Provisions in the Senate tax bill that would eliminate the Affordable Care Act's (ACA) requirement that persons purchase qualified health insurance (individual mandate) and that would lead to deep cuts to Medicare and other federal health programs will do great harm to tens of millions of the most vulnerable patients, including seniors. A Congressional Budget Office (CBO) report showed the number of uninsured would increase by four million in 2019 and 13 million in 2027.
Repeal of the individual mandate violates the imperative that any proposed changes to the ACA should first, do no harm to patients. The ACA, with the individual mandate, has been an effective tool in reducing the uninsured rate to its lowest level in decades, from 18.2 percent in 2010 to 10.3 percent in 2016.
What is more, the offsets the bill contains would negatively impact other federal health programs. Under a 2010 law called Statutory Pay-As-You-Go (SPAYGO) Act, any law that will add to the federal deficit must be paid for with spending cuts, increases in revenue or other offsets. Automatic cuts are imposed if Congress does not enact offsets to prevent them.
Tax cuts and other initiatives should not come at the cost of automatic cuts to programs that serve individual and public health, including Medicare, Medicaid, the Centers for Disease Control and Prevention, and other agencies.
A CBO report showed that the SPAYGO cuts triggered by the bill would result in a $25 billion cut to Medicare in 2018. It would cause additional cuts to graduate medical education, lab fees, and hospital payments. It would also cut or entirely eliminate hundreds of other federal programs that are critical to health, including those within the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the Prevention and Public Health Fund.
Rather than continuing the effort to repeal a key part of the ACA through budget reconciliation measures, or otherwise, Congress should work together in a bipartisan manner to improve coverage and lower costs. Repealing the individual insurance mandate, as part of this legislation or any other, would only result in harm to our patients as would any cuts to Medicare or other vital health programs.