The Health Coverage Stakes In The Tax Debate: The Individual Market And Beyond

November 29, 2017, Health Affairs Blog, Timothy Jost- Finally, the greatest threat of the tax bill to health coverage may not be the individual mandate repeal, but rather the large deficits built into the tax bill.The CBO estimates that the tax bill would increase the budget deficit by $1.4 trillion over the next decade. The agency predicts that it would not increase the deficit beyond 2027, but that conclusion is based on the individual tax cuts expiring at the end of 2025, which no one believes will happen. Moreover, if the CBO is wrong and fewer than 13 million individuals lose insurance coverage because of the individual mandate repeal, the budget savings of $318 billion the CBO projects from the repeal will shrink and the deficit will correspondingly grow. In fact, the deficits created by the tax bill can only be balanced by massive spending cuts, and the biggest targets for such cuts would be the Medicare and Medicaid programs. Indeed, current PAYGO rules could require sequestration of $25 billion in Medicare funds for the fiscal year 2018 if the tax bill passes, although Congress would most likely waive this requirement. In any event, unless completely unrealistic assumptions are made about future economic growth, the deficits caused by the tax bill would unavoidably result in later attempts to enact deep cuts in Medicaid and Medicare. It is not just the individual market that is at risk.

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