When some Republican senators pushed to end a key part of the Affordable Care Act as part of their tax-overhaul bill, Democratic critics including New York Gov. Andrew Cuomo pounced.
We examined his characterization and found his phrasing misses some important points, including this one: Many Americans would be choosing to give up their health insurance if the individual mandate were lifted. That’s the Obamacare provision that requires Americans to have health insurance or else pay a tax penalty.
Cuomo's tweet linked to an article in The Hill newspaper. The article supports Cuomo's assertion that savings from eliminating the individual mandate could help offset lower revenues from tax cuts elsewhere in the bill. The general principle is: The more money an additional tax bill provision saves, the more tax cuts lawmakers can propose without increasing the deficit.
The Congressional Budget Office, the nonpartisan office that studies legislative proposals for Congress, projected that eliminating the individual mandate would reduce the federal deficit by $338 billion over 10 years and reduce the number of Americans with health insurance by 4 million in 2019 and 13 million by 2027.
Cuomo is putting the cart somewhat before the horse. Even if a Senate bill that includes the individual mandate repeal does pass, that appears unlikely to be in the House bill. House Speaker Paul Ryan told CNBC that his chamber would not include the provision, though he left open the possibility that it could be included in the "conference committee" version of the bill negotiated between the House and Senate.
The bigger problem, however, is Cuomo saying the GOP will be taking away people’s coverage. In reality, it’s more complicated than that.
Some Americans who are only buying insurance under threat of the mandate will choose to drop their coverage voluntarily. But if this group is healthier than average, as health care economists say is likely, then the people remaining in the insurance pools would be less healthy and thus more costly to insure. That would increase premiums, potentially squeezing out some people who would rather have kept their insurance.
If the mandate is lifted, no one knows for sure how many people will drop their coverage voluntarily and how many will have their insurance stripped against their will.
Christine Eibner, a health policy analyst with the RAND Corp., said it’s reasonable to argue that the disenrollment from Medicaid would be voluntary, since price would not be a factor for beneficiaries. This would account for 1 million fewer Americans with insurance in 2019 and 5 million fewer in 2027, the bulk of them “voluntary.”
Eibner said it’s harder to guess about disenrollments from the individual market, policies purchased outside the employer-provided insurance market. In previous research, RAND estimated that roughly two-thirds of disenrollment would stem from voluntary choices and one-third would be due to price increases. Other research has put the percentage at about 50-50, said Linda Blumberg, a health policy specialist at the Urban Institute.
Cuomo did say “millions” rather than specifying a figure, and even on the lower end, estimates such as these could well produce “millions” of involuntary losses of coverage. But it’s worth remembering that there’s a lot of uncertainty in the numbers.
Our ruling
Cuomo has a point that Republicans could increase tax cuts if they could count on a projected $338 billion in added revenue over 10 years, and ending the individual mandate would result in an estimated 13 million fewer Americans with health coverage by 2027.
However, ending the individual mandate isn’t the same thing as stripping away health insurance away for a large number of Americans. While some would lose access to health insurance due to increased premiums, many others would drop their coverage voluntarily.
We rate the statement Half True.
Congressional Republicans “want to take health care from millions of Americans in order to pay for” a tax bill.
— New York Gov. Andrew Cuomo on Tuesday, November 14th, 2017 in a tweet
