News

Our Ever-Changing Political Landscape

With so much change in the healthcare industry and with the government shutdown (which, as of 1 PM Pacific Standard Time today, was resolved, thanks in part to a compromise that keeps the government open for three weeks), many of you may have a healthy inventory of questions and thoughts. What still looms is consensus or even bipartisan trust that a deal will get done on the Deferred Action for Childhood Arrivals program, or DACA. There are 212,000 DACA recipients in Los Angeles County with the majority of kids coming from Mexico, El Salvador, Guatemala, Korea and the Philippines. The next few weeks will be another political soap opera that adversely impacts the lives of millions of Americans.

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Another hot topic is single-payer in California. The California Medical Association (CMA) launched a new coalition of more than 100,000 California physicians, dentists, nurse practitioners, community clinics and pharmacists to protect the gains California has made under the Affordable Care Act (ACA) and improve California's healthcare system.The Coalition to Protect Access to Care will actively oppose efforts in Washington, D.C., to repeal and replace the ACA, as well as provide a more realistic and responsible solution to California's SB 562 – flawed legislation that would dismantle the healthcare marketplace and destabilize the state's economy. The Coalition also seeks to tie the current federal and state healthcare debate to practical realities that healthcare providers experience throughout the state. According to the Public Policy Institute of California, nearly 60 percent of Californians view the ACA favorably, and only 18 percent want the law repealed. The Coalition will work with policymakers to protect and expand coverage to the remaining 2-3 million without access to care.SB 562 would eliminate Medi-Cal, Medicare, all private insurance and the Covered California exchange for a singular healthcare insurance product provided by the state, without offering any way to pay for it. This measure threatens the healthcare marketplace for millions of Californians and is based on erroneous assumptions regarding how California can utilize healthcare funds provided by the federal government. It also ignores the fact that the state does not have the same powers as the federal government to effectuate a single-payer system.

What's more, the Legislative Analyst's Office (LAO) found that the proposal could "require new state tax revenues in the low hundreds of billions of dollars" and "could result in a lower minimum funding requirement for schools and community colleges" under Proposition 98. In other words, SB 562 would pit healthcare groups against public education advocates in an annual battle for state budget dollars, forcing Californians to choose between quality education and quality healthcare – an unfair, irresponsible and unnecessary request. Let me know where you stand on SB 562.

In addition to CMA, Coalition members include the American College of Obstetricians and Gynecologists (District IX), California Association of Nurse Practitioners, California Dental Association, California Pharmacists Association, the Central California Partnership for Health and Kaiser Permanente.

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Next on the agenda is the new Tax Plan and its impact on physicians. Take-home pay is set to rise slightly under both tax plans put forward by congressional Republicans. But most Americans shouldn't expect to collect a ton of extra pocket money. According to a recent CBS poll, only 35% of Americans approve of the Tax Cuts and Jobs Act. Career site Zippia provided data breaking down how different occupations fare under the Senate's tax plan. Americans making around $200,000 to $500,000 would benefit less so from the proposed changes to the tax brackets and deductions. That also happens to be the income range many physicians fall within. I listed some examples, by specialty, and estimated federal tax savings for a single, childless taxpayer who claims the standard deduction.Here's a look at how medical doctors, from pediatricians to anesthesiologists, could see their taxes change:

Pediatricians Average salary: $184,240 Current tax: $41,657 Tax under the Senate plan: $36,856 Percent tax cut: 11.5%

Psychiatrists Average salary: $200,220 Current tax: $46,131 Tax under the Senate plan: $41,970 Percent tax cut: 9.0%

Family Practice Average salary: $200,810 Current tax: $46,297 Tax under the Senate plan: $42,159 Percent tax cut: 8.9%

General Internist Average salary: $201,840 Current tax: $46,585 Tax under the Senate plan: $42,488 Percent tax cut: 8.8%

Oral and Maxillofacial Average salary: $232,870 Current tax: $56,814 Tax under the Senate plan: $53,044 Percent tax cut: 6.6%

OB/GYN Average salary: $234,310 Current tax: $57,290 Tax under the Senate plan: $53,548 Percent tax cut: 6.5%

Anesthesiologists Average salary: $269,600 Current tax: $68,935 Tax under the Senate plan: $65,900 Percent tax cut: 4.4%

For tax planning and income protection advice, I encourage our members to contact Vasquez & Company, CPA, LLC, a LACMA preferred partner. Bruce Webb is our subject matter expert and his email is b_webb@vasquezcpa.com.