What the proposed tax cut bills may mean for Mississippi’s healthcare

By Ryan Kelly –

Tax reform has long since been a goal of Republicans since the election of President Trump, and it appears that the House and Senate have found common language with enough votes to pass (down party lines).

The legislation, which will provide substantial tax breaks to individuals in all tax brackets (except for those not currently paying taxes), may increase the federal deficit by $1.5 trillion, according to the Congressional Budget Office.  House and Senate Republicans are anticipating increased tax receipts to make up the shortfall.

It is this deficit, along with provisions to effectively eliminate the individual mandate for health insurance,  that is causing some in the healthcare community heartburn.

In my investigation into what is likely going to make it into a reconciled House/Senate bill, I became nauseous at the lies, mistruths and propaganda put out about the bill.  It’s times like these that I wonder if there are any national news sources that are unbiased any longer.

So, instead of citing any source out there, I’m simply going to tell you the good and the bad of what I think will happen.  Please keep in mind, regarding “the good” and “the bad,” this is in my point of view.  And, this relates only to how it will affect healthcare both directly and indirectly.

The Good

The tax cut will benefit all Americans of all economic tax brackets, with the exception of the lowest tier, who do not pay taxes.  This will ideally free up extra dollars that can be saved and used toward healthcare as needed.

The tax cut will allow medical professionals (who normally fall in the middle class) to receive substantial tax breaks and eliminate the inheritance tax, which is essentially a double tax on already taxed dollars.

The tax cut will likely eliminate the tax penalty on the individual mandate for health insurance, which will allow individuals to self-pay or find more affordable coverages as they come online soon.  I see this a positive due to the very high premiums that many must pay with no ability to meet the high deductibles.  But…

The Bad

The tax cut, by eliminating the penalty for not having a health insurance plan, will likely destabilize the health insurance marketplace to some degree, causing premiums to continue to increase from unreasonably high levels to absurd levels.

The tax cut will likely prompt Congress to find additional cuts to entitlement programs, which will likely focus on Medicare and Medicaid.  It will almost certainly create a necessary cut to both, with Medicare possibly receiving a phased-in age of benefit increase for future generations (which was probably coming sooner or later anyway).

Perhaps the worst provision that I see is actually not with any of the above, but it’s with the rollback of tax-exempt municipal bond financing for capital projects undertaken by not-for-profit hospitals and other qualifying not-for-profit organizations. It would prohibit advance re-funding of prior tax-exempt bond issues.  This may prevent rural hospitals from having access to the bond market and force them to rely more heavily on conventional loans, which often carry higher interest and are more difficult to come by (thanks in large part to Dodd Frank).


I think it’s safe to say that it will have at least a moderate level of impact to the insurance marketplace, to consumer choice, and to hospital financing.  Whether this ends up being a catalyst for positive or negative change remains in the details and the rollout of the new provisions.

My suggestion for providers – stay flexible and prepare to change as needed.  My suggestion to consumers – find a health insurance plan that works best for you, and either create an official Health Savings Account (HSA) or start your own savings account to be used just for healthcare needs in case of emergencies.  These are all things we should be doing anyway, but it may be even more important moving forward.

State Representative Stacey Wilkes is Recipient of the One Rural Award

State Representative Stacey Wilkes, District 108, was recently recognized by the Mississippi Rural Health Association as the recipient of its One Rural Award before an audience of more than 180 healthcare professionals at its 22nd Annual Conference in Jackson. Wilkes earned this award due to her consistent support of healthcare legislation, particularly due to her support of policy that would support hospitals like Poplarville’s Pearl River County Hospital.

Ryan Kelly, executive director of the Mississippi Rural Health Association states, “Rep. Wilkes has worked both personally and professionally to support healthcare in Mississippi. Coming from a rural community, she fully understands the challenges that we face with delivering quality healthcare to a unique population under less than favorable economic conditions. Her dedication to making positive improvements while bringing all stakeholders to the table make her the ideal candidate for this prestigious award.”

State Senator Angela Hill, District 40, introduced Wilkes for her award with remarks including her personal and professional relationship with Wilkes as well as the need for those elected office that share the heart and values that we all have for our communities.

Rep. Wilkes won a special election in 2017 to fill the recently vacant House seat previously held by Mark Formby, who was appointed by Governor Phil Bryant to a state position. Wilkes, a native of Pearl River County, is married to Rodney Wilkes and resides in Picayune.


Sen. Roger Wicker Recognized as MRHA National Legislator of the Year

U.S. Senator Roger Wicker was recently recognized by the Mississippi Rural Health Association as its National Legislator of the Year before an audience of more than 180 health care professionals at its 22nd Annual Conference in Jackson. Sen. Wicker has supported multiple pieces of healthcare legislation in the past year, including those that supported the stabilization of rural hospital and rural health clinic payment methodologies, the 340(b) prescription drug program, telehealth, opioid abuse, colorectal cancer screenings, rural broadband access and new strategies for delivering rural healthcare.

Ryan Kelly, executive director of the Mississippi Rural Health Association states, “Sen. Wicker and his staff have done a superb job at supporting rural health in Mississippi. He is eager to support positive legislation that benefits Mississippi’s health infrastructure and policies in order to allow providers and facilities to take greater leadership roles at improving our citizens’ health Outcomes.”

Sen. Wicker has supported and co-sponsored multiple pieces of healthcare legislation over the past several years, most notably supporting telehealth. Other legislation has supported the creation of new models of healthcare, stabilizing rural hospital and rural health clinic payment methodologies, opioid abuse, colorectal cancer screenings, rural broadband access, Representing Mississippi in the US Senate since 2007, Sen. Wicker has held multiple leadership roles in the Senate and with the Republican Party. Prior to his service in the Senate, Wicker was elected seven times, beginning in 1994, to represent Mississippi’s First Congressional District in the House of Representatives. Before being elected to Congress, he served in the state Senate on behalf of Lee and Pontotoc counties.A native of Pontotoc, Mississippi, Sen. Wicker is married to the former Gayle Long of Tupelo, where they currently reside.


Susan Campbell Recognized with MRHA Distinguished Leadership Award

Susan Campbell, director of clinic operations at Rush Health Systems, was recently awarded the Mississippi Rural Health Association’s Mary Anne Sones Distinguished Leadership Award before an audience of more than 180 healthcare professionals in Jackson. The Mary Anne Sones Distinguished Leadership Award is presented to one individual each year who has not only achieved significant professional accomplishments, but has demonstrated consistent leadership and dedication to the Mississippi Rural Health Association. Rush colleague Sharon Turcotte introduced Campbell for the award. Ryan Kelly, executive director of the Mississippi Rural Health Association states, “Susan is an outstanding leader for our Association and has contributed in a multitude of ways. She is not only an outstanding colleague, but she is a good friend and we are very proud to be able to present her with the Association’s top leadership award.” Campbell has been an active member of the Association since 2009, serves as the immediate past president of the Association, was among the first hold its prestigious Fellow designation, and has led and participated in multiple committees and conferences. She and her husband Brad Campbell reside in Livingston, Alabama.


Sam Mims Recognized as MRHA State Legislator of the Year 

State Representative Sam Mims, District 97, was recently recognized by the Mississippi Rural Health Association as its State Legislator of the Year before an audience of more than 180 healthcare professionals at its 22nd Annual Conference in Jackson. Mims earned this award due to his consistent support of healthcare legislation, particularly that which supported rural hospitals and other rural healthcare providers.

Ryan Kelly, executive director of the Mississippi Rural Health Association states, “Rep. Mims has been a champion of rural healthcare for many years. Serving as the chair of the House Public Health and Human Services committee, he has led many efforts to improve healthcare, including the support and stabilization of Mississippi’s rural hospitals.”

Speaker of the House Phillip Gunn, District 56, introduced Mims for the award with remarks including his personal and professional relationship with Mims as well as the leadership and professionalism that he believed the representative brought to the legislature.

Mims, a native of McComb, was elected to the Mississippi House of Representatives in 2004. He is married to the former Amy Legg of Summit. They are the parents of two daughters and one son. They are members of Centenary United Methodist Church in McComb.


Meaningful Measures

By Ryan Kelly –

Seema Verna, administrator of the Centers for Medicare and Medicaid Services (CMS), announced yesterday (Monday, October 30th) that CMS will make an even greater shift from fee for service payments to quality based payments.  CMS has been working on making this shift for several years now, focusing on Meaningful Use, MACRA, and many other quality-based areas.  This has prompted commercial insurers to do the same.

But, this recent shift at CMS may be geared as much to the ‘deregulatory’ mantra of the Trump administration than it is anything.

The new focus, called Meaningful Measures, will allow providers to assess core issues that are most vital to providing high-quality care and improving patient outcomes.

“We need to move from fee-for-service to a system that pays for value and quality—but how we define value and quality today is a problem,” said Verma. “We all know it –  Clinicians and hospitals have to report an array of measures to different payers. There are many steps involved in submitting them, taking time away from patients. Moreover, it’s not clear whether all of these measures are actually improving patient care.”

It appears that the overall goal of this new program is to give providers more flexibility in innovation and patient engagement and minimize administrative burdens associated with the Medicare Access and Chip Reauthorization Act.

“Our overall vision is to reinvent the agency to put patients first.  We want to partner with patients, providers, payers and others to achieve this goal,” said Verma.

The Mississippi Rural Health Association will continue to monitor this new development and provide the appropriate level of training associated with it so that all of our providers and facility staff can be well aware of the changes before they happen.

President Trump Signs Executive Order for ACA Modification

By Ryan Kelly –

A Wall Street Journal article today well captures the changes announced by the White House yesterday: View Article

I won’t add any additional detail to the article as it lays out both sides of the argument nicely.  What I will say is that healthcare professionals and community members have all remarked how poor our marketplace is at the moment.  Not the fault of the insurers participating, ACA regulations have forced bloated insurance plans at unaffordable costs.  But, these plans still do not provide full coverage, resulting in a large increase in ‘bad debt’ patricianly among our state hospitals.  Reform is needed in one form or another.  And, this is a belief that is shared by elected officials on both sides of the isle.

It seems as though the identified reforms will be enforced by appointed agencies (CMS, HHS, etc), so it’s a big early to tell the specific impact.  But, considering the challenges that most of our population has had with the marketplace, any change could be a good thing so long as it does not significantly cause negative disruption in the overall healthcare system.

Just my two cents anyway…