Tax reform and individual mandate repeal put patients in the crosshairs


With the Senate speeding toward a final vote on tax reform legislation, Majority Leader Mitch McConnell (R-KY) and his leadership team are considering the inclusion of two additional health care proposals. Their hope is that these proposals will persuade undecided Senators to vote yes and make up for the fact that the bill includes the misguided decision to repeal the individual mandate. Unfortunately, while these proposals may have merit on their own, they won’t be enough to mitigate the damage caused by individual mandate repeal, which the Congressional Budget Office (CBO) estimates will lead to 13 million Americans losing health coverage.

Proponents of the two proposals have claimed that they would at least mitigate – if not completely undo – the harm of individual mandate repeal. The first, from Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) would restore cost sharing reduction (CSR) payments through 2019, after the Trump administration unilaterally decided to end the payments earlier this year.

The second, from Sens. Susan Collins (R-ME) and Bill Nelson (D-FL), provides $2.5 billion in both 2018 and 2019 for state reinsurance programs, which reimburse insurers for some or all of the costs associated with highest-cost claims.

However, without the individual mandate, fewer healthy people will sign up for coverage and average costs and premiums across the individual market will rise by 10 percent, according to the CBO; some providers have projected even larger increases. To offset this 10 percent increase, $10 billion in federal reinsurance funds would be needed each year (as opposed to the temporary “solution” offered by Collins-Nelson).

Worse, repealing the individual mandate increases uncertainty and instability about future open enrollment periods, risk pool profiles, and premium rates. Put simply, insurers would be forced to reconsider whether they want to continue taking part in the health insurance marketplace at all, a recipe for further disruption and additional loss of coverage among individual market enrollees.

Finally, while the Alexander-Murray proposal to reinstate CSR payments would be a laudable approach on its own, CBO has found that it would also fail to reverse the coverage reductions that will result from individual mandate repeal. In short, repeal creates a problem far bigger than the one Alexander-Murray was initially intended to address.

With a final vote looming, now is the time to tell your Senators that they should stand with patients and reject this bill. In the absence of substantive debate and expert input, grassroots pressure is the best hope for stopping this harmful legislation once and for all.

Repealing the Individual Mandate is the Worst Tax Reform Idea Out There


As the push for tax reform on Capitol Hill moves forward, President Trump continues his misguided calls to repeal the Affordable Care Act’s (ACA) individual mandate as part of the final package. Unfortunately, he isn’t alone.

Despite Congress’s repeated failure to replace the ACA, some Republicans in both the House and Senate still seem convinced that the missing tax reform ingredient is a provision that the Congressional Budget Office (CBO) has estimated would result in 13 million Americans losing coverage, and an overall increase in premiums for health care consumers nationwide.

Experts who have analyzed the ACA have repeatedly found that without the mandate, the health care system the bill implemented simply would not work. With the mandate in place, those who might otherwise be less likely to obtain coverage – such as young adults and those who currently enjoy good health – are incentivized to get covered. This in turn leads to lower premiums across the board by offsetting costs for sicker patients.

Despite the harm this policy proposal would inflict on health care consumers, any serious consideration of the individual mandate repeal is more likely fueled by the fact that the Republican base is dissatisfied with the President and Congress’s inability to advance their overall legislative agenda, perhaps most notably when it comes to health care.

The proposal to repeal the individual mandate is all the more puzzling given recent news that the two week-old Open Enrollment period has seen a surge in consumers signing up for or renewing their health coverage via the federal marketplace, despite the Trump administration’s refusal to adequately promote it. Moreover, voters in Maine voted last Tuesday to expand Medicaid and help an estimated 70,000 low-income residents obtain coverage. These are just the latest indications that voters overwhelmingly support policies that increase access to care, rather than reduce it.

When it comes to the individual mandate and health care reform in general, we continue to urge Congress to listen to nurses when considering the best way to move forward on transforming America’s health care system. Join us and add your voice by clicking here.

House Tax Bill’s Impacts on Nurses and Consumers


It is officially tax season on Capitol Hill, with the House of Representatives currently in the midst of marking up their tax reform proposal, Tax Cuts and Jobs Act. They contend that this tax reform bill will spur economic growth and cut taxes for the middle class. At ANA, we want to focus on a few provisions in this bill that could impact nurses and healthcare consumers. These provisions are as follows:

  • Repeal of Medical Expense Deduction: Repeal of this provision would make it more difficult for low- and middle-income families to afford medical care. The current law allows a taxpayer to claim an itemized deduction for out-of-pocket medical expenses for themselves, a spouse, or a dependent. This is allowed only to the extent that the expenses exceed ten percent of the taxpayer’s adjusted gross income. This tax deduction is critical because it allows low- and middle-income families and those with complex and costly medical conditions to afford treatment without being financially crushed.
  • Repeal of the Deduction for Interest Payments on Qualified Education Loans and Repeal of the Deduction for Tuition and Related Expenses: Current law allows an individual to claim a deduction for qualified tuition and related expenses incurred or for interest payments on qualified education loans for qualified higher education expenses of the taxpayer, their spouse, or dependents (a taxpayer can only claim one of these deductions). The repeal of these deductions could make it more difficult for nursing students and recent nursing graduates to pay off their student loans or could discourage individuals from nursing school. This is important considering the ongoing push for registered nurses to receive a BSN degree.
  • Repeal of Credit for Expenditures to Provide Access to Disabled Individuals: Current law allows small-business taxpayers to claim a 50% credit per year for expenditures of between $250 and $10,250 for providing access to disabled individuals. The repeal of this tax credit could make it more likely that a small business would choose to defer the purchase of improvements, which would help disabled individuals access the business.

Senate Republicans have yet to release their tax plan, but it is expected to differ considerably from the House version. It is unclear whether the Senate version will include the tax code changes listed above. ANA will continue to monitor these developments and their potential impact on nurses and healthcare consumers.

Finally, even though the last Congressional attempt to repeal and replace the Affordable Care Act died in the Senate in late September, Congress is still considering a few other pieces of key healthcare legislation. Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) have not given up on their bipartisan attempt to strengthen the nation’s individual insurance system, though this effort has been put on the back burner now that Congress is in full tax mode.

Congress is also now in the process of reconciling the House and Senate versions of bills which would reauthorize funding for the Children’s Health Insurance Program (CHIP); funding re-authorization for this program expired on September 30th, though states have enough funding to pay their CHIP bills through the end of 2017 (with the caveat that the end of 2017 is fast approaching). Congress must pass CHIP legislation quickly in order for states to be able to fund their CHIP programs in 2018. ANA will continue to keep you updated on any healthcare developments on the Hill.