Congress is voting on a sweeping $1.5 trillion tax bill this week that is likely to pass and be signed into law before the end of the year. This major piece of legislation contains several provisions that promise to significantly change the game for healthcare organizations, from reducing the corporate tax rate to eliminating the ACA's individual mandate to buy health insurance.
Leading up to the votes, the bill has garnered mixed reviews. Here are six reactions from major healthcare groups.
1. The American Hospital Association lauded the preservation of hospital access to tax-exempt private activity bonds and of medical expense deductions for patients with high medical costs, but voiced concern about repealing the individual mandate. "A vital source of low-cost capital financing, which helps keep healthcare more affordable, private-activity bonds are a proven benefit to the public at large and would be preserved under this legislation," AHA President and CEO Rick Pollack said in a statement. "However, we are concerned about the inclusion of the individual mandate repeal and the consequences that this would pose to our patients. It is unfortunate that the important task of overhauling the tax code will erode health coverage for many."
2. The Association of American Medical Colleges voiced a reaction similar to the AHA's, supportive of preserving tax benefits on private activity bonds, but disappointed in the repeal of the individual mandate. AAMC also indicated support for the removal of provisions that would tax tuition waivers and exemptions. "The removal of these provisions, and those that would have eliminated the student loan interest deduction and other education-related credits, will help keep medical education and biomedical research training within the reach of all who wish to pursue those paths," AAMC President and CEO Darrell Kirch, MD, said in a statement.
3. The American Medical Informatics Association was also in support of removing the tax on tuition waivers from the bill. In a letter to leaders of Congress, AMIA leaders voiced concern that this tax — which was later removed from the bill — would decrease modest graduate stipends and discourage participation in graduate programs. "The healthcare ecosystem is increasingly digital and data-driven," Thomas Payne, MD, AMIA board chair and medical director of IT services at the University of Washington's UW Medicine, said in a statement. "We must not do anything that would impede the education and training of a vital component of this ecosystem's future workforce."
4. America's Essential Hospitals largely opposed the bill in a statement published in early December because of the strain it will put on patients and healthcare providers. "We are deeply concerned the Senate plan to repeal the ACA's individual mandate would jeopardize ongoing coverage for those who need it most by pricing them out of the marketplace. As they drop out of coverage, and as others choose not to enroll, uncompensated care costs will rise at hospitals already struggling to meet their mission," Bruce Siegel, MD, president and CEO of America's Essential Hospitals, said in the statement. "The House and Senate bills would further destabilize hospitals that care for those who face financial hardships by triggering deep cuts to social programs. Sequestration would undermine care for Medicare patients and have a ripple effect on Medicaid and other social supports, particularly for dually eligible beneficiaries."
5. The Association for Community Affiliated Plans opposed the tax plan and urged representatives and senators to vote against it. In a letter to Congress, ACAP voiced concern about the repeal of individual mandate, which could cause premiums to jump up and insurance levels to drop. "ACAP is concerned that this decision will destroy the health insurance Marketplaces, which when coupled with the administration's forthcoming proposal to expand access to short-term limited-duration insurance, will further exacerbate the market, leading to a death spiral," said ACAP CEO Margaret Murray in the letter. ACAP also took issue with modifications to the deductibility of state and local taxes, which could lead to cuts to Medicaid and public health programs. "This will have a doubly disastrous impact on these vulnerable populations," Ms. Murray wrote.
6. Sixteen patient and consumer groups — including the American Heart Association, the American Cancer Society Cancer Action Network and March of Dimes — penned a letter to Congress last week imploring legislators to preserve the individual mandate. "Repealing the individual mandate without simultaneously enacting another mechanism that encourages young and healthy people to purchase insurance will destabilize current law, while also having a disproportionate impact on people with pre-existing conditions," the groups wrote. "We recognize that the current health care law and system are not perfect, but changes should work to stabilize the market and improve access to adequate, affordable health insurance rather than move backwards."
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