The House passed sweeping tax overhaul legislation Thursday,
shifting efforts to the Senate. The Senate’s tax bill differs significantly
from the House version in numerous ways, including the medical expenses
deduction, which remains intact in the Senate version.
The House passed the bill with 227 votes. Thirteen Republicans and
all Democrats voted against the legislation. On the same day, the U.S. Senate Committee on Finance voted along party lines to advance a markedly different
version of tax reform that includes a partial repeal of the individual mandate
included in the 2010 health care law but does not touch the medical expense
deduction.
AHCA/NCAL issued a press release last week opposing the
elimination of the medical expense deduction, which many long term care
patients use to offset the financial burden of receiving uncompensated long
term or post-acute care.
The Senate version differs primarily because of procedural
rules surrounding the budget reconciliation process. In order to avoid a
Democratic filibuster, Senate Republicans are using the reconciliation process
to pass legislation with a simple 50-vote majority. The process, however, ties
lawmakers’ hands on issues of deficit spending, meaning the Senate bill
necessarily must have more offsets or fewer revenue cuts than the House version
in order for it to come to the floor.
In addition to procedural hurdles, the Congressional Budget
Office (CBO) issued a report indicating that the Office of Management and
Budget (OMB) would be forced to cut Medicare if tax legislation creates too
much deficit spending. OMB would be forced to cut Medicare spending by $25
billion, or four percent of total spending. The House version of tax
legislation is projected to increase the deficit by $1.5 trillion, according to the CBO.
AHCA/NCAL will continue to monitor the tax reform effort
insofar as it affects its members and the patients they serve.
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