Let’s give thanks for a holiday respite from health policy turkey shoot in DC

Members of Congress have scattered back to their districts for Thanksgiving, giving the nation a bit of a break from the health policy turkey shoot that has besieged the nation’s capital. The health- and medical-related actions have piled up so fast and furious that it can be daunting.

But let’s not overlook:

• The hot mess that’s supposed to be a GOP wish list of tax changes has, instead, turned into yet another attempt to gut the Affordable Care Act, aka Obamacare, this time by eliminating the “individual mandate” that requires Americans to show through their tax returns that they have health insurance coverage. Tax policies invariably are complicated. Let’s simplify this one: Partisans want to slash the ACA, so they can take money from it — $300 billion or so — to help “pay for” $1 trillion or more in tax cuts for giant corporations and the wealthy. This legislative legerdemain will mean 13 milllion Americans will lose health coverage and insurance premiums for millions will rise 10 percent, according to the independent Congressional Budget Office.
• The tax bill, combined with the GOP budget, will mean billions of dollar in cuts to Medicare and Medicaid. Democratic opponents also warn that the measure, which boosts the deficit by $1.5 trillion, will lead the GOP to demand cuts in other safety net programs, notably Social Security.
• It’s unclear whether the tax bill, approved in the House, will win passage in the Senate. And it’s up in the air still what the measure might look like, if successful in both chambers and then reconciled between them. But the important deduction for medical expenses is at big risk. For patients with major medical care bills, this could be a big loss.
• Medical and scientific study, to advance, requires significant human talent, a steady flow of top graduate and post-graduate students from universities, colleges, and research institutions. A major way they get supported is imperiled in the tax bill. It would tax tuition waivers as income. Students never see money from waived tuition, and most live on significantly lower stipends. Instead of paying taxes on only their actual pay, they now also would have to cover taxes on their waivers, which would mean, for a grad student with a $30,000 stipend getting a $50,000 tuition waiver, paying income tax on $80,000. Maybe higher education and research institutions need to figure fairer ways to compensate these hard-working scholars and teachers. Hospitals, schools, and affordable housing, by the way, all may take a hit in the tax bill, too.
• President Trump has proclaimed that he would make a major push to help Americans besieged by the drug industry’s soaring prices. Now he has chosen Alex Azar, a Big Pharma executive, to head the Health and Human Services department. By all accounts, Azar (shown above) is a low-key, no-nonsense, well-informed and longtime participant in U.S. health care. But it’s hard to ignore his tenure as a president at Eli Lilly & Co., one of three firms under major fire for jacking up the price of insulin, a treatment that diabetics are in dire need of. Azar also is a staunch, anti-regulatory conservative, closely tied to Vice President Pence. Partisans of this stripe see little or no role for government in medical care and services, and this view will come into robust play as Trump officials seek administratively to rollback Obama era policies and practices on the Affordable Care Act, Medicaid, Medicare, and more. Azar may not be as outspoken and dogmatic as his predecessor, Tom Price, a Georgia orthopedist ousted for his disgraceful abuse of flying on charter and government jets. Azar also inherits an agency that’s still turned upside by Price’s scandal. That includes internal questions about a top-level Price budget appointee, who signed off on all the former secretary’s travels and who now is working on plans to slash staff at HHS.
• Congress still hasn’t reauthorized a crucial program to help protect the health of roughly 9 million kids who are poor or children of the working poor. The Children’s Health Insurance Program in most years has won bipartisan support, and its scheduled Oct. 1 renewal wasn’t supposed to be controversial. Lawmakers had said they had reached a bipartisan deal that would extend the program for five years and give it needed funding. The partisan feuding over the failed repeal-and-replacement of the ACA, combined with a GOP frenzy for tax action, has put CHIPs in limbo, even as states are running out of money for the program.

In my practice, I see not only the significant harms that patients suffer while seeking medical services but also their giant struggles to access and afford medical care. If you qualify for coverage under the Obamacare exchanges, be grateful over this holiday weekend that the program exists—and go to heathcare.gov before Dec. 15 to see what insurance you might wish to sign up for.  And while all the public policy and government issues that I’ve written about above might be complicated and daunting, we also all can be grateful that we’re thriving under a democratic, representative system. Phone calls, emails, and letters to elected officials matter. Let them know what’s on your mind. Say some special thanks, too, this week to all the doctors, nurses, first-responders, and other caregivers who will toil through the holiday.