Vice President for Health Policy
The House will likely vote tomorrow on yet another attempt to block health reform, this time by preventing the Treasury Department — which includes the Internal Revenue Service (IRS) — from implementing any of it. Like the 40-odd bills that the House has already approved to repeal part or all of health reform or block its implementation, this bill won’t become law. But if it did, it would (among other things) make health coverage less affordable for millions of low- and moderate-income Americans, leaving many uninsured.
The bill would bar the IRS from providing the tax credits that will offset part of the premiums for people with incomes between 100 percent and 400 percent of the poverty line (between $23,550 and $94,200 for a family of four) who buy private coverage through the new health insurance marketplaces, also known as exchanges.
It also would prevent the IRS from enforcing the so-called “individual mandate” (the requirement that individuals must have health coverage or face a penalty). As we’ve written, health reform’s welcome changes to the flawed individual insurance market, such as barring insurers from denying coverage to people with pre-existing conditions, would drive up premiums unless they are coupled with the individual mandate. Otherwise, older and sicker people (who largely have been shut out of the individual insurance market) could buy coverage while healthier and younger uninsured people could wait until they got sick to buy it.
Without the individual mandate, which would encourage people to enroll, the pool of people with coverage would get older and sicker, on average, so premiums would go up. These premium hikes would lead some healthier people to cancel their coverage, which would raise premiums still higher, and so on.
Fortunately, the House bill stands no chance of getting through the Senate or avoiding a presidential veto. Health reform will continue to progress. For example, on October 1, millions of uninsured Americans can start enrolling in the private health insurance plans offered by the new exchanges for 2014.