Thursday, November 30, 2017

Warning: Congress’ tax reform bill is bad for your health

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.