Louisville Medicine Volume 65, Issue 8 - Page 29

OPINION DOCTORS' Lounge SPEAK YOUR MIND If you would like to respond to an article in this issue, please submit an article or letter to the editor. Contributions may be sent to editor@glms.org or may be submitted online at www.glms.org. The GLMS Editorial Board reserves the right to choose what will be published. Please note that the views expressed in Doctors’ Lounge or any other article in this publication are not those of the Greater Louisville Medical Society or Louisville Medicine. RUINATION And Damnation Mary G. Barry, MD Louisville Medicine Editor editor@glms.org 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 (continued on page 28) JANUARY 2018 27