Trump’s Tax Plan Is Seriously Bad For Our Health

After months of unsuccessful attempts to repeal the Affordable Care Act (ACA), Senate Republicans are at it again.

This time, they’ve added repeal of a key provision of the ACA to an already damaging tax bill.

The bill would force cuts to Medicaid, Medicare, and other programs that help everyday Americans to pay for massive tax cuts for the very wealthy and big corporations.

As an emergency medicine doctor, I’m more interested in patients than political games.

But repealing the individual responsibility provision would have real-world consequences for the patients who come into my emergency department in Los Angeles and for millions of Americans who are at risk of losing their health care if Congressional Republicans have their way.

The Congressional Budget Office (CBO) estimates that repealing this provision – which requires that everyone have health insurance if they can afford it – would take healthcare away from 13 million Americans and increase premiums by about 10 percent for millions more.

GettyImages-97630359 The Trauma Unit at the John H. Stroger Jr. Cook County Hospital, November 6, 2009 in Chicago, Illinois. Scott Olson/Getty

The individual responsibility provision is about increasing access to care by keeping premiums lower for all of us when younger and healthier people are included in the health insurance market.

Without this provision, increased premiums might put health insurance out of reach for lower-income Americans, and patients struggling to make ends meet may decide that their limited resources are better spent elsewhere – not foreseeing a health crisis that may be just around the corner. Too often I’ve seen patients delay coming in for routine care or treatment because they didn’t have healthcare coverage. Later, these same patients face much higher costs when a crisis forces them to go to the emergency room.  

Congressional Republicans may try to pass off repeal of this portion of the ACA as a cost-saving measure for working families, but it would actually increase health care costs for millions of families, and the rest of the tax bill makes it clear that they’re focused on reducing taxes for the very wealthy and corporations – not with Americans struggling to afford visits to the doctor.

Both the House and Senate versions of the tax bill would force trillions of dollars in cuts to Medicaid, Medicare, and other critical programs that help keep families healthy – all to pay for massive tax giveaways to millionaires, billionaires and corporations. The communities who need health care the most – children, seniors, and people with disabilities – will be among the hardest hit if these tax bills are passed.  

Every day in the emergency department, I see patients who have delayed care until the last possible moment because they don’t have health insurance, and they are afraid they won’t be able to afford care.

Earlier this year, I saw Joseph, a gentleman in his 50s, who came in to the emergency department because he couldn’t move his legs. Our work up revealed a metastatic cancer that had spread across his body, including his spinal cord, leaving him paralyzed.

As I talked to the patient, it was clear he had been having symptoms for at least a year, but I was the first doctor he had seen. When I asked him why he had waited so long to go to a doctor, a tear ran down his face and he looked away.

“I was scared,” he said.

“Scared to learn you might have cancer?” I asked.

“No, scared I wouldn’t be able to afford the bills. I knew deep down it was something bad, but I hoped that I would die peacefully, without being a burden to my family. Now that I can’t walk, they had to bring me in, and I don’t know how we’re going to afford it.”

Joseph’s story is heartbreaking. I want a future health care system where I never see patients like this again in my emergency department, but I fear the Republican tax plan will lead to millions more.

Making it even harder for families to afford the care they need, the Republican tax plan would increase taxes on millions of poor and middle-class Americans.

One of the ways is by eliminating deductions that working families depend on, like the deductions for state and local taxes and college loans, as well as the deduction for high medical expenses, which helps millions of families.

Meanwhile, the wealthiest 1 percent of taxpayers would enjoy an average tax cut of $62,000. And nearly 75 percent of tax cuts in the bill go to multi-national corporations and big pharmaceutical companies.  

For me, this issue isn’t about politics – it’s about my patients. Doctors like me are standing up against this tax bill – and against any attack on programs like Medicaid and Medicare that make healthcare more affordable for American families.

Elected officials are expected to consider the bill on the floor of the Senate as early as this week, and they should know that Americans will be watching very closely.

Kyle Ragins practices emergency medicine in Los Angeles at several emergency departments, including Olive View-UCLA Medical Center.

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