With life expectancy gains down, tax bill will make things worse

The Republican tax bill approved by Congress this week will create financial headaches for millions of taxpayers trying to navigate all the new rates and rules.

But the legislation now headed for President Donald Trump’s signature also will have this grim impact: thousands of additional, preventable deaths every year.Where do I get this outlandish-sounding prediction? From Daniel Kim, a social epidemiologist and professor at Northeastern University in Boston. Kim has spent more than a decade studying the effects of income inequality on public health, and recently published a study comparing the impacts of a 2016 Trump campaign tax plan with one proposed during the presidential race by Senator Bernie Sanders of Vermont.

The Trump tax plan differs in some respects from the Tax Cuts and Jobs Act (TCJA), which was approved by Congress this week and is headed to the president for his signature. But Kim concludes its impact on mortality will be as bad or worse.

“All signs suggest that the tax bill will disproportionately benefit corporations and the wealthy, rather than the middle class,” Kim said. “And what we know from numerous health studies is that a wider gap between the rich and the poor means that more people will die unnecessarily.”

Rapid gains in life expectancy during the last decade have stalled. And the United States lags behind other wealthy nations in life expectancy.

Social epidemiologists like Kim study the impacts of our social and economic environments on health. Social determinants such as income inequality, poverty, and education shape our diets, attitudes toward smoking, and stress levels and are considered root causes of poor health and disease.

The TCJA mounts a direct attack on access to healthcare. For starters, it eliminates the Affordable Care Act individual mandate requiring people to have health insurance coverage. The Congressional Budget Office estimates that will mean 13 million fewer Americans with health coverage over the next 10 years – many of whom would have received inexpensive or free coverage via premium subsidies or Medicaid. Harvard University economist Larry Summers, who directed the National Economic Council under President Barack Obama, forecasts that the mandate repeal alone will translate into at least 10,000 more deaths annually – so we can add that to Kim’s projection of 30,000 deaths.

TCJA also will force automatic cuts to Medicare of $25 billion next year, and $400 billion over the next decade, under the Statutory Pay-As-You-Go Act of 2010. Republican lawmakers are promising to pass a waiver for those cuts, but the outlook on that is uncertain.

The automatic cuts would just be the start. The Republican agenda for 2018 calls for further “reforms” and cuts to Medicare, Medicaid and Social Security to offset the TCJA’s massive tax cuts.

Learn more in my column this week at Reuters Money.


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