This is a commentary piece by John Rother, President and CEO of the National Coalition on Health Care. A version of this piece was published by Modern Healthcare.
When Congressional leaders set their sights on comprehensive tax reform, the aims were to improve our tax system and create a tax code that suited our country’s economic needs. This should have meant finding a way to improve the health of our economy—not harm our health care. Instead of bipartisan progress, the current tax reform debate has devolved into an eerie case of déjà vu—echoing this summer’s failed health care repeal efforts. Between the Senate’s individual mandate repeal—yet another iteration of “repeal without replace”—and cuts to Medicare and Medicaid, the tax bill, as it stands today, is set to do more harm than good to America’s health.
Right now, America needs constructive Congressional action to avoid disrupting the health care system and to curb the growth in costs. Unfortunately, the Senate’s tax legislation would do the opposite—disrupt existing coverage, drive up premiums, and lead to drastic cuts to Medicare and Medicaid.
Throughout this decade-long health care debate, the organization I lead, the National Coalition on Health Care, has urged Congress to pursue bipartisan solutions in health care. We have called for reforms that improve our health system and reduce costs through evidence-based policy—but instead, Congress is pursuing across-the-board cuts hidden in a tax bill.
In the individual market today, bipartisan solutions would mean continuing cost-sharing reduction payments and stabilizing premiums—without pushing millions off health coverage. Instead, the Senate tax bill’s repeal of the individual mandate would increase the number of uninsured by 13 million and increase premiums in the nongroup market by about 10 percent, according to the Joint Committee on Taxation and the Congressional Budget Office (CBO).
In Medicaid today, bipartisan solutions would mean fostering state innovation, not shifting the cost burden onto states, beneficiaries, or providers. States are already making efforts to transform their care delivery systems by helping beneficiaries remain independent in their homes and integrating care for lower income seniors and disabled individuals enrolled in both Medicare and Medicaid. Targeted federal policy has the ability to improve and expand upon these initiatives. Unfortunately, in this bill, much of the savings attributed to the individual mandate repeal would come from a substantial reduction in federal support for state Medicaid programs. An analysis of the mandate repeal published earlier this month by CBO projected those Medicaid cuts would total $179 billion over ten years.
In Medicare today, bipartisan solutions would mean improving the quality of care and reducing costs while avoiding indiscriminate cuts that harm beneficiaries. The Senate-passed CHRONIC Care Act is one example of such an effort, providing vital flexibilities to enable providers and health plans to deploy high-tech telehealth and high-touch personal support to improve care for the chronically ill. The recently announced Ways and Means Committee deal on Medicare Extenders is another strong example. In addition to avoiding disruption to the Medicare program, this agreement funds a permanent fix for Medicare outpatient physical, occupational, and speech therapy through reforms to post-acute care payment. Instead of focusing on reforms such as these, Congress is debating a tax bill that would trigger $25 billion in automatic cuts to Medicare starting next year, according to CBO. If those automatic cuts are waived through future Congressional action, the resulting deficits could drive even larger Medicare cuts.
And while Congress has struggled to pass this tax bill despite all its harmful consequences for the healthcare system, it has failed to assure funding for crucial health initiatives on which American families depend. The U.S. now faces potential lapses in coverage for kids in the Children’s Health Insurance Program, hiring freezes in community health centers, and defunding of scholarships and loan forgiveness for primary care physicians and nurses in our communities.
Congress should pursue bipartisan solutions to the growing costs of care and abandon efforts to pay for tax reform by slashing health care.