Yesterday Congress passed — and President Trump will soon sign — sweeping changes to the nation’s tax code. The final outcome for hospitals and health care is mixed. The congressional calendar for the remainder of the year remains packed with items important to the hospital community, including extending CHIP, preventing deep cuts to the 340B program and finalizing Medicare payment extensions. Once again, some in Congress will push for Medicare hospital payment cuts to offset the cost of these initiatives. We will strongly oppose these proposals.
It’s likely that action on Medicare extenders — i.e. extensions of the low-volume payment adjustment, Medicare dependent hospital status, and the rural ambulance and home health add-ons — will be pushed into 2018. Sen. Murray and Rep. McMorris Rodgers will be in the thick of these fights. WSHA will continue to communicate with our delegation to advocate for positive outcomes on all of these issues.
In the tax bill, we are pleased the conference agreement preserves tax-exempt private activity bonds for qualified 501(c)(3) hospitals. PABs are a critically-important source of low-cost capital financing and enable communities throughout the state to maintain a health care infrastructure that ensures access to high-quality care. WSHA and its members advocated extensively with members of the Washington delegation to preserve PABs.
We are also pleased that the agreement preserves medical expense deductions for patients with high medical costs. However, we are disappointed that the tax bill includes repeal of the Affordable Care Act’s mandate that individuals maintain health insurance coverage. We are also disappointed the final bill includes elimination of advance refunding of existing tax-exempt bonds with new tax-exempt bonds. Advance refunding of existing tax-exempt bonds with new tax-exempt bonds has been an important tool for hospitals to lower their costs by refinancing existing debt at lower interest rates.
It is unfortunate that overhauling the tax code will erode health coverage for many in the communities we serve. The number of Washingtonians lacking health insurance has plummeted under the ACA. (Chris Bandoli and WSHA Federal Lobbyist John Flink)