U.S. Capitol Building – Photo: Raul654, via Wikimedia.
Republicans have passed a sweeping overhaul of the nation’s tax code, approving a bill that permanently cuts corporate tax rates and temporarily cuts taxes for middle-income earners, but could potentially trigger spikes in insurance premiums and massive cuts to crucial health care programs.
The approval of a tax bill marks the first significant legislative victory for President Donald Trump, who has long advocated for reducing corporate tax burdens and repealing parts of the Affordable Care Act, specifically the mandate requiring Americans to purchase health insurance.
LGBTQ advocates slammed Republicans for passing the tax bill, focusing much of their criticism on the ripple effects that will be created by the repeal of the ACA mandate. Without the mandate, an estimated 13 million people are expected to leave the insurance market over the next 10 years.
The Human Rights Campaign was particularly harsh in its assessment of the tax overhaul bill, criticizing Republicans for limiting the number of hearings and passing the measure without seeking input from congressional Democrats.
“If the Trump-Pence tax scam becomes law, programs crucial to the LGBTQ community like Medicare, Medicaid, global HIV/AIDS programs, and the Ryan White Care Act will surely face future efforts to cut their benefits,” David Stacy, the government affairs director for the Human Rights Campaign, said in a statement.
By shrinking the pool of healthy individuals who are paying into the healthcare system through monthly premiums, the GOP bill would further restrict the amount of money available to care for those who are sick or injured.
In order to compensate for this reduction in available funds, providers will demand more and insurers will be compelled to raise premiums for everyone who has insurance.
In turn, lower-income people who cannot afford the higher premiums will likely be forced to drop their insurance, leading to poorer health outcomes long-term and creating a vicious cycle of ever-increasing health insurance costs.
The tax bill’s impact on health care access is particularly concerning for LGBTQ advocates, as 65 percent of LGBTQ adults with pre-existing conditions rely on the Affordable Care Act to get coverage, without which they could be charged higher premiums or denied coverage altogether for medically necessary care.
To pay for the significant tax cuts contained in the bill, Congress will likely have to make equally deep cuts in entitlement spending, including Medicare and Medicaid. (Some Republicans have even floated the idea of cutting Social Security, though that is more a decades-long Republican desire, and isn’t directly related to health care spending.)
Cuts to Medicaid are problematic for LGBTQ people, who experience higher rates of poverty than the general population and rely on Medicaid as an insurance of last resort.
Cuts to Medicare are concerning for those living with HIV, as Medicare is the largest funder of HIV/AIDS-related programs, constituting 30% of all spending on HIV detection and treatment efforts. As a result, any cut to Medicare would likely also cut programs that allow HIV-positive individuals to access life-saving yet costly medications.
Transgender people, in particular benefit immensely from Section 1557 of the Affordable Care Act, a provision that prohibits discrimination in health insurance markets based on a number of characteristics, including “sex,” which has typically been interpreted to include gender identity. Without this provision, gender-nonconforming or transgender individuals are more at risk of being denied coverage for transition-related care, such as hormones or gender confirmation surgery, which insurers, historically, have been only to happy to classify as “cosmetic” or “elective.”
On the tax side of the bill, LGBTQ Americans, particularly those who are transgender, people of color, or same-sex couples, are more likely than other Americans to fall in the tax bracket of people making less than $30,000 a year. Under the bill, those people will pay more in taxes. The bill also contains an expanded child tax credit that excludes low-income families.
“Congressional leaders rammed through a highly unpopular and dangerous bill under the false promise of a middle-class tax cut while intentionally ignoring the devastating effects this legislation will have on LGBTQ and low-income communities,” Sarah Kate Ellis, the president and CEO of GLAAD, said in a statement. “This scam tax bill will have serious consequences on the lives of our nation’s more marginalized communities, by directly targeting access to affordable and inclusive health care.”