Maine Sen. Susan Collins voted for the Senate GOP tax plan despite its repeal of the individual mandate because GOP leadership promised her a vote on her reinsurance bill, and a vote on legislation to restore some payments to insurers. But it’s doubtful getting those provisions enacted would mitigate the damage to exchanges from the mandate repeal.

ROBERT SIEGEL, HOST:

Inside the latest version of the Republicans’ tax bill, the one hammered out by the Senate and the House, is a provision on health care. It amounts to a repeal of the Affordable Care Act’s individual mandate, something that could undermine the health care exchanges. It had seemed to be a sticking point for Maine Republican Senator Susan Collins. But Collins now indicates that she will back the tax bill if Congress acts on two other health measures. Maine Public Radio’s Patty Wight reports.

PATTY WIGHT, BYLINE: Senator Collins has never been a fan of the individual mandate.

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SUSAN COLLINS: Never the less, I recognize that repeal of the individual mandate would have consequences for the stability and the premiums in the individual market.

WIGHT: The nonpartisan Congressional Budget Office projects that repealing the mandate would hike premiums about 10 percent annually over the next decade and cause 13 million people to lose coverage. Collins says the solution is found in two proposed bills.

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COLLINS: Together, those two bills would more than offset the increase in premiums.

WIGHT: One bill sponsored by Republican Senator Lamar Alexander of Tennessee and Democratic Senator Patty Murray of Washington would restore payments President Trump recently ended. Those payments helped insurance companies reduce costs for people with low incomes. But Mitchell Stein, a health policy consultant, says that’s a separate issue from the mandate.

MITCHELL STEIN: To say that that will impact the negative effects of eliminating the mandate is like saying, to quote Senator Murray herself, it’s like saying you can fight a fire by giving someone a shot of penicillin.

WIGHT: The second bill that Collins wants passed is one she’s co-sponsoring with Democratic Senator Bill Nelson of Florida that would fund a reinsurance program.

STEVE BUTTERFIELD: You know, reinsurance isn’t a bad idea.

WIGHT: At least in theory, says Steve Butterfield, policy director for the Maine-based advocacy group Consumers for Affordable Health Care.

BUTTERFIELD: It’s something that you do, you know, to stabilize a market influx.

WIGHT: For example, if the individual mandate penalty goes away, younger, healthier people might forgo insurance, leaving older, sicker consumers in the market. Collins’ bill would give states funding to help pay their higher medical costs. But it’s only $10 billion over the next two years, says Butterfield.

BUTTERFIELD: You can’t permanently repeal a critical component of America’s current health care system forever and then say, well, you know, here’s a Band-Aid for two years. You guys can limp through until a future Congress fixes what we’re breaking.

WIGHT: But Collins points to an analysis by consulting firm Avalere, which found that the two bills would increase enrollment by 1.3 million people and lower premiums by 18 percent in 2019.

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COLLINS: And that is more than the 10 percent increase in premiums that would result from repealing the individual mandate.

CAROLINE PEARSON: The story’s much bigger than premiums.

WIGHT: That’s Avalere’s Caroline Pearson. She says the analysis Collins mentions did include a caveat. It did not examine the bills in the context of no individual mandate. No mandate, says Pearson…

PEARSON: Could create significant instability in the market. And it may cause some insurers to drop out of the market, which really could lead to a lack of coverage availability for some consumers.

WIGHT: Another question hanging over those bills is whether Congress will pass them. Senator Collins has a written commitment from Senate Majority Leader Mitch McConnell that he will support their passage before the end of the year. House leadership has not provided a written commitment, but Collins says she’s received assurance from the vice president. For NPR News, I’m Patty Wight.

SIEGEL: That story is part of a partnership of NPR, member stations and Kaiser Health News.

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