House Republicans have unveiled their tax reform proposal, and a number of provisions within the bill could impact providers.
Perhaps most strikingly, the bill (PDF) proposes cutting a decades-old tax deduction for people with extremely high medical expenses. The deduction, which was first established in World War II, applies to people whose medical expenses make up 10% of their adjusted gross income.
But the American Hospital Association said that the bill's effect on hospitals could be significant as well. In a statement, Tom Nickels, the AHA's executive vice president for governmental relations and public policy, said the Tax Cuts and Jobs Act would eliminate hospitals' access to capital financing through tax-exempt bonds and would impose a 20% excise tax on the pay of some hospital employees.
"For many communities, tax-exempt financing, such as private activity bonds, has been a key to maintaining vital hospital services," Nickels said. "If hospital access to tax-exempt financing is limited or eliminated, hospitals' ability to make new investments in new technologies and renovations in the future could be challenged."
The excise tax would be imposed on tax-exempt hospitals with employees making more than $1 million a year, according to the bill. Nickels said the AHA is "concerned" about the proposal, as there is already a "rigorous process" with the Internal Revenue Service for setting up executive pay.
Healthcare CEO compensation under the Affordable Care Act skyrocketed to $9.8 billion. Though revenues are up, spending on charity care at some of the nation's largest hospitals has decreased, according to an investigation from Politico.
The AHA commended the House bill for maintaining tax exemptions for nonprofit hospitals but did express concern about eliminating the medical expenses deduction.
"As Congress engages in the important work of reforming the nation’s tax code, we urge them to retain tax code incentives and fair treatment for hospitals that continue to work to provide access to healthcare in communities all across the country," Nickels said.
There are provisions in the bill that could benefit hospitals, too. The House bill proposes slashing the corporate tax rate from 35% to 20%, which could be a boon to profitable providers.
The goal, according to a fact sheet (PDF) from the House Ways and Means Committee, is to reduce the tax burden on businesses of all sizes and across industries. Committee Chairman Kevin Brady, R-Texas, said in a statement that the bill delivers on long-promised Republican goals.
"We made a promise to deliver tax reform that creates more jobs, fairer taxes and bigger paychecks," Brady.
But Democrats warned that the tax cuts could be used as a means to cut back on spending for entitlement programs like Medicare and Medicaid, another trend providers should watch as the bill moves forward. In a statement, Sen. Patty Murray, D-Wash., said that the GOP is just paying lip service to low- and middle-income families.
"If anyone was still under any illusions that Republicans were concerned about the deficit or debt, that should end today," she said. "This massive tax cut for the rich would add trillions of dollars to the national debt, allowing Republicans to then come after Medicare, Medicaid, Social Security and other middle-class priorities."