Bill Overview
Title: Medical Care Equity Act
Description: This bill allows a tax deduction for the unreimbursed Medicare-based value of qualified charity care (i.e., physicians' services furnished without expectation of reimbursement, including medical screenings and treatment for emergency medical conditions and labor-related treatments). The bill also specifies that a physician is not liable under federal or state law for harm caused by an act or omission of the physician, or attending medical personnel supporting the physician, if the act or omission (1) occurs in the course of furnishing charity care, and (2) was not grossly negligent. The bill preempts laws of a state or locality that are inconsistent with this exemption, unless the laws provide greater protection from liability for a defendant.
Sponsors: Rep. Higgins, Clay [R-LA-3]
Target Audience
Population: People involved in providing and receiving charity care
Estimated Size: 31000000
- The legislation primarily affects healthcare providers who offer charity care, as it enables them to deduct unreimbursed Medicare-based value of such care from taxes.
- Patients who receive charity care, which includes medical screenings and treatments for emergency medical conditions, do not directly interact with the tax aspects but benefit from potentially increased willingness of providers to offer free care.
- The legislation affects state legal systems due to the preemption of inconsistent state and local laws, potentially limiting malpractice liabilities for physicians regarding charity care.
- Charity care is a common practice in the US healthcare system, particularly in hospitals, and this could lead to more physicians participating in charity services.
Reasoning
- We need to simulate a population mix that would be both directly and indirectly affected by the policy: healthcare providers, patients receiving charity care, and general public.
- Consideration of various locations and demographics that represent both urban and rural populations is important.
- The estimated 30 million uninsured people may not all receive charity care, so the actual impact might be on a smaller group within that population.
- Budget limitation requires that we limit the intensity of impact, since not all uninsured or underinsured can be served under the given financial boundaries.
- Legal exemptions could have a broader psychological impact on healthcare providers, influencing their willingness to provide charity care.
Simulated Interviews
Emergency Room Doctor (New York, NY)
Age: 34 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- This policy might encourage more physicians like me to engage in charity care, knowing there's a tax deduction and limited legal liabilities.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 9 | 7 |
| Year 10 | 9 | 7 |
| Year 20 | 9 | 7 |
Uninsured Construction Worker (Kansas City, MO)
Age: 29 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- If more doctors are willing to offer charity care, I might finally get some of my health issues addressed.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 8 | 4 |
| Year 20 | 7 | 4 |
Hospital Administrator (Austin, TX)
Age: 45 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 5/20
Statement of Opinion:
- Reducing potential lawsuits is a big win. We might expand our charity care programs as a result.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 6 | 6 |
| Year 20 | 6 | 6 |
Retired Veteran (Birmingham, AL)
Age: 60 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- It's comforting to know that the folks helping me are also getting something back for their trouble. I might worry less about my next medical emergency.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
Pediatrician (Seattle, WA)
Age: 52 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 10.0 years
Commonness: 9/20
Statement of Opinion:
- Getting a tax break for what I was already doing is a nice bonus. It makes offering free care more sustainable.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 8 | 7 |
Nurse Practitioner (Rural Tennessee)
Age: 40 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 8.0 years
Commonness: 10/20
Statement of Opinion:
- Fewer worries about gettin' sued will make it easier to keep seeing uninsured folks without losing sleep over it.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 6 |
Retired Engineer (Phoenix, AZ)
Age: 67 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 15/20
Statement of Opinion:
- Doesn't really affect me, but I'm glad doctors who help the less fortunate will be getting some help too.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Health Policy Analyst (Chicago, IL)
Age: 38 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 4/20
Statement of Opinion:
- This act is a step in the right direction to increase healthcare access, though its reach may be limited without additional funding.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Uninsured Part-time Worker (Miami, FL)
Age: 26 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 20.0 years
Commonness: 6/20
Statement of Opinion:
- If more hospitals offer free care, I might finally see a doctor without fear of bills.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 5 | 3 |
| Year 5 | 6 | 3 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 3 |
Lawyer (San Francisco, CA)
Age: 49 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 9/20
Statement of Opinion:
- Reducing liability for charity care is a double-edged sword; it's good for encouraging charity work but may reduce protection for patients.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Cost Estimates
Year 1: $5000000000 (Low: $3000000000, High: $7000000000)
Year 2: $5050000000 (Low: $3030000000, High: $7070000000)
Year 3: $5100500000 (Low: $3060300000, High: $7140700000)
Year 5: $5202025000 (Low: $3121803000, High: $7274707000)
Year 10: $5522761500 (Low: $3314382330, High: $7714928900)
Year 100: $8910055630 (Low: $5346033378, High: $12477077882)
Key Considerations
- The cost estimates are sensitive to the adoption rate of the tax deduction among eligible physicians and the average value of charity care provided.
- Legal and liability shifts could alter the number of physicians willing to provide charity care, affecting near-term dynamics.
- Monitoring of the ripple effects in the health and insurance sectors is essential to understand the broader impacts.