Threats to Medicaid and the Affordable Care Act (ACA) are heightened, because of the sweeping Tax Cuts and Jobs Act bills passed by the U.S. House and Senate. Senate passage of the bill December 2 followed House approval, and starts a process of reconciling the different pieces of legislation. Final floor votes are expected before Christmas.

The bills represent the largest tax overhaul in three decades and the impacts are devastating. Emboldened lawmakers vow that Medicaid and Social Security will be their next targets. Businesses and individuals in the highest tax brackets expressed support as they will benefit most.

But for people with disabilities, low-income people and many senior citizens, the bills are a disaster. Disability and elder groups around the nation weighed in on the very real threats to the supports that keep people healthy, employed and living in their home communities. Many expressed dismay at Congress’s actions, which are paving th way for cutting Medicaid, Medicare, Supplemental Security Income and other critical programs for people with disabilities in order to pay for the tax cuts later. Another worry is that the bills will significantly increase the deficit, providing tax cuts for corporations and the wealthiest Americans.

The Senate bill is seen as a bigger threat because it repeals the individual mandate for people to have health care coverage. If this happens, nearly 14 million people will lose health coverage. It could also increase premiums for people buying insurance on the health insurance exchange by 10 percent per year. The individual mandate is a key part of the ACA, which greatly benefits people with disabilities by eliminating pre-existing condition exclusions, banning annual and lifetime limits, prohibiting discrimination based on health status and more.

The House version also has items of concern. It eliminates a tax deduction for those with high medical expenses. It eliminates tax incentives that encourage businesses to hire people with disabilities and make businesses.

The proposed tax cuts are expected to create massive pressure on the federal budget. Legislation that adds to the national debt must be offset, under existing budget rules. Programs like housing assistance and vocational rehabilitation could face automatic cuts.

Many disability and elder groups have lobbied furiously against the bills. So did state and regional groups including Minnesota’s This Is Medicaid coalition. After the Senate passed the bill, This is Medicaid released a statement.

“Having defeated substantial threats to the promise of Medicaid since February, the This Is Medicaid coalition is extremely dismayed to witness the passage of a tax bill that causes over 5 million people to lose Medicaid as a result of the individual mandate repeal. The bill adds more than $1 trillion to the federal deficit, and lawmakers have made clear their plans to deeply cut Medicaid, Medicare, and other federally-funded services that support families and build thriving communities.”

“With the passage of this widely unpopular bill, millions who live and thrive because of Medicaid face threats to critical services and supports – including the nation’s children, elderly, people living with disabilities or mental illnesses, and those living on lower wages.”

“In the end, this bill harms all of us. We’re calling on our Congressional representatives in the House to soundly reject a tax bill that essentially dismantles the promise we made 50 years ago to people who need health care as the one that passed the Senate.”

National organizations are also weighing in. The Arc described the Senate’s action as “a big and dangerous step closer to cutting the services and supports that people with disabilities rely on to be a part of their community.” The Arc’s longstanding position on tax policy is that it should raise sufficient revenues to finance essential programs that help people with disabilities to live and work in the community. The Arc also supports tax policy that is fair and reduces income inequality; people with disabilities are twice as likely to experience poverty. The advocacy organization states that both the House and Senate versions of the bill fail to meet either standard. By reducing federal revenue by at least $1.5 trillion, the Senate bill turns up the pressure on Congress to cut Medicaid and other programs that are critical to people with intellectual and developmental disabilities.

The Arc CEO Peter Berns said, “The disability community has fought against threats to vital programs and won several times this year, and we are prepared to do it again. As the House and Senate finalize the bill, we encourage our advocates across the country to act now. We’ve shown again and again this year our strength, and now we have to do it again, or we will be right back where we started in the coming new year.”

“The proposed tax cuts will create enormous pressure on the federal budget,” Julia Bascom, executive director of the Autistic Self Advocacy Network, told the online publication Disability Scoop. “Both the administration and congressional leadership have made clear that they plan to alleviate that pressure by slashing Medicaid, including (home and community-based) waiver services, and other basic programs that allow people with disabilities to live good lives in our community.”

But all eyes are on programs that have been a lifeline for people with disability and elders. The Congressional Spending Office projects that spending on Social Security, Medicare and Medicaid would cost the federal government $28.6 trillion through 2027. The tax cuts add to pressure to cut those programs. Medicare along would face a $25 billion cut for the current fiscal year. AARP has warned that the one impact could be of hospitals turning away patients, because of dramatic cuts to reimbursements.

Want to learn more about what is happening next? Negotiations over the House and Senate bills are underway, and will be tracked closely by national and regional media. Advocacy groups will also be tracking the issues. One of the best resources for information on the tax cut legislation and impacts is thehill.com.