The Republican backed tax legislation was approved in the Senate by a 51 – 49 margin in the early morning hours this past Saturday. With its passage, the bill now moves into a conference committee where Rep. Noem has been appointed to participate from the House and Sen. Thune is expected to be appointed from the Senate to reconcile the differences in the Tax Cuts and Jobs Act of 2017. The conference committee process is anticipated to move quickly as President Trump is pushing to have the final bill ready for his signature by the end of the year.
The Senate and House passed versions of the legislation each include provisions troubling for health care. The Senate version repeals the individual insurance mandate by eliminating the fee charged to those who do not have health insurance. It includes a hospital’s ability to access low-cost capital financing through tax-exempt private activity bonds, but it eliminates the ability of nonprofit hospitals to execute “advance refunding” of outstanding tax-exempt bonds. Also, the Senate version doesn’t include changes to the existing tax provisions allowing individuals or couples filing jointly to deduct qualified medical expenses that exceed 10% of their annual adjusted gross income.
The House version eliminates tax-exempt private activity bonds and advance refunding bonds. It also eliminates the deduction for large, out-of-pocket qualified medical expenses. Also, the House version did not include a provision to repeal of the individual insurance mandate. Negotiations have been underway behind the scenes, and will now move into the next phase in hopes of reaching a compromise and tackling outstanding funding issues.
The 115th Congress was originally scheduled to conclude by Dec. 15, however estimates now have them working through the end of year and possibly continuing into January 2018.