The Senate just passed a tax bill that would strike a blow to a fundamental part of Obamacare

The Senate just passed a tax bill that would strike a blow to a fundamental part of Obamacare

susan collins

Alex Wong/Getty Images

Sen. Susan Collins of Maine.

  • The Senate on early Saturday morning passed its massive tax reform bill, in a 51-49 vote.
  • If passed into law, the bill would make significant changes to the Affordable Care Act.
  • The bill can now either be passed as is in the House - or the Senate and the House can conference on changes for the bill.

The Senate GOP passed its massive tax reform bill on early Saturday morning in a 51-49 vote.


The bill, Tax Cuts and Jobs Act (TCJA), saw major changes over the course of Friday night with handwritten notes scribbled in the margins.

The bill would cut the corporate tax rate to 20% and change individual tax brackets. If passed into law, it would also make significant changes to the Affordable Care Act, a bill the GOP unsuccessfully tried to repeal earlier this year.

Here are the major ways the bill would affect healthcare spending

  • The bill passed by the Senate repeals the individual mandate, the provision in the ACA that requires individuals to have health insurance or face a penalty fee. Without the individual mandate, healthy people may opt out of getting insurance, and the number of uninsured Americans would increase by 13 million, according to the Congressional Budget Office.
  • Initially, the tax bill included a provision that would repeal an itemized deduction of healthcare expenses. Cutting that deduction would hit people with high medical costs hard. On Friday, Republican Sen. Susan Collins of Maine, introduced an amendment that saved that deduction - and even lowered the threshold of how much of a person's income is spent on healthcare expenses to qualify for the deduction from 10% to 7.5%. Collins had voted against all versions of the ACA repeal bill over the summer, but ultimately voted in favor of the tax bill.

Collins, who was concerned the individual mandate repeal would increase premiums, said she got Senate Majority Leader Mitch McConnell to support two pieces of legislation that would stabilize the ACA.


  • The first is the Alexander-Murray bipartisan bill that would provide funding to stabilize the individual insurance exchanges.
  • The second is a bill that would provide $5 billion to reinsure high-cost plan members and lower premiums.

"Having secured these key improvements in the bill, as well as the commitments to legislation to help lower health insurance premiums, I will cast my vote in support of the Senate tax reform bill," Collins said in a statement.