GOP tax plan fuels anxiety in U.S. health care system

WASHINGTON - Doctors, hospitals, patient advocates and others who work in the nation's health care system are growing increasingly alarmed at the Republican tax bill, warning that it threatens care for millions of sick Americans.

The legislation - which GOP leaders are rushing to pass this week - will eliminate beginning in 2019 the Affordable Care Act penalty on consumers without health coverage, a move many experts warn will weaken insurance markets in parts of the country.

The bill, which includes huge tax cuts for corporations, may also force tens of millions of dollars in cuts to the Medicare program under federal budget rules, though congressional leaders say they are confident they can waive the rules as they have in the past.

Most worrisome to many, the bill will open a $1.5 trillion hole in the federal deficit over the next decade. That will put substantial new pressure on government health care programs such as Medicare and Medicaid and has already ignited a renewed Republican campaign to cut them back.

"This is a horrid bill," said John Baackes, chief executive of L.A. Care, a public insurance plan that covers more than 2 million mostly low-income residents of Los Angeles County.

"They haven't been able to repeal and replace (the health care law), so they'll attack it through the budget by looking for ways knock down the money that's needed to cover people."

The GOP tax package - which would reduce the corporate tax rate from 35 percent to 21 percent - may mean more money for drugmakers and for-profit insurance companies and hospital systems.

But across the country, dozens of health care groups, including every major physician association and patient advocacy organization, have urged GOP lawmakers to slow down and at least preserve the insurance requirement.

"This bill leaves too many patients behind and saddles millions more with higher premiums," said Harold Wimmer, chief executive of the American Lung Association, which was among 16 patient organizations that sent a letter to congressional leaders this month warning that the tax bill could erode sick patients' access to care.

The groups include the American Diabetes Association, the American Heart Association, the Cystic Fibrosis Foundation, the Arthritis Foundation, the March of Dimes, the National Multiple Sclerosis Society and the advocacy arm of the American Cancer Society.

Last week, the American Academy of Actuaries sent congressional leaders a similar warning that if the mandate is eliminated, "premiums would increase as a result, reducing affordability and eroding pre-existing condition protections."

At highest risk may be consumers in regions of the country where there are few insurers selling plans now and where premiums are already very high.

Republican leaders have dismissed the objections of health care groups and others, arguing that eliminating the penalty on people who don't get health insurance will remove an unfair government requirement.

GOP lawmakers have also rejected analyses by the nonpartisan Congressional Budget Office, independent economists and others that the massive tax cuts in the legislation will drive up the federal deficit. President Donald Trump and his congressional allies say the cuts will fuel economic growth.

But senior Republicans have made no secret of their interest in renewing a push to cut government health care programs next year to control the ballooning government debt.

"We're going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit," House Speaker Paul Ryan, R-Wis., said during a recent appearance on "The Ross Kaminsky Show," a conservative talk radio program in Denver.

Ryan has long advocated major changes to the federal Medicare program.

noam.levey@latimes.com

Credit: By Noam N. Levey - Washington Bureau - noam.levey@latimes.com

Caption: Medical providers fear the GOP tax plan will force major cuts to the health care safety net, such as Medicaid.

Don Bartletti/Los Angeles Times 2014