Healthcare provisions of tax bills take center stage

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The Republican tax plans are suddenly looking a lot more like healthcare bills, with provisions that may affect coverage and increase medical expenses for millions of families.

The Senate plan for the tax bill would repeal the Obamacare requirement that most Americans carry insurance, a move that insurers promise would raise premiums in the nationwide individual insurance market. The House version of the tax bill, which President Donald Trump endorsed on Tuesday, would end a deduction that enables families of disabled children and elderly people to write off large medical expenses.

The provisions would help offset the cost of large tax cuts for corporations and individuals. But the move has sparked a new wave of opposition from the healthcare industry and others who are concerned about its impact—the same political headwinds that tanked Republican efforts to repeal the Affordable Care Act earlier this year.

Either proposal, if signed into law, “could be devastating for some families with disabilities,” said Kim Musheno, vice president of public policy at the Autism Society, an organization that advocates for people with autism. “Families depend on that deduction. And if they deal with the individual mandate, that’s going to cut 13 million people from their healthcare,” she said, citing a Congressional Budget Office estimate.

Republicans and some conservative groups, however, argue that removing the penalty for uninsured individuals would represent a tax cut for many low-income people who pay it now. Americans for Tax Reform, the group led by anti-tax crusader Grover Norquist, said that Internal Revenue Service data from tax year 2015 show that 79 percent of households that paid the penalty earned less than $50,000 a year.

Most Americans already think the tax legislation is designed to benefit the rich and oppose the bill by a two-to-one margin, according to a Quinnipiac University poll released on Wednesday. The survey was conducted before the repeal of the Obamacare mandate was introduced. Some of the details in both tax plans have changed since the survey, and the Senate tax-writing committee is still working on its draft.

Few Republicans have spoken out about the House bill’s repeal of the medical-expense break. The bill faces a vote on the House floor Thursday. But some criticism has begun to surface as advocacy groups, including the AARP and the American Cancer Society, have highlighted the harm the House bill could have on families battling diseases and on the elderly. People with tens of thousands of dollars in annual medical expenses often rely on the tax deduction to make ends meet.

Rep. Walter Jones (R-NC) said Wednesday he’ll vote against the House bill in part because it eliminates the deduction for out-of-pocket medical expenses. “There are a lot of seniors in my district, and this is life and death for them,” he said. The deduction is allowed under current law if medical expenses exceed 10 percent of a taxpayer’s adjusted gross income. Almost 9 million taxpayers deducted about $87 billion in medical expenses for the 2015 tax year, according to the IRS.

Rep. Greg Walden (R-Ore.), who chairs the Energy and Commerce Committee, said some of his constituents who live in expensive elder-care facilities could be harmed if the deduction is scrapped. “I think it’s one we have to continue to massage a bit,” he said. “There’s a lot of things out there, and there’s maybe going to be an opportunity to adjust some of them.” He declined to elaborate.

On the other side of the Capitol, Senate Republican leaders’ sudden decision to add a partial Obamacare repeal to their bill has energized Democratic opposition.

“You don’t fix the health insurance system by throwing it into a tax bill and causing premiums to go up 10 percent,” Sen. Sherrod Brown (D-Ohio) said.

Were the ACA’s insurance mandate repealed absent a new policy to compel the purchase of coverage, the CBO projects that premiums would rise 10 percent for people who buy insurance on their own, and more than 13 million Americans would lose or drop their coverage. But a reduction in the number of people with insurance also translates to less taxpayer money spent to provide subsidies for premiums under the ACA. Ending the requirement as of 2019 would save the government an estimated $318 billion, helping to offset the cost of lowering the corporate tax rate.

In addition, the Senate’s tax plan could trigger sharp cuts to Medicare and other programs in order to meet budget deficit rules, according to CBO.

The White House argues that the ACA’s insurance mandate isn’t popular and disproportionately affects low- and middle-income Americans who are forced to buy insurance that may be more expensive than they can afford.

Like Republicans’ failed attempts to repeal the ACA, the tax plan is amassing a growing list of opponents from the world of medicine.

Insurers, hospital groups and disability advocates have spoken out forcefully against the healthcare proposals in the bill. Hospitals and insurance groups wrote a letter to Congressional leaders on Tuesday warning of dire healthcare outcomes if the tax measure becomes law.

“Repealing the individual mandate without a workable alternative will reduce enrollment, further destabilizing an already fragile individual and small group health insurance market on which more than 10 million Americans rely,” said the letter, signed by six healthcare groups, including the American Hospital Association and America’s Health Insurance Plans.

In addition, Senate Republicans may face a political problem in the final push for their tax-cut plan, and they might need Democrats to help fix it.

The Congressional Budget Office says the $1.5 trillion tax-cut proposal would trigger $25 billion in automatic spending cuts next year to Medicare, plus another $111 billion in reductions to other programs, including farm subsidies. That’s because of a law known as Paygo.

While some conservative Republicans would welcome the cuts, moderates in the party are likely to balk -- and President Donald Trump has promised repeatedly not to cut Medicare.

Waiving the automatic cuts could take 60 votes in the Senate, requiring support from at least eight Democrats in a chamber Republicans control 52-48.

The GOP could try to waive the cuts as part of the tax bill—although that could anger the party’s deficit hawks—or they could promise to do it later, which could worry moderates who in the meantime would be voting for a bill that cuts benefits to senior citizens.

Bloomberg News
Healthcare reform AHCA Obamacare Tax Law and regulation Health insurance Healthcare costs Donald Trump Barack Obama