It may take days, weeks, years, or even a decade to fully determine what the Republicans in Washington have done to the nation’s health care with the U.S. Senate’s middle-of-the-night approval of more than $1 trillion in changes to the U.S. tax code. But it will at least be big, and maybe huge.
The House and Senate still must reconcile their versions, and President Trump must agree to what lawmakers settle among themselves. So the extent of the health harms the ostensible tax bill—which many have said is really a health bill with tax cuts attached—may inflict on Americans remains up in the air, to a degree.
Millions will lose their health insurance coverage, because the tax bill repeals Obamacare’s requirement that taxpaying citizens show they have health coverage, the so-called individual mandate. Without the mandate, consumers can wait to buy insurance until they get sick, the equivalent of buying fire insurance on your house when it’s burning down. But this means insurers have to jack up rates to offset all the gaming of the system. It also opens the way to “skinny” or skimpy health plans that really offer little or no coverage for the sick or those in need of medical services.
Combined with the GOP budget proposals, the tax bill will reward the rich by forcing cuts in programs for the sick and poor (Medicaid) and the aged (Medicare). Medical research and prevention programs already had been on the Trump Administration’s chopping block, and it is even less clear, with so many tax benefits going to the rich, how the nation now will fund its much praised studies in medical science. Higher education, which provides a pipeline of the doctors and scientists that hospitals and research institutions voraciously require, will be staggered by tax changes in the GOP bill. So will patients who may not be able to deduct or will get lower deductions for big medical bills. Hospitals will be stung by tax law changes, both when they try to put up new facilities and in the funding they get for Medicaid and Medicare patients.
Plenty will be written about this tax and spend mess, which will add more than $1 trillion to the U.S. deficit. It’s farcical to think the measure will pay for itself, experts say.
In my practice, I see the major harms that patients suffer while seeking medical services and their heart-breaking struggles to access and afford quality medical care. The process by which the GOP railroaded the tax bill through Congress was slipshod, lacked careful evidence, and was unacceptable — the last similar overhaul of so important aspect of federal governance took almost two years. Elections have consequences, and the Republicans, as a majority party, have the political privilege to enact policies in keeping with its voters’ will.
But partisans also must be Americans first, taking the broad view as well as the narrow about what benefits the most people in a balanced democracy. The poor health outcomes alone should have made politicians wary of the partisan tax and budget plans.
Voters may wish to express their displeasure with their elected representatives now as they see fit, with calls, emails, letters, and in person entreaties. They also can take one key step in a hurry: Congress hasn’t been so dim as to kill the ACA for 2018, so individuals who qualify for help with health insurance under Obamacare, should consider applying for it immediately.
Go to healthcare.gov now — December 15 is the deadline — and do what you can to protect your health and that of your loved ones for at least a little while. It’s clear that individuals must look out a lot for their own well-being because their political leaders in Washington have other interests ahead of theirs.