The Republican tax plans are suddenly looking a lot more like health care bills, with provisions that may affect coverage and increase medical expenses for millions of families.
The House version of the tax bill, which President Donald Trump endorsed on Tuesday, would end a deduction that allows families of disabled children and elderly people to write off large medical expenses. The Senate plan would repeal the Affordable Care Act requirement that most Americans carry insurance, a move that insurers promise would raise premiums in the nationwide individual insurance market.
The provisions would help offset the cost of large tax cuts for corporations and individuals. But the move has sparked a new wave of opposition from the health care industry and others who are concerned about its impact — the same political headwinds that tanked Republican efforts to repeal the Affordable Care Act earlier this year.
Either proposal, if signed into law, "could be devastating for some families with disabilities," said Kim Musheno, vice president of public policy at the Autism Society, a Bethesda, Maryland, organization that advocates for people with autism. "Families depend on that deduction. And if they deal with the individual mandate, that's going to cut 13 million people from their health care," she said, citing a Congressional Budget Office estimate.
Republicans and some conservative groups, though, argue that removing the penalty for uninsured individuals would represent a tax cut for many low-income people who pay it now. Americans for Tax Reform, the group led by anti-tax crusader Grover Norquist, said that Internal Revenue Service data from tax year 2015 show that 79% of households that paid the penalty earned less than $50,000 a year.
Most Americans already think the tax legislation is designed to benefit the rich and oppose the bill by a two-to-one margin, according to a Quinnipiac University poll released on Wednesday. The survey was conducted between Nov. 7 and Nov. 13 — before the repeal of the Obamacare mandate was introduced — and has a margin of error of 3 percentage points. Some of the details in both tax plans have changed since the survey, and the Senate tax-writing committee is still working on its draft.
Republican Concerns
Few Republicans have spoken out about the House bill's repeal of the medical-expense break. The bill faces a vote on the House floor Thursday. But some criticism has begun to surface as advocacy groups including the AARP and the American Cancer Society have highlighted the harm the House bill could have on families battling diseases and on the elderly. People with tens of thousands of dollars in annual medical expenses often rely on the tax deduction to make ends meet.
Rep. Walter Jones, a North Carolina Republican, said Wednesday he'd vote against the House bill in part because it eliminates the deduction for out-of-pocket medical expenses.
"There are a lot of seniors in my district and this is life and death for them," he said.
Jones went ahead and today became one of the 13 House Republicans who voted against the bill, as House members proceeded to approve the bill by a total vote of 227-205.
The deduction is allowed under current law if medical expenses exceed 10% of a taxpayer's adjusted gross income. Almost 9 million taxpayers deducted about $87 billion in medical expenses for the 2015 tax year, according to the IRS.
Rep. Greg Walden, R-Ore. (Photo: House Energy)
Rep. Greg Walden, an Oregon Republican who chairs the Energy and Commerce Committee, said some of his constituents who live in expensive elder-care facilities could be harmed if the deduction is scrapped.
"I think it's one we have to continue to massage a bit," he said. "There's a lot of things out there and there's maybe going to be an opportunity to adjust some of them."
He declined to elaborate.
ACA Individual Mandate
