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.

Congressional Inaction Threatens Healthcare for 9 Million Vulnerable Children


With the hubbub surrounding healthcare reform, North Korea, protesting football players, and several devastating hurricanes, it is imperative that we as nurses and citizens not lose track of other important issues that also deserve our attention. For instance, on Saturday, 9 million of our most vulnerable children stand to lose their healthcare if Congress does not act.

The Children’s Health Insurance Program (CHIP) is a popular bipartisan program that was created in 1997 in order to serve children who would not otherwise have access to health insurance. Unfortunately, funding for CHIP runs out on September 30th.

Despite a reported bipartisan agreement to extend financing for this critical program, Congress has yet to take action.  And time is running out: Axios reports that the situation is dire for at least three states—Minnesota, Arizona, and North Carolina—as well as the District of Columbia, all of whom would run out of CHIP funding between October and December of this year if Congress does not meet its September 30th deadline. Most other states are projected to run out of CHIP funding sometime early next year without immediate action to fund CHIP.

Nurses know that this is unacceptable. We can all agree that America’s children are our most precious and valuable resource—simply put, leaving 9 million American children without healthcare is immoral and wrong. Moreover, it would be bad policy. As the Children’s Hospital Association puts it, “healthy children grow up to become healthy adults, and CHIP helps ensure that the children covered by the program are able to reach their full potential.”

The American Nurses Association agrees. The evidence shows that children with access to CHIP experience improved health outcomes, reductions in avoidable hospitalizations, and lower child mortality, all of which reduce overall healthcare costs. CHIP recipients are also more likely to attend school and graduate from college, and less likely to cause their parents to miss time at work.

Bottom line: CHIP translates into gains with “positive implications for both individual economic well-being and overall economic productivity.” In short, it’s a no-brainer.

It’s time for Congress to act now, before funding runs out for this common-sense program. Our children deserve no less.

Senate Republican Healthcare Push Ends in Defeat (Again)

Photo: Al Drago, New York Times
Photo: Al Drago, New York Times

Senate Majority Leader Mitch McConnell (R-KY) has chosen not to hold a vote on the Graham-Cassidy-Heller-Johnson bill to repeal and replace the Affordable Care Act. With a September 30th deadline to pass healthcare legislation with a simple majority of votes, opposition from at least 3 members of the 52-member Republican caucus, united Democratic opposition, and no viable alternative plan, the Senate Republican push to repeal and replace the ACA is effectively dead (for now).

The American Nurses Association would like to express its immense gratitude to all of our members, constituent and state nursing associations, organizational affiliates, and partner advocacy groups for all of your work in helping to defeat this latest attempt to gut the American healthcare system. Your calls, emails, and letters to your elected officials, as well as your physical presence at rallies and hearings, ratcheted up the pressure on these officials and made it known loud and clear that this legislation would have had an enormously adverse impact on the ability of your patients to receive high quality healthcare.

Quite simply, the Graham-Cassidy-Heller-Johnson bill was bad public policy. Its provisions would have: ripped away coverage from Americans receiving care under Medicaid expansion and limited federal funding for the Medicaid program overall; eroded protections for individuals with pre-existing conditions; made it easier for states to remove the 10 Essential Health Benefits requirements; slashed federal funding for healthcare services; defunded the Prevention and Public Health Fund; and defunded Planned Parenthood for one year. The non-partisan Congressional Budget Office, in the very limited time it had to do an analysis, concluded that millions of Americans would have lost their healthcare coverage under this bill. In addition, many experts noted that states would have had only two years to implement drastically different healthcare systems with no federal support to speak of – a nearly impossible task.

ANA would also like to offer our tremendous thanks to the members of Congress who opposed the Graham-Cassidy bill. In particular, the 48-member Democratic caucus once again showed its grit and resolve by standing united against this bill in favor of the best interests of its constituents. ANA would also like to thank Sen. Susan Collins (R-ME) and Sen. John McCain (R-AZ) for demonstrating their resolve in the face of tremendous pressure from their caucus to pass repeal and replace legislation. These senators should be commended for putting the best interests of their constituents ahead of their party and standing opposed to this legislation.

As we have seen before, the failure of one repeal and replace proposal does not automatically mean that the healthcare system is safe. It is very likely that the Trump administration will continue to undermine the ACA through regulatory and other policy measures; we have already seen this in their assaults on value-based purchasing regulations, their brinksmanship with respect to cost-sharing reduction payments, and their refusal to undertake a robust ACA enrollment strategy crucial to connecting Americans with individual health insurance coverage. Senate Republicans are also already discussing language for the FY 2019 budget which would allow them to once again use reconciliation to repeal and replace the ACA.

ANA believes that the current healthcare system created by the ACA can and should be improved upon. However, any healthcare reform proposals should be done in a bipartisan manner, through regular order, and should offer pragmatic solutions to real problems faced by Americans. Of immediate importance are the reauthorization of the Children’s Health Insurance Program (CHIP) – which runs out of funding on September 30th – the stabilization of the individual insurance market, which received several bipartisan hearings in the Senate Health, Education, Labor, and Pensions Committee, and the implementation of a robust enrollment campaign for the ACA’s individual insurance market. These issues are straightforward, would advance ANA’s principles of health system transformation, and, most importantly, ensure that more Americans are able to receive high-quality healthcare.

The fight over healthcare reform is not over. While another repeal and replace bill has gone down to defeat, there will be further attempts to undermine the gains realized under the ACA. For these reasons, we urge you to continue to press your elected officials – local, state, and federal – to commit to ensuring healthcare reform in alignment with ANA’s principles of health system transformation. For now, however, let’s take a deep breath and celebrate stepping back from the brink of what would have been a disastrous transformation of the healthcare system.