The Senate’s tax bill is a sweeping change to every part of federal health care

The Senate tax bill is really a health care bill with major implications for more than 100 million Americans who rely on the federal government for their health insurance.

The bill reaches into every major American health care program: Medicaid, Medicare, and the Obamacare marketplaces.

These are expected outcomes based on two significant policy changes in the bill. First, the bill repeals the individual mandate, a key piece of Obamacare that requires most Americans get covered. Economists expect its elimination to reduce enrollment in both the Affordable Care Act’s private marketplaces and Medicaid by millions. The money saved will be pumped into tax cuts for the very wealthy.

The bill also includes tax cuts so large that they would trigger across-the-board spending cuts — including billions for Medicare. The last time Medicare was hit with cuts like this, patients lost access to critical services like chemotherapy treatment.

This tax bill deserves a broader name. Its policies will cause millions of vulnerable Americans to lose coverage, disrupt care for the elderly, and potentially change the health care system in other ways we can’t fully predict.

The Senate bill includes a provision to repeal the Affordable Care Act’s requirement that nearly all Americans carry insurance coverage, known as “the individual mandate.”

Republicans see it as a winning move. The individual mandate is very unpopular. And repealing it will save more than $300 billion — which can pay for big tax cuts for corporations and the very wealthy.

The best economic evidence we have shows that if the individual mandate disappears, premiums go up and millions of Americans lose coverage. The Congressional Budget Office pegs the decline in the number of insured at 13 million.

he Senate tax bill is expected to trigger a $25 billion annual cut to Medicare, the CBO estimated earlier this month.

The Medicare cuts aren’t part of the tax bill itself. Instead, they are mandatory spending cuts that would occur because of the tax bill’s $1.5 trillion increase to the deficit. These spending cuts are known as a sequester — and we know what happens to Medicare in a sequester, because it happened just a few years ago.

Across-the-board cuts often have outcomes that are tricky to predict. Because they aren’t targeted, they often hit programs no legislators would want to cut.

The last sequester in 2013 unexpectedly caused cancer clinics to turn away thousands of Medicare patients In that particular case, Congress had actually tried to shield Medicare from some of the deepest cuts. But because of some quirks in how Medicare pays for cancer drugs, it didn’t work — and clinics were left with incredibly difficult choices.

As the tax bill slides to a vote (with the expectation that it will clear the Senate), we should also be talking about health care. When Obamacare faced repeal this spring, many groups mobilized to demand clarity on what the bill would really do. We need those answers now too.

Because the tax bill isn’t just a tax bill. It is a bill that has sweeping consequences for the American health care system — that could stand to affect the health care of vulnerable and elderly citizens.

 

(Excerpted from Vox 11/29/17)