How 4 Healthcare Measures Weathered Tax Bill Reconciliation

Steven Porter, December 18, 2017

From a linchpin of the Affordable Care Act to a decades-old drug research tax credit, lawmakers had considered several provisions that would impact healthcare. Not all survived.

The healthcare impacts of the GOP’s tax reform plan came into focus over the weekend after lawmakers from the House and Senate unveiled their reconciled version of the bill Friday evening.

Dire headlines had warned that millions could lose health coverage and hospitals could lose access to low-cost financing options if either chamber’s bill were to become law. The reconciled bill—which is widely expected to pass this week—drew a partial sigh of relief from some industry stakeholders.

Here are four key healthcare-related provisions of the nearly 1,100-page bill:

1. Individual mandate repeal included

The House bill had no provision addressing the Affordable Care Act’s individual mandate, which requires most Americans to pay a tax penalty if they don’t have health insurance. But the Senate’s version had called for the tax penalty to be reduced to zero beginning in 2019—language that made it into the reconciled bill.

The Congressional Budget Office and Joint Committee on Taxation estimated last month that repealing the individual mandate beginning in 2019 would reap four key outcomes: It would (1) reduce the federal budget deficit by $338 billion over 10 years, (2) reduce the insured population by 4 million in 2019 and 13 million in 2027, (3) maintain the stability of non-group insurance markets in most of the country for the coming decade, and (4) raise premiums by about 10% annually.

2. Medical expense deduction expansion

Although an earlier version of the bill had called for the elimination of the medical expenses deduction, the reconciled bill would temporarily expand it.

Before the ACA, taxpayers who itemize their deductions were able to write off qualifying medical expenses that exceed 7.5% of their adjusted gross income, CNBC’s Sara O’Brien reported. The ACA raised that threshold in 2013 to 10% for people younger than 65, with an expiration date in 2016. The reconciled bill calls for the 7.5% threshold to be applied across all age groups for tax years 2017 and 2018, before returning to 10% for younger Americans in 2019.

But remember, O’Brien notes, that this deduction is available only to taxpayers who itemize their returns and for whom itemizing exceeds the standard deduction. That’s a significant caveat since the standard deduction would nearly double across the board until 2026.

Steven Porter

Steven Porter is editor at HealthLeaders Media.

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