WASHINGTON — President Trump celebrated the tax bill that Congress approved on Wednesday by characterizing it as a two-for-one victory, falsely claiming that it also made good on his promise to repeal the Affordable Care Act.
"When the individual mandate is being repealed, that means Obamacare is being repealed," Mr. Trump said in a cabinet meeting. "We have essentially repealed Obamacare, and we will come up with something that will be much better."
Mr. Trump's suggestion that he kept two key campaign promises with one bill is not accurate.
Effectively, the tax bill does repeal the individual mandate beginning in 2019. The mandate is a core component of the Affordable Care Act, and fines people who do not have health insurance. But the tax bill leaves every other vital part of the current health care law intact.
"The A.C.A. is far more than the mandate, and the repeal of the mandate is by no means a fatal blow. Most of the A.C.A. survives, and most of its coverage gains will remain," said Timothy Jost, an emeritus professor at Washington and Lee University School of Law and a contributing editor for the journal Health Affairs.
Republicans repeatedly and unsuccessfully attempted to repeal the Affordable Care Act over the summer. The individual mandate was one of 12 key elements of the health care law, which also included provisions that addressed access to insurance, requirements for insurance policies and costs of coverage.
Under the Affordable Care Act, businesses with at least 50 employees must offer insurance to full-time workers. Medicaid eligibility was expanded to cover more low-income people and young adults under 26 could stay on their parents' plans.
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The law stipulated that insurers guarantee essential health benefits. It limited insurers in placing annual lifetime caps on the value of benefits while prohibiting them from denying coverage to those with pre-existing conditions or increasing costs for older Americans.
The law also set up federal and state exchanges for purchasing insurance, provided subsidies for out-of-pocket costs and gave tax credits for premiums purchased on these exchanges. Additionally, it levied a series of new taxes to pay for the costs.
Repeal of the individual mandate "will undoubtedly do harm, however, to insurance markets and those who depend on them," Mr. Jost said. It will lead to higher premiums and fewer people insured, and insurers may flee smaller markets.
But millions of people will keep their health coverage, regardless of the tax bill.
The expansion of Medicaid, for example, is responsible for insuring more than half of the 20 million people who gained health coverage under the Affordable Care Act. While the Congressional Budget Office estimates that 5 million people may opt out of Medicaid coverage without the individual mandate, twice as many will remain insured because of the original expansion.
Nearly 50 percent of Americans who obtain insurance through their employers also will feel little impact from the individual mandate repeal. But they will continue to have health insurance plans with broader benefits, as required by the Affordable Care Act.
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