On Wednesday, December 20, Congress passed the Tax Cuts and Jobs Act (TCJA). There were several health-related changes included in the legislation, such as a repeal of the Affordable Care Act’s individual mandate, and changes to the medical expenditure tax deduction. Below we explain the key health provisions that made it into the final law, how it may impact you, and what’s next.
让我们从个人强制开始。
What is the individual mandate?
The individual mandate was established by the Affordable Care Act and requires individuals to have health insurance or face a tax penalty.
为什么废除个人强制医保令人担忧?
According to the latest Congressional Budget Office (CBO) estimates, up to 13 million Americans could lose coverage if the individual mandate is repealed. The mandate was a cornerstone of the Affordable Care Act because it created an incentive for younger, healthier people to have health insurance, which balances the overall risk pool, lowering health costs for everyone. Without the individual mandate, it’s possible that a smaller number of healthy people carry health insurance, which could lead to higher premiums and out-of-pocket costs. In particular, those with chronic diseases and others who rely on regular, on-going access to care may be disproportionately affected.
When would this go into effect?
The repeal of the tax penalty would go into effect for the 2018 tax year, which means when you file taxes in early 2019 you would not be required to pay a penalty for not maintaining health coverage.
How will this impact states in 2018?
随着强制保险的废除，帮助稳定个人保险市场的政策选择将在很大程度上落在各州身上。2018年，各州可能会寻求通过自己的个人强制要求，要求个人购买医疗保险(马萨诸塞州是目前唯一一个有个人强制要求的州)。各国还可以采取其他办法，鼓励健康的人投保健康保险，并平衡风险池。
我能做些什么来改变我的状态?
Connect with your state legislators and insurance commissioner to make your voice heard. Legislators have the authority to pass laws such as individual mandates, and insurance commissioners have the authority to regulate the health care marketplace and enforce existing laws. To find your state elected officials, use the look-up tool on ourlegislative action center, and to find your insurance commissioner, visit your state’s Department of Insurance website.
现在我们来谈谈税单中包括的其他健康条款。
Does the bill change the medical expenditure deduction?
Yes, the legislation reduces the medical expense deduction to 7.5 percent of an individual’s gross income. This threshold rises back to 10 percent beginning in 2020.
When does the change take effect?
The change would officially go into effect for the 2018 tax year, which means it would affect you when you file your taxes in early 2019.
Finally, let’s talk about what’s next.
关节炎基金会正在做些什么来解决废除个人强制令的潜在后果?
The Arthritis Foundation supports bipartisan legislation introduced by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) that seeks to stabilize the individual insurance market. We have signed ontostatements and letters最近的12月20日，他呼吁降低消费者费用，稳定个人保险市场。We stand ready to work with Congress to advancebipartisan solutionsto strengthen the health care system.
What is the status of the Alexander-Murray bill?
There are ongoing conversations about including the bill in the fiscal year 2019 legislation early next year. However, as Congress wraps up legislative business for 2017, this development is subject to change.
What can I do to make a difference?
联系你的联邦代表和参议员，让他们听到你的声音!Use the look-up tool on ourlegislative action centerto find your elected officials and to share your story.
For additional questions or comments, contact our Advocacy & Access department atadvocacy@arthritis.org.
I suffer with severe osteoarthritis throughout most of my joints with my significant pain now in both shoulders. Even after I have had one shoulder replaced the pain can be extreme. To try and control pain I’m taking strong long acting and a low dose Rx for break through pain. In my life controlling pain is a large issue. What is the organization’s position on pain control with opiates or nerve controlling medicine like Lyrica? So many states have gone over board with control of pain Rx the real users are suffering!
Yes, I would like to see advocacy for opiods to remain a treatment option. Loss of access to medications that allow patients to have improved quality of life is essential… for saving lives. Pain is unrelenting, limiting, and it wears you down emotionally and physically. I’m able to work because I’m on an opiate. Prior to getting treatment, I feared that I was going to lose my job, be unable to remain financially independent, which would mean I would lose my insurance coverage. Opiods do work. Most patients do not abuse their medications or divert their scripts. Doctors need to be able to spend more time with patients to discuss the risks of addiction and that pain flare-ups mean that a patient should contact their doctor rather than take extra pills. I had this talk with a doctor… The doctor helped me understand that the pills were not meant to completely eliminate pain. He talked about realistic expectations and the goal of treatment to be improve function rather than eliminate pain. This is what’s needed. The system is broken but that doesn’t mean that pain patients should lose access to treatments or be forced into a position where they have to choose medical marijuana or no pain management at all. We need to preserve options and avoid one-size-fits-all treatment. Opiods have their place – they allow patients to engage in meaningful, purposeful activities that make life worth living (time with family, employment, some hobbies, social involvement/engagement).
Hello
Thank you for this blog. I hope you can also suggest that the powers that be that they can campaign for the tax deductions being provided to the rich, for example the estate tax reduction and use it to subsidise the health insurance premiums so that the individual mandate does not even have to be a topic of discussion. I have been to develop as well as developing countries and it still boggles my head on why healthcare is so costly. The real problem is the high cost of treating routine illnesses which increase the premiums for everyone. Anecdotally, it doesn’t seem to me that the US provides a level of care which is far better than any of the other countries for a flu or common cold. Yet a doctor’s visit for flu will cost more than $ 50 even to the health insurance with the negotiating power.