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US tax bill could destroy central pillar of Obamacare

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5656 (Published 05 December 2017) Cite this as: BMJ 2017;359:j5656
  1. Owen Dyer
  1. Montreal

The tax reform bill passed by Senate Republicans this week threatens to strip 13 million Americans of their health insurance coverage through a provision eliminating the Affordable Care Act’s individual mandate, a rule requiring most US residents to have health insurance or pay a penalty.

By adding younger and healthier customers who otherwise would not seek insurance to the risk pool, the individual mandate is Obamacare’s principal mechanism for keeping insurance premiums down for older patients and people with pre-existing conditions.

The Congressional Budget Office, which has scored the tax bill’s likely effects, found that repealing the mandate would make four million people uninsured by 2019 and 13 million by 2027. It would drive up premiums by 10% a year, it found.1 …

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