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By Jennifer Zweifel

Congress’ Tax Bills: The Impact on Healthcare and the Affordable Care Act

The House and Senate have now passed versions of the biggest rewrite of tax law in decades. If you are filing your taxes you should get a PAN card to help save all your documents for future references, here are essential PAN documents that you will be need.

Since the bills are not identical, the final legislation must be negotiated in a conference committee. While not all provisions will survive, it is predicted that the final bill will most closely resemble the Senate version, which includes repealing the Affordable Care Act’s individual mandate, according to an article by the Association of Health Care Journalists (AHCJ).

Our team at Intellimed wanted to know the impact on healthcare of Congress’ bills. Here’s what we learned…

Impact on the Affordable Care Act (ACA)

Both bills as they stand now would significantly impact ACA/Obamacare. The biggest changes include:

  • Abolishment of Mandatory Insurance Coverage: The Senate tax bill would eliminate the government’s enforcement of the ACA requirement that most Americans carry insurance coverage. According to a recent Chicago Tribune article on the bill’s impact, abolishment of the coverage mandate would result in government savings from fewer consumers applying for taxpayer-subsidized coverage, giving GOP tax writers nearly $320 billion over 10 years to help pay for tax cuts. With healthier people opting out of insurance and foregoing a penalty, it is speculated that premiums would continue to rise for those maintaining coverage. The Washington Post concurs in its coverage, stating “The result could cause an extra 13 million people to become uninsured and drive up insurance premiums in marketplaces created under the law, according to anestimate by Congress’s nonpartisan budget analysts.

The House bill would not end penalties for Americans who fail to carry insurance. However, House Republicans have been sympathetic to the idea, which was part of legislation the House adopted this year to dismantle much of the ACA.

  • Impact on Medicare: The impact on Medicare is somewhat unclear. However, the impact of both chambers’ bills is predicted to increase federal deficits by about $1 trillion over 10 years, even after accounting for stronger economic growth expected from tax cuts. More red ink means higher borrowing costs for the government, and that would reduce the options for policymakers when Medicare’s long-postponed financial reckoning comes due, although GOP leaders House Speaker Paul Ryan, R-Wisc., and Senate Majority Leader Mitch McConnell, R-Ky. said in a joint statement that speculation about the tax bill’s cuts to Medicare are unfounded, according to the Chicago Tribune.

    The Washington Post
    notes, “Cuts, if they happen, would decrease federal spending on Medicare by 4 percent — amounting to about $25 billion next year, the Congressional Budget Office forecast. Because paygo rules do not allow Medicare benefits to be touched, the funding loss would be spread among payments to doctors, hospitals and others that provide care to the program’s 56 million older and disabled Americans.
  • Impacts to Federal Programs for Low-Income Americans & CDC: The bills would leave untouched some health-care programs that provide help to low-income Americans, including Medicaid and the Children’s Health Insurance Program (CHIP). Nearly $1 billion a year would be eliminated for a Prevention and Public Health Fund, created under the ACA that now represents 12 percent of the Centers for Disease Control and Prevention’s (CDC) budget, according to The Washington Post.
  • Tax Deduction for High Medical Expenses: The House bill repeals the tax deduction for people with high medical expenses not covered by insurance. The Senate bill would make the deduction more generous than what’s currently allowed. People could deduct amounts that exceed 7.5 percent of their income. The differences would have to be resolved in conference.
  • Tax Credit to Drug Companies: In an effort to raise money to pay for lower tax rates, the House bill eliminates a current tax credit available to drug companies that develop medications for people with rare diseases; the Senate bill scales back the tax credit.

Health Associations’ Take on the Republican Tax Bill
In a joint statement this month, the American Psychiatric Association, American College of Physicians, American Congress of Obstetricians and Gynecologists, and American Academy of Pediatrics, among others, voiced opposition to the Republican tax proposal. The main concern of these groups was around repeal of the individual insurance mandate, which would leave millions more people uninsured by 2027, according to the Congressional Budget Office (CBO), with speculation that individual and small-group marketplaces would be destabilized and rates of medical bankruptcy would skyrocket.

And the Story Continues…

The tax bill story is certainly not over and we’ll all get to watch it unfold over the coming weeks and months as we head into the New Year. We hope this quick overview of the House and Senate bills’ impact on healthcare has been informative. Please add your comments and let us know if we’ve missed any key points.

Jennifer Zweifel serves as Chief Financial Officer of Intellimed, a leader in healthcare data analytics software and analysis based in Phoenix, AZ. 

healthcare data, preventive care

By Jennifer Zweifel

Healthcare Data and Preventive Care: A Pathway to Success in Value-Based Healthcare

Healthcare Data and Preventive Care: A Pathway to Success in Value-Based Healthcare

An area where healthcare data is beginning to make inroads and has tremendous potential for significant impact is in preventive healthcare.

Preventive care plays in important role in value-based healthcare – the direction healthcare models continue to evolve into as they move away from fee-for-service. A couple notable factors act as incentives for placing prevention at the forefront of care: 

Changing Hospital Revenue Mix
Hospitals face changing payment mixes due to:

  • High volume of Medicare usage by an aging population, notably the Baby Boomers.
  • Increased numbers of Medicaid patients, in part, a result of the Affordable Care Act (ACA) Medicaid expansion.
  • Decreasing reimbursements from commercial payers.

With payments for quality on the line, hospitals have a strong incentive to keep these populations on the preventive continuum of care, especially those most at risk for costly chronic health conditions like diabetes. 

Hospital Readmissions
There’s no doubt that hospitals with successful readmissions rates have leveraged big data to do so. This requires using data for proactive patient care, including using data platforms that can detect harmful drug side effects and interactions so pharmacists can assist doctors in tailoring a patient’s drug regimen to optimize its therapeutic effect while mitigating risk.

Feeling the Squeeze
Given changing revenue mixes, managing hospital readmissions and much more, it’s a rare hospital that’s not feeling the squeeze these days. Let’s look closer at how data can support preventive care, thus helping fuel success in a value-based model.

Before we jump in, we want to acknowledge what we all know and are watching unfold – it’s hard to say what will happen with ACA in the current political climate. If ACA is repealed, it’s also unclear what will emerge in its place. It does remain reasonable, though, to assume that a payment for outcomes versus payment for service model will likely continue to shape the healthcare industry.   

Quality Measures
For years, providers have submitted quality measures for programs such as Hospital Inpatient Quality Reporting (IQR), Hospital Outpatient Quality Reporting (OQR) and Physician Quality Reporting System (PQRS). Now these measures are tied to penalties and incentives. There is an opportunity here to leverage these quality and performance measures at a population health level – recognizing trends in vulnerable populations – for prevention. This will, however, require data tools in the form of sophisticated data analytics and data warehousing.

Precision Health
At a more granular level beyond broader population health, integrating healthcare data across data silos can allow hospitals to be more predictive and capture similarities across defined patient populations and at the individual level for more personalized risk profiling. The idea of precision health is the ability to narrow down to very specific segments of a population. Being able to predict risk at this more granular level will allow for proactive preventive treatment and improved cost management.

Claims Data and Preventive Healthcare
While we are in the business of providing healthcare claims data analytics, we recognize that claims data is a piece of the larger data puzzle for preventive healthcare. Integration of various forms of data for business intelligence and improved care may be the only way hospitals can weather shifting payment mixes, care models, penalties and more.

With Medicare setting clear goals for 90 percent of all payments to be tied to quality or value by 2018, healthcare data integration is a must to achieve this goal and bend the cost curve. Cloud technology and warehouse-based big data and analytics platforms are an investment for a hospital system. But without them, there will simply be no way to gain the insights hospitals need for success in preventive care or more broadly across their care outcome and business goals.

Jennifer Zweifel serves on INTELLIMED’s leadership team as chief financial officer, a role she has held for 21 years. Jennifer is an Arizona State Graduate. In her spare time, she enjoys cooking, reading, dancing and travel.

Congress’ Tax Bills: The Impact on Healthcare and the Affordable Care Act
healthcare data, preventive care
Healthcare Data and Preventive Care: A Pathway to Success in Value-Based Healthcare