Top Takeaway from this week – (1) Over 600,000 people enrolled in coverage through during the first four days of the ACA’s fifth open enrollment period; (2) Despite a push to include a repeal of the individual mandate into tax reform, it has not yet been added to either the House or Senate versions; (3) the White House is reportedly preparing an Executive Order that would gut the individual mandate; and (4) Maine voters approved a ballot initiative to expand Medicaid on Tuesday.

Congressional Action –

Congress continues to debate whether to include the individual mandate as part of tax reform despite an ongoing concern that the ACA’s divisiveness could endanger tax reform’s prospects. In fact, on Monday, Sen. Daines (R-MT) sent a letter to House Speaker Ryan (R-WI) and House Committee on Ways & Means Chair Brady (R-TX), urging them to include a full repeal of the mandate, which he refers to as “a fine on the low income in our country.” Sens. Cotton (R-AR) and Cruz (R-TX) are also calling for a repeal. Press releases: and

In addition to wanting to repeal the ACA’s individual mandate, several republicans are also looking to use the deficit savings that would accrue to help pay for tax reform.

The Congressional Budget Office released an estimate of those potential savings yesterday, finding that repealing the individual mandate would reduce the federal deficit by $338 billion from 2018 to 2027. The CBO also found that coverage would be reduced by 4 million in 2019 and 13 million in 2027, and that average premiums in the individual market would increase by about 10 percent. Blog post: Analysis:

The House did not include a repeal in the bill text released last week, or in a manager’s amendment released today by House Ways & Means Committee Chair Brady (R-TX), but House Speaker Ryan (R-WI) has indicated that its inclusion is “being discussed.” The Senate version of the bill, released this afternoon, also does not repeal the mandate. However several Senators have noted that it is under discussion, indicating it could be added at a later date.

Administration Action –

While Congress debates whether to include a repeal of the individual mandate in tax reform, the Administration is reportedly preparing an executive order that would weaken the mandate by broadening the use of “hardship exemptions” to allow more people to exempt themselves from coverage.

Today, CMS released enrollment data for week one of Open Enrollment, finding that over 601,000 people selected plans using, including 137,000 new consumers. Many expect enrollment to dip this year due to ongoing confusion and uncertainty surrounding the law, high premiums for unsubsidized consumers, and reduced funding for outreach and educational efforts from the Administration. Press release:

Meanwhile, following a report from the HHS Office of the Inspector General finding that the Administration’s decision to cancel several contracts related to ACA open enrollment outreach last January resulted in the loss of $1.1 million, Senate HELP Committee Ranking Member Murray (D-WA) and Sen. Warren (D-MA) sent a letter on Monday to HHS Acting Secretary Hargan requesting information about HHS’ decision. Press release: Letter:

State Action –

On Tuesday, voters in Maine approved a ballot initiative to expand Medicaid in the state, making Maine the 32nd expansion state. According to independent estimates from the Maine legislative fiscal office, an estimated 80,000 adults are expected to gain coverage through the expansion. However, Maine Governor LePage opposes expansion, and has vetoed legislation to expand Medicaid five times. Governor LePage released a statement, noting that “credit agencies are predicting that this fiscally irresponsible Medicaid expansion will be ruinous to Maine’s budget. Therefore, my administration will not implement Medicaid expansion until it has been fully funded by the Legislature at the levels DHHS has calculated…” Statement: Discussion: