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Tax Reform: What Repeal of ACA Individual Mandate Means & More


On Dec. 22, 2017, President Trump signed sweeping tax reform, formerly known as the Tax Cuts and Jobs Act, into law, marking the largest change to U.S. tax policy in decades. What changes are coming for healthcare organizations?

The repeal of the Affordable Care Act’s individual mandate has perhaps the widest-reaching implications, as it will increase the number of uninsured individuals by about 13 million in 2027, according to Congressional Budget Office estimates. A sharp increase in the number of people without insurance could hurt hospitals’ finances as they treat more uninsured patients.

To help organizations navigate the issues most impactful and urgent to the healthcare industry, we’ve prepared a summary of the major industry implications based on the signed legislation.


Here are five steps healthcare organizations should take now to tackle tax reform:

  1. Assess impact. Tax professionals will likely need to review the bill text manually and measure their organization’s specific circumstances against it to assess the impact of the provisions and their holistic effect on their organization’s bottom line.


  1. Assemble a team. While the heaviest burden may fall on accountants, companies and their finance teams will have an important role to play in gathering all the necessary data.


  1. Dig into the data. Assessing the impact of tax reform requires a substantial amount of data. Organizations need to move from modeling the impact of tax reform to focusing on data collection and computations as soon as possible. If you have an international presence, bear in mind that some of the information needed could date back to 1987.


  1. Establish priorities. When considering what next steps to take, focus on the areas that could have the greatest impact on your organization.


  1. Initiate tax reform conversations with your tax advisor. Tax reform of this magnitude is the biggest change we’ve seen in a generation and will require intense focus to understand not only how the changes apply at the federal level, but also to navigate the ripple effect this is likely to have on state taxation as well.

What actions should you take if you’re a non-profit vs a for-profit healthcare entity? Read more here.

Compliments of BDO – a member of the EACC in New York.