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Stephanie Pellitt

Policy and Advocacy Associate

Senate Plans Vote on Repeal of Individual Mandate, Tax Reform

November 21, 2017 | ACA | Nonprofits/Charitable Giving | Comments
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Senate Majority Leader Mitch McConnell (R-KY) has announced that the Senate will vote on its tax reform bill, which includes a repeal of the Affordable Care Act’s individual health insurance mandate, next week. The bill could negatively impact mental health and addiction organizations in numerous ways by increasing health care costs and narrowing coverage, reducing charitable giving, and eliminating the medical expense deduction. With members of Congress back home in their districts, now is a key time for advocates to voice their concerns about this harmful legislation.


The National Council has concerns with several provisions of the Senate tax reform bill that will have a direct impact on mental health and addiction organizations’ ability to provide life-saving services and Americans’ ability to receive them. The chief concerns include:

  • Preventing the repeal of the health law’s individual mandate, a key component of the Affordable Care Act that helps lower premiums and fund comprehensive insurance plans which include mental health and addiction services;
  • Protecting itemized deductions to preserve charitable giving, which could see a staggering loss of $13 billion annually if the standard deduction is doubled. Charitable giving is a critical revenue source for community behavioral health organizations;
  • Preserving the medical expense deduction which keeps costs low for those with costly chronic conditions; and
  • Creating a tax break for alcohol producers equaling $4.2 billion, which could result in higher rates of drinking. This change would come as per capita alcohol consumption is climbing with 88,000 alcohol-related deaths occurring each year nationwide.


While repeal of the ACA is a long-standing Republican priority, some worry that including a health care provision in the tax bill could sink the plan altogether. In an interview with CNN on Monday, White House Budget Director Mick Mulvaney said that the administration wants to repeal part of the ACA in Congress’ tax bill but is “OK with taking it out” if “it becomes an impediment.” It is not yet clear if Senators Collins (R-ME), Murkowski (R-AK) and McCain (R-AZ), who all voted against the last health care bill this summer, would oppose this new bill.

Importantly, Washington insiders warn that if the individual mandate is eliminated, it could clear the way for repeal of other important ACA provisions that help ensure that patients have affordable and comprehensive health care.


Last week, the House passed its version of the Tax Cuts and Jobs Act and now all eyes have turned to the Senate. With a vote expected in the Senate next week, the National Council is calling on its advocacy network to mobilize and prevent potential devastating proposals to become law. Will you take time today to urge your Senators to oppose the Tax Cuts and Jobs Act and preserve health care for millions of Americans? Take action here.