If legislation harmful to health was required to carry a
Surgeon’s General warning like tobacco, the tax bill being voted on today by
the Senate would surely qualify. It will
harm health care for many millions of Americans, leading to more uninsured
persons and higher premiums. It also
will lead to automatic scheduled cuts to Medicare and many other programs that
are vital to health care. Yet despite
all of this, the Senate is poised to vote later today on the Tax Cuts and Jobs
Act, and right now, it looks more likely than not it will pass the chamber by a
party-line, Republican only majority vote (all Democrats are expected to vote
against it).
Here are 2 things you need to know about the bill and how it
will hurt patients and their doctors:
1. By repealing the Affordable Care Act (ACA)
requirement that people purchase a qualified health insurance plan or pay a
penalty to the government, people who buy coverage in the individual insurance
market will see double-digit premium increases, many insurers will bolt from the
markets resulting in less competition and choice, and 13 million people will
become uninsured. The individual insurance requirement is needed because
without it, many people will wait until they get sick to enroll in coverage,
knowing that the ACA prohibits insurers from charging sick people more. With more sick people and fewer healthy
people in the insurance pool, insurers will have no choice but to jack up
premiums for everyone, or simply, decide not to see insurance at all in the
individual market. The American Academy
of Actuaries has warned
that repeal of the individual mandate would lead to premium increases, weaken
insurer solvency, cause an increase in insurer withdrawals from the market, and "lead to severe market disruption and loss of coverage among individual market
enrollees." According to a report
by the non-partisan Congressional Budget Office, repealing the individual
mandate would increase the number of uninsured by four million in 2019 and 13
million in 2027 and "average premiums in the non-group market would increase by
about 10 percent in most years of the decade."
2. Medicare and other vital health care
programs will be cut by billions of dollars to pay for the tax cuts that go
mainly to corporations. Under a 2010
law called Statutory Pay-As-You-Go Act (SPAYGO), any law that will add to the
federal deficit must be paid for with spending cuts, increases in revenue or
other offsets. Automatic cuts are
imposed, through budget sequestration, if Congress does not enact the required
offsets. The Senate tax bill is projected
to increase the federal deficit by $1.5 trillion over the next 10 years, so
automatic across-the-board cuts will be triggered next year unless Congress
passes separate bills to offset the cost in some other way. Medicare would be automatically cut by $25
billion in 2018, which will result in an average cut of 4 percent in Medicare
payments for health care services provided by
doctors, hospitals, clinical laboratories, graduate medical education
programs, and other "providers." For
doctors, this cut will be on top of a near 3 percent cut that Congress
previously imposed on them in 2013, 14, 15, 16, and 17—combined, Medicare
payments to physicians will have been cut 7 percent less as a result. Many other vital health programs, like the
Centers for Disease Control and Prevention (which we all count on to help
prevent infectious diseases, whether it is this year’ seasonal flu, or global
pandemics that could sicken millions worldwide), will also be subjected to
deep, across-the-board spending cuts to pay for the tax bill; some will be
completely eliminated. The New York
Times has a very useful list and graphic of what will be cut, and by how much.
Is it any wonder then that the American College of
Physicians, the nation’s largest physician specialty society, and second
largest physician membership organization, came out today in opposition to the Senate bill?
Should the Senator ignore ACP’s advice and pass the bill, it
doesn’t mean that the fight is over, since the Senate would have reach an
agreement on a identical tax bill that both chambers could support (the House
passed its own, but different version, several weeks ago). But any Senator who votes for Tax Cuts and
Jobs Act must be held accountable by their constituents for voting for a bill that is bad for their
health, while disregarding doctors’ warnings about the harm it will do.