Category: Health Care

Tax Reform and Spending Measures Threaten Healthcare for Millions – Including Children

  

Congressional Republicans threaten to put coal in the stockings of millions of Americans this holiday season, as they are poised to pass a massive tax bill – the Tax Cuts and Jobs Act – that promises to significantly reduce the number of Americans with health insurance. Meanwhile, House members have decided to play politics with the health care coverage of 9 million children, as they have placed a provision to re-authorize the Children’s Health Insurance Program (CHIP) into a spending measure that could potentially lead to a government shutdown.

The Tax Cuts and Jobs Act

The push toward final passage of a tax reform bill took a major step forward this week, as House and Senate Republican members of the conference committee  settled on a compromise version of the Tax Cuts and Jobs Act. Among its many provisions, the bill eliminates the Affordable Care Act’s individual mandate, which requires Americans to purchase health insurance or pay a financial penalty. As we have written before, the Congressional Budget Office (CBO) estimates that repealing the individual mandate would result in 13 million fewer Americans having health insurance. Such a reduction in coverage would result in negative health outcomes, higher costs, and a decreased focus on primary care and preventive services.

The bill also lowers the threshold for an individual to claim a medical expense deduction. More Americans will also likely find it necessary to take this deduction – without health insurance coverage, they will be much more likely to experience crippling medical expenses.  The bill allows individuals to deduct medical costs greater than or equal to 7.5% of an individual’s income; this is lower than the 10% threshold under current law. This is deceptive, however, as the threshold to claim the medical expense deduction will return to 10% in tax year 2019 and is only available to tax filers who itemize their deductions.

The likelihood for passage of the Tax Cuts and Jobs Act that came out of conference committee is still fairly uncertain. The conference committee held its only public meeting yesterday. The next steps in the process will be votes on the floors of the House and Senate. The timeline for these votes is not crystal clear, but the expectation is that both chambers will vote on final passage next week. Once this occurs – and assuming that the bill passes both chambers – it will head to President Trump’s desk, at which point he will sign it into law.

Children’s Health Insurance Program

Congress recently passed a continuing resolution to fund the government at current levels through December 22nd. This funding deadline, however, is fast approaching, and Congress will need to pass yet another spending bill by that date in order to avoid a government shutdown. House Republicans have already proposed such a measure, which would extend government funding through January 19th, and provide a crucial five-year extension of CHIP. A point of contention, however, is that the spending measure would fully fund the Department of Defense for the full year with a $73 billion funding increase over current spending levels. This is a non-starter for Congressional Democrats, who have demanded a dollar-for-dollar increase in spending for domestic programs for any spending increase in defense programs.

The funding situation for CHIP is truly dire. Federal spending authorization for the program ran out on September 30th; Congress has failed to act for over two months. While states have been using reserve funding to fill the gap, that excess funding will soon run out. Sixteen states – Washington, Oregon, Idaho, Nevada, California, Texas, Arizona, Colorado, Utah, Minnesota, Virginia, Pennsylvania, Florida, Massachusetts, Delaware, and New Hampshire – anticipate running out of funding by the end of January 2018. It is absolutely critical that Congress pass a CHIP reauthorization immediately; playing politics with the healthcare of 9 million American children is unacceptable.

We urge you to make your voices heard in Washington and to make it known that nurses demand comprehensive and quality care for all of the nation’s citizens, regardless of age or income level. Click here to tell your  representatives loudly and clearly that the Tax Cuts and Jobs Act is bad for Americans’ health and well-being and that CHIP is a crucial program for our children’s health.

 

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.

Senate Attempts to Stabilize Healthcare with Bipartisan Agreement

  

Yesterday, Senate HELP Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) announced they had reached a short-term deal bipartisan healthcare legislation. This legislation would stabilize individual insurance markets and protect patients and families from premium spikes and uncertainty caused by the Trump Administration’s two decisions last week intended to destabilize the ACA marketplaces.

The deal negotiated by Alexander and Murray would fund payments to help lower costs for families, provide added flexibility to states, protect essential health benefits for patients, and restore investments for open enrollment outreach.

The bill would:

  • Restore Cost-Sharing Reduction payments and the certainty that is crucial to continued market stability and affordability for families. Insurers have raised rates by as much as 30% because of the uncertainty around CSR payments and continue to threaten exit from insurance markets.
  • Restore certainty to health care markets by ensuring CSRs will continue through 2017, 2018, and 2019.
  • Include steps to ensure 2018 enrollees receive the financial benefit of CSRs for the coming year.
  • Require the Department of Health and Human Services (HHS) to increase funding for outreach and enrollment assistance activities for 2018 and 2019; this is a top priority for ANA with Open Enrollment beginning November 1.
  • Put in place extensive reporting requirements to make sure HHS is held accountable for implementing Open Enrollment in 2018 and 2019.

Most importantly, the bill would generally keep in place essential health benefits and protections for pre-existing conditions with the exception of consumers who qualify for catastrophic plans.

The legislation will need 60 votes to pass through the Senate and ultimately Majority Leader Mitch McConnell will determine if the bill goes to the floor for a vote. In addition, lawmakers will need to convince the President that this bill will benefit the consumer and not the insurers. To date, the President has responded with mixed reviews.