iProtean staff will be celebrating the holidays over the next two weeks. We hope you will celebrate as well! Enjoy your holiday season.
Very little has changed in the tax reform bill from our report in late November. Here is a summary.
- Republicans have agreed to preserve tax-exempt, municipal private-activity bonds as a way for hospitals and other not-for-profit organizations to raise capital for construction projects. But the final bill prohibits advance re-funding of prior tax-exempt bond issues. (These make up a significant portion of municipal bond activity.
- NFP organizations would pay a 21 percent excise tax on compensation to executives exceeding $1 million. Compensation paid to certain qualified medical professions for their medical services would be exempted. The American Hospital Association and others have argued they have to pay market rates for top management talent, and the proposed new excise tax would reduce resources for providing healthcare to their communities.
- The Affordable Care Act’s tax penalty for people who don’t buy health insurance would go away in 2019. The provision is strongly opposed by health insurers, providers and consumer groups. It is anticipated it would reduce the number of insured Americans by 13 million in 2027 and drive up average premiums each year by 10% more than they otherwise would rise.
Healthcare analysts warn that the tax cut bill overall will have big downstream effects on funding for Medicare, Medicaid, Affordable Care Act subsidies and other federal and state healthcare programs. That’s because the projected $1 trillion-plus increase in the federal deficit resulting from the tax cuts will pressure Congress to slash healthcare spending.
In addition, the Congressional Budget Office estimated that passing the tax bill would trigger an automatic $25 billion cut in Medicare in 2018 to offset the reduced revenue, under the pay-as-you-go rule.
(Source: “Final GOP tax cut bill has big loss and smaller wins for healthcare stakeholders,” Modern Healthcare, December 15, 2017)
Strategic Issues for Boards, iProtean’s latest advanced Mission & Strategy course, now appears in your library. It features speakers on cyber-security and the Medicare Access and CHIP Reauthorization Act of 2015—complex topics that stymie many of us! Martin Liutermoza, Global Head of Information Security at Nasdaq, discusses IT security and risk management as well preparing for and mitigating cyber attacks. Seth Edwards talks about MACRA and MIPS versus the Advanced Alternative Payment model.
Coming soon in your library: the advanced Governance course The Board’s Role in Leading Through Transition featuring Karma Bass and Marian Jennings.
For a complete list of iProtean courses, click here.
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