OPINION
DOCTORS' Lounge
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RUINATION And Damnation
Mary G. Barry, MD
Louisville Medicine Editor
[email protected]
T
hose in control of Congress have
been hell-bent on hurting access
to medical care for anyone but
themselves. ities, a family with an income of $500,000
would get $2,000 credited per child, but the
vast amount of lower-income families would
get all of $75 per child.
As I write this, the tax reform bill is still
in conference committee. It had no hear-
ings and no input from the Congressional
Budget Office before being rushed into a
votable form. The Senate bill voted on was
handwritten in parts and submitted for the
approval and editing of many lobbyists, but
no Senate Democrats, prior to the floor vote
at 0200. It contains the Murkowski provi-
sion allowing Artic drilling in protected
wilderness. It adds 1.4 trillion dollars to the
national debt, but hands corporations enor-
mous tax cuts. It changes the way inflation
is measured, so that more people are not as
protected by lower tax brackets. They are
thrown into higher brackets that, by 2027,
would cost low and middle-income families
$134 billion more over the next 10 years,
money gifted directly to those in the higher
echelons of wealth. It contains a huge corpo-
rate tax giveback, but none for families. The
large corporate tax cuts are permanent, the
ones for the rest of us expire. Its “child tax
credit” will be based on income; according
to the Center on Budget and Policy Prior- The Senate version continues to protect
the deduction for medical expenses (in fact,
improves it) which got started during World
War II to help the home front. The House
version removes that deduction. Heather
Long reports in The Washington Post that
this means the average older retired person
will have to pay tax on a greater chunk of a
limited income, but will still have the typi-
cally ever-growing medical expenses of the
aging body. The problem is compounded by
state taxes that use the federal tax scheme as
a base, raising the overall “taxable income”
the person has. The person on a limited
income then loses much larger chunks of
that income to the state and federal gov-
ernments. The AARP says that 70 percent
of those who currently use the medical ex-
pense deduction make less than $75,000
per year. They will be saying to themselves
eventually, “Should I buy insulin, or pay
LG&E?” They will be keeping their cataracts
and ruined knees. They will do without pre-
ventive medicines. They will be unable to
afford nursing home long-term care. If its
enormou s cost (well over $100,000 a year) is
no longer deductible, their taxable income,
in the example given by Ms. Long, will go up
by six figures and they will owe not $2,300
in taxes, but $50,000!
Imagine the twin Nazareth Homes,
where people with retirement income saved
for this cost suddenly become people de-
pendent on the state to pay. The adminis-
trative expenses of long-term care will only
increase over time; if there are any federal
and state programs left that still will provide
a Medicaid bed, they will get paid at only
the Medicaid rate. The old and frail will be
more and more neglected, then more and
more sent to the hospital on the revolving
door that covers the facilities’ legal risk but
often changes nothing about the actual day-
to-day care the elderly and disabled will
receive on their return.
Nearly 9 million people filed the medical
expenses deduction in 2015. As the Baby
Boomers age, that number will only go up.
As it stands today, the tax act repeals
the ACA’s individual mandate. Without a
guaranteed pool of younger and healthier
insureds, those companies that still offer
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JANUARY 2018
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