The Senate Republicans are again attacking the Affordable Care Act (ACA). This week, they added a new provision to their tax bill repealing the requirement that everyone have insurance. The Congressional Budget Office (CBO) projects this would increase the number of uninsured by 13 million in a decade, inflate premiums by 10% and reduce Medicaid enrollment by 5 million. These consequences are projected to save the government about $316 million – which will help secure the votes needed to pass the bill. The Senate should learn from our experience.  Washington State had an individual mandate repealed and it left the market in shambles. In addition, passing a $1.5 trillion tax cut could trigger required cuts across some major mandatory spending programs – including Medicare. This is because of PAYGO – a 2010 law that says all passed legislation cannot collectively increase the estimated national debt. Medicare cuts would be capped at $25 billion per year, but would still pack a punch to seniors. Mandatory ACA spending would also be on the chopping block (other than Medicaid expansion and Exchange subsidies). But didn’t President Trump promise no cuts to Medicare?