It can be hard to grasp the enormity of the tax bill the Senate is expected to pass this week. It’s multitrillion-dollar legislation that will reshape the American health care industry, offer huge new benefits to corporations, and set up a substantial across-the-board tax hike for the middle class starting in 2026.
Here are a few key numbers to remember when considering the bill’s likely effects:
61.8 percent of the tax cuts go to the top 1 percent in 2027
According to the Tax Policy Center (whose analysis does not include the health care changes in the bill), fully 61.8 percent of the total federal tax change under the bill will go to the top 1 percent in 2027, its 10th year of implementation. They would get an average tax cut of $32,510, and the top 0.1 percent (who make at least $5.1 million a year) would get $208,060 back on average.
That’s because the wealthy disproportionately benefit from cuts to the corporate income tax, and corporate tax cuts in the bill are permanent. However, individual cuts expire at the end of 2025. Meanwhile, certain tax hikes for individuals, like a change in the inflation measure used to adjust tax brackets, remain permanently. The result is a substantial across-the-board tax increase for Americans not rich enough to own stock, financing large corporate cuts that benefit the rich.
$1.4 trillion in lost revenue over 10 years — and maybe much more
To comply with Senate rules, the tax bill is written to not increase the deficit after 10 years. It does this principally by having all its benefits for individuals expire, with the understanding that future legislators should make them permanent before they do.
But within the 10-year window, the Joint Committee on Taxation has estimated the bill costs more than $1.4 trillion. That undercounts the likely real cost, if all the other provisions are actually extended, considerably. The Committee for a Responsible Federal Budget estimates that the true cost if everything is made permanent (as Republicans are promising) is $2.2 trillion over 10 years, and more after that.
Now, maybe you think that the deficit is currently too low, because interest rates on federal debt remain pretty low, the economy isn’t growing particularly fast, and adding some grease to the wheels to get things moving a bit faster would be a good idea. But even in that case, it’s worth asking whether a $1.4 trillion to $2.2 trillion expansion of the federal debt for the purpose of lowering corporate tax rates is the best use of that money from an economic growth perspective, compared to expanding subsidies for parents to help them work and raise kids, or investing in infrastructure.
13 million more uninsured people
This is the big one. The Congressional Budget Office has estimated that the tax bill’s repeal of Obamacare’s individual mandate will raise about $338 billion to pay for tax cuts focused at corporations — but will, in the process, lead to 13 million fewer people having health insurance by 2027; 4 million fewer will have insurance as early as 2019, when the provision takes effect.
The most immediate effects are on people with individual market insurance, including that subsidized by Obamacare, and people on Medicaid. The CBO finds that 3 million fewer people would have individual market insurance and 1 million fewer would have Medicaid in 2019 if the mandate goes away. Five million fewer each would have Medicaid and individual market coverage in 2027; the remaining millions are people with employer-based coverage who'd lose it.
Some Republicans defending the tax bill argue that the 13 million figure is exaggerated, that the mandate can’t possibly spur that many people to sign up. But there’s empirical evidence backing up the idea that it drives a significant number of people into health insurance.
Also notable that Massachusetts, which already had a mandate, saw a much smaller recent decline in the uninsured rate above 400% of the FPL. /4 pic.twitter.com/fcX5ouyY8Q— Matt Fiedler (@MattAFiedler) November 27, 2017
Matt Fiedler at the Brookings Institution looked at how enrollment in individual health insurance changed after the mandate took effect, focusing on Americans too rich to get Obamacare subsidies (so the only new reason they’d have to sign up is the mandate), and comparing people outside Massachusetts to those in Massachusetts, since the state already had an individual mandate. He found big increases in the share of people in this group insured outside of Massachusetts — but no similar increase in Massachusetts. That strongly suggests that the addition of the mandate made a big difference.
15,600 more deaths every year because people don’t have health insurance
When my colleague Julia Belluz dived into the evidence on the effect of health insurance on mortality, she found two particularly compelling studies, analyzing the effects that Massachusetts’s health reform law (which was very similar in structure to Obamacare) and Medicaid expansions in three states had on death rates. Extrapolating from those studies' findings, she found that 20 million people losing health insurance translates to anywhere between 24,000 and 44,000 extra deaths per year.
Using the smaller figure to be conservative, and extending it to the 13 million people who the CBO estimates would lose coverage under this tax bill, that means 15,600 extra deaths every year.
There is substantial uncertainty baked into these estimates, of course. But even if the figure is “just” 1,560 more deaths per year, 10 times smaller, that would still be very troubling. Which brings us to…
1,550 more people dead every year due to drunk driving and other alcohol-related causes
This is a less well-known provision of the bill, but Senate Republicans are proposing slashing federal alcohol taxes across the board by about 16 percent, a cut affecting beer, wine, and liquor alike.
There is voluminous economic evidence showing that higher alcohol taxes save lives by reducing binge drinking and thus reducing deaths due to drunk driving, liver cirrhosis, alcohol-fueled assault and domestic violence, and other causes. That suggests that lower alcohol taxes, in turn, increase deaths from those causes.
Adam Looney, an economist at the Brookings Institution, uses the best estimates from the economic literature to calculate that roughly 1,550 more people will die every year from alcohol-related causes if the alcohol tax changes in the bill take effect. Of those deaths, 280 to 660 will be in motor vehicle accidents, the rest from other causes.
This is a smaller mortality figure than the one caused by repealing the individual mandate. But this is concerning nonetheless. This is one of the few pieces of federal tax legislation in recent years for which it is possible to compute a body count.
$1.54 billion taken from families earning less than $10,000
Repealing the individual mandate doesn't just have health consequences. It has economic consequences for people who don't sign up for insurance in its absence. The CBO has broken down how the distribution of federal taxing and spending changes for different income groups under the tax bill, and finds that $1.54 billion less goes to people earning under $10,000 a year, starting in 2019. The number gradually rises, reaching $10.07 billion by 2027.
Meanwhile, in 2019 millionaires would get a $34.1 billion total tax cut directed their way — and that's excluding the effects of cutting the estate tax, which only hits rich families.
2.08 percent growth in its first year of full implementation
The Tax Foundation, a conservative-leaning institution known to be quite optimistic about the growth effects of tax cuts (particularly corporate tax cuts), has estimated that this bill would grow the economy. Long-run GDP would be 3.7 percent higher, they conclude, with a particularly big boost in 2018, when the corporate tax rate is still 35 percent but a new provision allowing the total expensing of all investments is added. That provision is worth more with a 35 percent rate than the 20 percent rate that the bill later introduces, so 2018 would see a big boost in investment, according to the Tax Foundation.
But given the group’s economic positions, the limited scale of economic growth in subsequent years that it projects is fascinating:
There’s the big 2018 jump — but after that, the bill only gets growth to 2 to 2.3 percent annually. That’s better than the projected baseline growth rate, but a far cry from the supercharged 3 percent growth that the Trump administration has been promising.
And again, the Tax Foundation is really optimistic about this kind of thing. Other economists, like Obama administration vets Jason Furman and Larry Summers, have projected that the reforms won’t juice growth much at all (0.02 percentage points per year, by one estimate), and might cramp it if they increase the debt too much.
Given the mortality estimates, financial costs on the poor, and other downsides to the bill, senators should ask themselves if growth effects this small are worth the price.