Enrollment opened November 1 and runs through Dec. 15 for individual health insurance plans subsidized through the Affordable Care Act. Credit: Gabor Degre

The tax bill that passed the Senate on Saturday with the help of Maine’s Susan Collins would do away with the Affordable Care Act’s “individual mandate,” a key provision of the law that broadens the risk pool and, thus, helps hold down health insurance costs.

By requiring all Americans — even healthy young adults — to be insured, the mandate balances out the expense of covering older, sicker people.

The House did not include repeal of the mandate in its tax package. If repeal eventually passes the full Congress and is signed into law by President Donald Trump, that would free up hundreds of billions of tax dollars to help pay for the legislation’s tax cuts. But repeal might also mean that far fewer Americans would have health insurance and that many of those buying insurance would have to pay more for it.

Repeal would not directly affect the availability of premium subsidies available to low- and middle-income individuals through the Affordable Care Act. But the nonpartisan Congressional Budget Office estimates that 4 million fewer Americans, including many who qualify for those subsidies, would have coverage by 2019 as a result of repealing the mandate and that the number would rise to 13 million by 2025.

In Maine, an estimated 50,000 fewer people could have health coverage by 2025. That’s because insurance rates would rise if, as expected, many healthy young people exercised their option to go without insurance — leaving the pool of insured people older and sicker. And as those rates rise, even more people would be priced out, including some who qualify for subsidies. The budget office estimates that average premiums in the individual market would rise about 10 percent a year for the next decade as a result of repeal. That would be on top of unrelated premium increases.

“Fewer people will have coverage, and those who have coverage will face higher and higher premiums,” said Mitchell Stein, an independent health policy analyst based in Freeport. The impact of repeal would fall heavily on Mainers in their 50s and early 60s, many of whom earn too much to qualify for a significant subsidy, can’t afford unsubsidized premiums and aren’t yet 65 so don’t qualify for Medicare.

“They’ll really have no viable options,” Stein said.

For millions of Americans, including tens of thousands of Mainers, the Affordable Care Act has made health insurance more affordable. Particularly for those who are self-employed and others who don’t have access to an employer-based plan, the Affordable Care Act has brought health coverage within their financial reach — in some cases, for the first time.

In 2017, some 79,400 Mainers were covered by individual plans purchased on the state’s insurance marketplace. That an Affordable Care Act provision that allows consumers to make apples-to-apples comparisons between available plans. The majority of the plans purchased in Maine qualified for a premium subsidy, available to enrollees who earn up to 400 percent of the federal poverty limit. That’s about $48,424 for an individual and $98,400 for a family of four. The subsidy takes the form of a tax credit.

In 2015, the most recent year for which information is available, 38,560 taxpayers in Maine qualified for that credit, at a total subsidy value of $184.3 million, according to the Internal Revenue Service. Of those taxpayers, 15,460 had household incomes of between $10,000 to $25,000. Another 13,340 had household incomes between $25,000 to $50,000.

Collins, who earlier this year helped defeat efforts to end the Affordable Care Act, initially said that repealing the individual mandate would destabilize health insurance markets. But in the days leading up to the vote, Collins said she was reassured by Trump’s assertion that other steps will be taken to offset any negative impacts of repeal.

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Meg Haskell

Meg Haskell is a curious second-career journalist with two grown sons, a background in health care and a penchant for new experiences. She lives in Stockton Springs. Email her at mhaskell@bangordailynews.com.