How Trump’s Tax Bill Impacts Medicaid, ACA Plans, and Hospitals: Key Takeaways

1. Medicaid Funding: The tax bill doesn’t directly cut Medicaid funding. However, it repeals the Affordable Care Act’s (ACA) individual mandate, which could lead to fewer people being insured, indirectly affecting Medicaid enrollment and funding.

2. ACA Plans: Repealing the individual mandate may cause healthier individuals to forgo insurance, leading to a sicker, more expensive pool of insureds. This could increase premiums for ACA plans, making them less affordable for many Americans.

3. Hospitals: The loss of insured patients due to the repeal of the individual mandate could increase the number of uninsured patients seeking care, leading to higher uncompensated care costs for hospitals. This could especially impact hospitals in states that did not expand Medicaid under the ACA.

4. Rural Hospitals: Rural hospitals, which often operate on thin margins, could be disproportionately affected by increased uncompensated care costs, potentially leading to more hospital closures.

5. Healthcare Workforce: The changes could also impact the healthcare workforce, as reduced Medicaid and ACA funding could lead to fewer jobs in the healthcare sector, particularly in rural and underserved areas.

6. State Responses: Some states may respond to these changes by seeking waivers to implement their own healthcare reforms, potentially leading to a more fragmented healthcare system across the country.

7. Long-term Care: The bill’s impact on long-term care is less direct but could be significant. Changes in Medicaid funding and the healthcare landscape could affect the ability of individuals to afford long-term care services.

8. Children’s Health Insurance Program (CHIP): While the tax bill does not directly address CHIP, the broader healthcare policy environment could influence CHIP funding and enrollment, affecting children’s access to healthcare.

9. Market Stability: The repeal of the individual mandate without a replacement could destabilize the health insurance market, leading to higher premiums and fewer plan options for consumers.

10. Future Legislative Actions: The impact of the tax bill on healthcare may be a precursor to further legislative actions on healthcare reform, potentially including changes to Medicaid, the ACA, and other healthcare programs.

The recently passed tax and spending legislation in the US Congress is expected to have significant impacts on the country’s healthcare system. The bill, which is awaiting President Donald Trump’s signature, will cut federal health spending by about $1 trillion over a decade, leading to increased healthcare costs for millions of Americans. The Congressional Budget Office estimates that nearly 12 million more people will be without insurance by 2034, which will undermine the finances of hospitals, nursing homes, and community health centers.

The bill’s provisions will affect healthcare access in several ways:

1. Medicaid work requirement: The bill introduces a Medicaid work requirement, which will require some Medicaid enrollees to work, volunteer, or attend school for at least 80 hours a month to maintain their coverage. This requirement is expected to end coverage for millions of enrollees who do not meet the new standards.
2. Cuts to rural healthcare: The bill targets states’ use of provider taxes, which will lead to fewer health services, medical professionals, and hospitals in rural communities. Rural hospitals, which often operate on thin profit margins, may be forced to reduce services or close altogether.
3. ACA coverage changes: The bill makes it harder for people to enroll and retain their Affordable Care Act (ACA) coverage. ACA marketplace policyholders will have to update their income, immigration status, and other information each year, and the annual open enrollment period will be shortened.
4. Increased out-of-pocket costs: Medicaid enrollees will be required to pay more out-of-pocket for appointments, with costs up to $35 for some services. This may prompt low-income people to forgo needed care.
5. Loss of subsidized ACA plans for immigrants: The bill will cause hundreds of thousands of lawfully present immigrants, including asylum-seekers, victims of trafficking, and refugees, to lose their ACA marketplace coverage by cutting off subsidies that make premiums affordable.

The bill’s provisions have been criticized for undermining the healthcare gains made during the Biden and Obama administrations, which made it easier for millions of people to access healthcare and reduced the US uninsured rate to record lows. Republicans argue that the trade-off for these gains was higher costs borne by taxpayers and increased fraud. However, health researchers and advocates argue that the bill’s provisions will have little impact on employment and will instead harm vulnerable populations, including low-income individuals, rural communities, and immigrants.