It's looking more and more unlikely that the Republican Congress is going to meet a September 30 deadline to repeal Obamacare, not that they won't still make a lot of noise about it. Even if the Senate could manage to pass it in the next ten or so days, the House finished business for the week on Thursday, and will be out until September 25. They could conceivably take up a bill passed next week by the Senate (which is not likely to happen, but not impossible), but they're not likely to pass it as is, not when groups like Heritage Action are opposed to it.
It seems as though if they want repeal, they're just going to have to content themselves with trying to repeal parts of it in their tax cuts for the rich bill. So that's one of the things they've talked about in meetings with the White House, according to Axios's sources.
That meeting included Health and Human Services Secretary Tom Price, as well as discussion of repealing:
- The ACA's tax on medical devices
- Its tax on health insurance plans
- The individual mandate, which is administered as a tax penalty
These are exploratory discussions, not final ones. But all of these taxes have been on Republicans' chopping block for a long time, and sources said they're serious options, though they've not been socialized on Capitol Hill. Nor has the administration tested whether it's politically possible to attach elements of the health care fight to tax reform.
Getting rid of the individual mandate—which Trump is already trying to do at the executive level by just telling the IRS to not enforce it—might be a challenge even just with Republican votes. It would result in higher premiums and more market destabilization. If it were entirely out of the law, at least some insurers would leave the markets because they wouldn't be guaranteed customers.
Insurance companies have been lobbying for the tax on insurance plans to be repealed, since they pay it. Or will pay it next year. The 2015 budget deal postponed its implementation until 2018. The medical device tax is paid by manufactures of devices, who have profited under the law because there are more patients who can afford their products. They—and both Republicans and Democrats who have device manufacturers in their states and districts—have been trying to get rid of this one since it was enacted.
The fate of these tax repeals is totally unclear right now, as is the whole of the Republican tax cuts for the rich plan. It could go the same way as ACA repeal, brought down by the Republican civil war.