By a 224-201 vote, the House has passed the tax bill that will result in health care changes categorized as alarming by medical groups such as the AAFP and American College of Physicians. The House's action follows the Senate passing the bill by a 51-48 vote yesterday.
President Donald J. Trump is expected to sign the bill, but an exact date has not been set yet.
According to the 1,011-page document the House Ways and Means Committee released Friday evening, the individual mandate under the Affordable Care Act would be eliminated. While this gives Republicans a partial victory in their long attempt to repeal ACA, the nonpartisan Congressional Budget Office predicted earlier this fall such a repeal would result in 10% yearly increase in premiums and approximately 4 million people dropping insurance by 2019 and 13 million by 2027.
Further, CNBC reports that the medical tax deduction agreed to on Friday will allow taxpayers who itemize deductions to write off qualifying medical expenses that surpass 7.5% of their adjusted gross income for tax years 2017 and 2018. But for tax years 2019 and beyond, the threshold is 10%.
The bill passed Friday also drops the orphan tax credit for testing drugs for orphan or rare diseases that impact small portions of the population from 50% to 25%. “This is better than the 0% that was proposed, but it is still unwelcome news,” Memo Diriker, DBA, MBA, BS, and founding director of the Business, Economic, and Community Outreach Network at the Franklin P. Perdue School of Business at Salisbury University in Maryland told Healio.
When asked what these changes could mean for the health of the American public, Diriker said, “Hard to tell with great precision but, overall, this is not good news. There will be millions without insurance; public health spending will be lower; many trend watchers believe Medicare and Medicaid funding will go down; orphan drug development may also slow.”
The American College of Physicians (ACP) was swift to comment on the most recent votes.
"While ACP remains firm in our opposition to the repeal of the individual mandate, we acknowledge that improvements were made to the tax bill in other areas in response to advocacy from ACP and others," Jack Ende, MD, MACP, president, ACP said in a statement. "The bill does maintain the tax deductibility of student loan interest payments and tuition waivers. In addition, the tax deductibility of high cost medical expenses were not only maintained, but the threshold to qualify for deductions was temporarily lowered from 10 percent of income to 7.5 percent of income as ACP recommended."
He added, "However, despite these improvements, there are additional steps Congress must take to ensure that the bill does not do even greater harm health care. Congress must immediately take action to waive statutory Pay-Go cuts to Medicare, the [CDC], and other vital programs, cuts scheduled to automatically go into effect on Jan. 1, 2018. We urge members of Congress to make a public commitment to not using the deficit increases resulting from the tax bill as a reason to cut Medicare and Medicaid next year to pay for the tax legislation. Supporting fiscally and socially responsible ways to lower health care spending, while opposing such cuts to Medicare and Medicaid, will be one ACP’s top advocacy priorities in 2018."
The American Psychiatric Association shared in the disappointment felt by the ACP, stating the tax bill will inflict “unnecessary damage to the nation’s health care system.”
“This legislation, which calls for the removal of the individual mandate in the [ACA], sacrifices the health care of 13 million Americans who will lose their insurance by 2027,” Saul Levin, MD, MPA, CEO and medical director of the APA, said in a statement. “By significantly raising the federal deficit, this bill sets the stage for future cuts to Medicare and other critical safety net programs. What is being sold as a tax cut bill is also an attack on our health care system. There is no reason for these two issues to be decided by the same vote. We need Congress to pass legislation that will stabilize the ACA markets and shore up our health care system. We stand ready to work with Congress on a thoughtful, bipartisan approach to health care reform.”
AAFP did not immediately issue a statement on the most recent House and Senate votes, but in previous weeks, it had urged lawmakers to vote no.
Diriker told Healio that on Dec. 1, Republican Congressional leaders announced that they will work to ensure the spending cuts to Medicare are avoided. – by Janel Miller
References: “Tax Cuts and Job Act” Available at: http://docs.house.gov/billsthisweek/20171218/CRPT-115HRPT-%20466.pdf. Accessed Dec. 18, 2017.
Diriker reports being an unpaid volunteer board member and trustee of nonprofit regional medical center in the Salisbury, Maryland, area. Ende is president of ACP. Levin is CEO and medical director of the APA.