As the Senate gears up to vote on its tax bill this week, experts warn that the changes could negatively impact low-income patients' health outcomes.
Of particular concern are elements that would eliminate the individual mandate, according to an article from The Commonwealth Fund. The healthcare elements of the tax bill are virtually the same as the summer's failed "skinny repeal" bill, which the Congressional Budget Office estimated could lead to higher premiums in the individual markets and millions more people without insurance.
Healthcare industry groups urged Congress to reconsider the provision, saying it could further destabilize the Affordable Care Act's insurance exchanges.
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But the elements of the tax bill that do not directly touch on healthcare could also lead to worse healthcare outcomes for the poor, according to The Commonwealth Fund. Tax cuts included in the bill would, over time, actually reduce the incomes of the poorest people.
Americans earning less than $75,000 a year would pay higher taxes by 2027. People making less than $10,000 would, on average, see their federal taxes increase by $182 each year until 2027, while people earning $1 million or more per year would see their taxes decrease by $6,800 a year on average over the next 10 years.
Income plays a role in health outcomes, according to the article. Men in the highest 1% of incomes live on average 15 years longer than men in the poorest 1%, and for women the gap is 10 years. Rich people also report better health when compared to the poor.
"The Senate tax bill is not only a tax bill, it’s also a healthcare bill," according to the article. "Its passage would lead to poorer health and more inequality."
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The healthcare industry doesn't put as much of a focus as it could on issues like socioeconomic inequality and the role those problems plan in patients' health. The investment to both address socioeconomic problems and public health concerns would likely be significant—and may come too late—but there is still much the healthcare industry can do, says healthcare futurist and consultant Ian Morrison, Ph.D.
Looking at incomes, though, he said, can help providers and public health agencies focus population health initiatives.