Letter to Congress on Proposed Tax Reform, Individual Mandate

November 15, 2017

The Honorable Paul Ryan
Speaker, U.S. House of Representatives

The Honorable Nancy Pelosi
Minority Leader, U.S. House of Representatives

The Honorable Mitch McConnell
Majority Leader, United States Senate

The Honorable Chuck Schumer
Democratic Leader, United States Senate

via electronic communication


Speaker Ryan, Leader McConnell, Leader Pelosi, and Leader Schumer:

On behalf of the Association for Community Affiliated Plans (ACAP) and the 61 Safety Net Health Plans and 21-plus million Americans they serve, I write to express strong concerns about the Tax Cuts and Jobs Act. We are particularly concerned about the impact that these changes will have on health care for low-income and medically-needy populations in America.

ACAP has concerns about policy that is currently included in the House and/or Senate legislation:

  • The repeal of the Affordable Care Act’s individual mandate will send the health care marketplace into a death spiral and increase the number of uninsured Americans by 13 million over the next 10 years according to the Congressional Budget Office. In addition, it may discourage necessary coverage for millions of Medicaid-eligible indviduals.
  • The elimination of the personal medical tax deduction will increase taxes for people who use the deduction to pay for high-cost patients who receive Medicaid coverage, particularly those in institutions and who have complex health care needs.
  • The elimination of the state and local tax deduction may force states and localities to cut their tax revenues, leading to cuts in state support for Medicaid, other state-based coverage programs, and state- and locally-funded social supports for low-income, high-need populations.
  • The addition of $1.5 trillion to the national debt may be used to justify future cuts in federal coverage payments for Medicaid and Medicare, or for future cuts to non-defense discretionary spending that will undermine coverage programs, essential community health care providers and other social supports.

While ACAP recognizes that this legislation is in the midst of the legislative process, we raise these issues now and urge members to consider their impact on health care for nearly 86 million Americans who receive coverage through Medicaid and the health insurance exchanges.  If these issues are not addressed in the final version of the bill, ACAP will be forced to oppose final passage of this legislation.


Margaret A. Murray
Chief Executive Officer