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Daily Archives: November 2, 2017

House Tax Bill Would Scrap Deduction For Medical Expenses

The tax bill unveiled by Republicans in the House on Thursday would not, as had been rumored, eliminate the tax penalty for failure to have health insurance. But it would eliminate a decades-old deduction for people with very high medical costs.

The controversial bill is an effort by Republicans to revamp the nationâs tax code and provide dramatic tax cuts for business and individuals. However, its future is not yet clear because Republicans, who control both the House and Senate, appear divided on key measures.

The medical deduction, originally created in World War II, is available only to taxpayers whose expenses are above Ǫ percent of their adjusted gross income.

Because of that threshold, and because it is available only to people who itemize their deductions, the medical expense deduction is not used by many people — an estimated 8.8 million claimed it on their 2015 taxes, according to the IRS.

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But those 8.8 million tax filers claimed an estimated $87 billion in deductions; meaning that those who do qualify for the deduction have very high out-of-pocket health costs.

“For many people, this is a big deduction,” said David Certner, legislative counsel for AARP, which opposes the change. AARP has calculated that about three-quarters of those who claim the medical expense deduction are 50 or older, and more than 70 percent have incomes $75,000 or below. Many of those expenses are for long-term care, which is typically not covered by health insurance. Long-term care can cost thousands or tens of thousands of dollars a year.

Sen. Ron Wyden (D-Ore.), ranking member of the tax-writing Senate Finance Committee, called the bill’s elimination of the medical expense deduction “anti-senior.”

But defenders of the bill say the elimination of the deduction should not be seen in isolation.

In an FAQ posted on the House Ways and Means Committee website, the billâ€s sponsors denied that the change would “be a financial burden.”

“Our bill lowers the tax rates and increases the standard deduction so people can immediately keep more of their paychecks — instead of having to rely on a myriad of provisions that many will never use and others may use only once in their lifetime,” the sponsors said.

Getting rid of many current deductions “is being done to finance rate cuts and increase the standard deduction and child tax credit,” said Nicole Kaeding, an economist with the business-backed Tax Foundation. So, for many tax filers, she said, “there will likely be offsetting tax cuts.”

On the other hand, those offsetting cuts almost by definition will not make up the difference for people with very large medical expenses, who are the only ones who qualify for the medical deduction.

“That’s why tax reform is hard,” Kaeding said.

Strikingly absent from the bill — for now — is any reference to the elimination of the tax penalty for failure to have health insurance. The so-called individual mandate is one of the most unpopular provisions of the Affordable Care Act, which Republicans failed to change or repeal earlier this year.

Sen. Tom Cotton (R-Ark.) is continuing to push language to add to the bill that would eliminate the penalty. President Donald Trump has added his endorsement via Twitter: “Wouldn’t it be great to Repeal the very unfair and unpopular Individual Mandate in ObamaCare and use those savings for further Tax Cuts,” he wrote Wednesday.

But while the president is correct that there would be savings from eliminating the mandate, the Congressional Budget Office has also estimated that millions more Americans would become uninsured as a result.

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House Republicans Aim To Yank Tax Credits For Orphan Drugs

As part of a sweeping tax reform bill, House Republicans on Thursday proposed eliminating billions of dollars in corporate tax credits that have played a key role in the booming “orphan drug” industry.

For more than three decades, pharmaceutical and biomedical companies have claimed a 50 percent tax credit for the cost of clinical trials on orphan drugs, or those that treat rare diseases affecting fewer than 200,000 people.

The credits were approved as part of the 1983 Orphan Drug Act, which has been under scrutiny in the past year as the country grapples with skyrocketing drug prices. Drugs that win special orphan status get a package of financial incentives, including the credits and seven years of market exclusivity. The drugs routinely have five-digit price tags and have become a sought-after market for drugmakers.

The National Organization for Rare Disorders (NORD) predicted, drawing from a 2015 report, there would be 33 percent fewer orphan drugs coming to market if the credit vanishes — “an unprecedented decrease in the development of these life-improving therapies,” NORD’s statement read. The group said advocates had sent over ᒴ letters to Congress in support of the credit.

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The powerful Biotechnology Innovation Organization, along with 20 drug companies such as Novo Nordisk, Horizon and Sanofi, wrote to Congress late last month urging them to keep the credit in the tax overhaul bill. BIO vowed Thursday to work with lawmakers to save the credit. If they fail, the repeal would be effective in January.

Yet, James Love of the think tank Knowledge Ecology International welcomed the potential repeal as a way to begin a conversation about “deeper reform” in the financial incentives for rare diseases.

Love noted that cancer drugs and “huge blockbuster drugs [have] qualified for orphan tax credit[s] … and certainly provided no relief from high prices.”

Earlier this year, the high prices caused one of the bill’s creators and champions, former U.S. congressman Henry Waxman (D-Calif.), to co-author a report that suggested restricting or replacing the tax credit in some manner.

A KHN investigation in January this year, which was published and aired by NPR, found that many drugs that now have orphan status aren’t entirely new. Of about 450 drugs that have won orphan approval since 1983, more than 70 were drugs first approved by the Food and Drug Administration for mass-market use. Those include cholesterol blockbuster Crestor, Abilify for psychiatric disorders and rheumatoid arthritis drug Humira, one of the world’s best-selling drugs.

In March, the Government Accountability Office confirmed it would investigate potential abuses to the law after Sens. Orrin Hatch (R-Utah), Chuck Grassley (R-Iowa) and Tom Cotton (R-Ark.) sent a letter to the agency, asking if the law needed to be changed.

This summer, the FDA announced an orphan drug modernization plan and promised to eliminate a backlog in drugs applying for the rare disease status. In a September update, FDA Commissioner Scott Gottlieb wrote he wants to ensure financial incentives are granted in a way that’s consistent with the manner Congress intended” when it passed the law decades ago.

Orphan drugs hit $36.1 billion in sales last year, according to a report released last month by QuintilesIMS and NORD. And, according to EvaluatePharma’s 2017 Orphan Drug Report, orphan drugs will account for nearly 22 percent of global prescription sales, excluding generics, by 2022.

With that growth, the cost of the orphan drug tax credits to the U.S. government also grows.

“A billion here and a billion there and eventually it’s real money,” said Nicholas Bagley, a law professor at the University of Michigan who has studied the credits.

In 2018, the U.S. is expected to grant nearly $2.8 billion in orphan drug tax credits to companies, according to estimates from the Treasury Department. And, the reduced tax revenue for the U.S. government increases every year, to total $75 billion from 2018 to 2027.

“Repealing this credit will effectively increase the cost of doing research on orphan drugs,” said Kathy Michael, an analyst with PricewaterhouseCoopers’ US Pharmaceutical & Life Sciences Tax Sector.

“It’s significant,” she said, adding that a number of companies have used the credit and that many have drugs in the pipeline that could qualify for the credit down the road.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

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Facebook Live: It’s ACA Sign Up Season. Here’s What you Need To Know This Year.

The open enrollment season for health insurance under the Affordable Care Act began this week. And a lot has changed for consumers who buy their own individual coverage through the health law’s state and federal marketplaces. For example, the sign-up period is shorter than it has been in the past. There also will be less on-the-ground assistance available to help them navigate the ins and outs of these online marketplaces. And that’s just the beginning. This live chat features KHN senior correspondent Julie Appleby answering questions about these changes and offering tips for consumers about how to shop around and compare options for the 2018 coverage year.

For more in-depth conversations with KHN reporters, check out our Facebook video archive.

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Poll: Americans Avoid Planning For Serious Illness

“I’ll deal with it tomorrow. The perpetual tomorrow.”

That’s what one person told a pollster, encapsulating how Americans avoid planning ahead for serious illness and death.

While the vast majority of Americans say it’s important to write down their medical wishes in case they become seriously ill, only a third have done so, according to the poll, released Thursday by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

When adults with serious illness don’t write down their wishes, family members are much less likely to know exactly what their loved one would want, and the adults themselves are less likely to feel their wishes are closely followed, the poll found.

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The poll surveyed a representative sample of 2,040 American adults by phone, including 998 with direct experience of serious illness in the family.

Americans 65 and older are more prepared than younger Americans but, still, only 58 percent in that age group have a written document outlining their medical wishes in case of serious illness, and 67 percent have documented who they want to make medical decisions on their behalf if they become incapacitated, the poll found.

The top reason people gave for avoiding these tasks is that “there are too many other things to worry about right now.”

The poll identifies differences across racial and ethnic groups:

Black adults 65 and older were far less likely than white and Hispanic counterparts to have written down their medical wishes.

Black and Hispanic adults were more likely than whites to cite “don’t want to think about sickness and death” as a major reason they didn’t document their wishes.

The poll also highlights challenges faced by seriously ill adults and their families. A seriously ill adult is defined as someone 65 or older who has a chronic condition, such as diabetes, asthma or heart disease, and also has functional limitations, such as difficulty eating, dressing or using the toilet. The findings include:

  • About half of adults with serious illness had trouble understanding instructions for medications and medical care in the previous year.
  • One in five family caregivers said no one can give them a break if they need it.
  • About a third of family caregivers said they did not receive any training on how to move their loved one safely, recognize signs of pain or distress, or administer medications.

“The one thing I would say, for my family members, I was able to show them how to wash hair, how to change the bed with the person in it, those things,” one caregiver told pollsters. “But it would have been so helpful if the hospital, community center, anybody, had offered some basic classes.”

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation.

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What The Health? How Confused Are We?

Open enrollment started with more of a whimper than a bang Nov. 1, as the Trump administration continued to talk down the health law it is required to operate. Meanwhile, on Capitol Hill, lawmakers continue to struggle to reach agreement on legislation to renew funding for the Children’s Health Insurance Program, which expired Oct. 1. And President Donald Trump™s commission on the opioid epidemic released its final report and recommendations.

In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Stephanie Armour of The Wall Street Journal, Joanne Kenen of Politico and Paige Winfield Cunningham of The Washington Post discuss these topics as well as possible health changes included in the emerging tax overhaul bill in Congress.

Among the takeaways from this week’s podcast:

  • Wednesday was a strangely quiet opening day for Obamacare enrollment. The administration had no special announcements or events — but former President Barack Obama released a video, and other interested groups, such as hospitals, insurers and brokers, may step in to try to encourage people to sign up.
  • Republicans continue to blame Democrats for problems with the Affordable Care Act, while Democrats say the GOP is strangling the law. This messaging war may prove critical for the 2018 midterm campaign.
  • Republicans are deeply divided about whether to include a provision in the tax reform bill that would get rid of the ACA’s individual mandate penalty. The provision would save the federal government money, but it would also result in millions fewer Americans with health insurance, according to the Congressional Budget Office. Among those urging its inclusion, however, is Trump.
  • Democrats may be between a rock and a hard place on the bill to fund the Children’s Health Insurance Program. They love that program, but Republicans want to raid the ACA’s public health prevention fund to pay for CHIP.
  • The administration released a proposed rule last Friday that could have significant changes in which health benefits are guaranteed for consumers buying coverage on the ACA marketplaces.
  • President Trump has yet to offer more money to fight the problem of opioid abuse, but many of the individual recommendations from his commission are being welcomed by the public health community.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

Julie Rovner: Kaiser Health News’ ’No One Is Coming’: Hospice Patients Abandoned At Death€™s Door,” by JoNel Aleccia and Melissa Bailey.

Stephanie Armour: Slate’s “Going Out With a Bang,” by Melissa Jayne Kinsey.

Joanne Kenen: Health Affairs†“Choosing Wisely Campaign: Valuable For Providers Who Knew About It, But Awareness Remained Constant,񎧞-2017,” by Carrie H. Colla and Alexander J. Mainor.

Paige Winfield Cunningham: Vox.Com’s “The fax of life,” by Sarah Kliff.

To hear all our podcasts, click here.

And subscribe to What the Health? onÂiTunes, Stitcher or Google Play.

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Viewpoints: Examining The ‘Planned Parenthood Divide’; Maternal Health Issues Are Back In The Spotlight

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Policy Perspectives: The Complexities Of Choosing A Health Plan; GOP Continues To Fumble On Health Care

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Longer Looks: Puerto Rico, The Opioid Emergency; And Alexander-Murray

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State Highlights: In Kansas, New Scrutiny Is Focused On Rural Hospitals’ ‘Profitable But Questionable Billing Schemes’; Minn. Vulnerable To Another Measles Outbreak

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Using Aspirin Long-Term Helps Dramatically Cut Risk Of Certain Types Of Cancer

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