intent that an additional $1.5 trillion in federal debt created by this legislation will be used to justify dramatic and devastating cuts in federal healthcare programs like Medicaid, will have disastrous impacts on America's healthcare system."
In November, America's Health Insurance Plans, the American Hospital Association and other healthcare organizations wrote a letter to House and Senate leaders, urging them to maintain the individual mandate until Congress could enact reforms to ensure a balanced risk pool to prevent "extraordinary" premium increases.
The $1.5 trillion tax cut package will lead to 13 million people losing their health insurance and triggers a $25 billion cut in Medicare, according to a statement from ProtectOur Care that was tweeted out by Andy Slavitt, former acting administrator for the Centers for Medicare and Medicaid Services, just after the House vote.
Democrats on Tuesday spoke out against the tax reform bill though they were more vocal about the bill's tax cut for wealthy Americans and what one member called the "systematic dismantling of the social contract," than the loss of the individual mandate.
"This bill is ruthless," said Rep. Barbara Lee, D-California.
"This is a Christmas gift to the Trump family, no one else," said Rep. Sheila Jackson Lee, D-Texas.
The $1.5 trillion tax cut explodes the deficit, said Rep. Louise Slaughter, D-New York.
"Obviously that Medicaid money will pay for the tax cuts for the rich," Slaughter said.
The bill has only tiny benefits for the middle class, said Rep. Peter Welch, D-Vermont.
The average family of four making $70,000 a year would see a $2,000 tax cut, said, Rep. Cathy McMorris Rodgers, R-Washington, Republican Conference Chair.
Republicans spoke proudly of ending the mandate but mostly about the bill's effect to stimulate jobs and the economy and to keep jobs from going overseas.
While Ryan said earlier Tuesday that he was working flipping burgers the last time tax reform passed in 1986 - he was 16, Rep. Joe Barton, R - Texas, said he was among the few members serving in the House at the time of Ronald Reagan's presidency.
Reagan and Democratic Speaker of the House Tip O'Neill worked together to cut taxes across the board, Barton said.
The result was economic growth, Barton said.
Rep. Kevin McCarthy, R-California, said the bill was for everyone who could not get a job, did not get a bonus, or wondered why another business left America for another country.
Ryan tweeted after the vote, "Today has been a moment decades in the making. Let's get it done."
Tax reform will help people with disabilities and will expand opportunities for people trying to reach their potential, Ryan said. Families at every income level will get a tax cut. This will help many families who are living paycheck-to-paycheck.
"There is real economic anxiety in America," Ryan said. "This is real relief."
Next year the focus will be on people, welfare to work, he said. Ryan said on "Good Morning America" this morning that Congress would make sure the cuts to Medicare would not happen.
To a question that the bill is deeply unpopular and whether that was a concern politically, Ryan said yesterday he had no concerns.
"Results are going to make this popular," Ryan said.
To another question about a published report that he would be stepping down, Ryan said, "I'm not going anywhere, anytime soon. I'll leave it at that."