Drafters added the changes in an effort to hold down the federal budget deficit and offset the cost of keeping and adding tax breaks, such as an existing provision that limits which families have to pay the federal estate tax and a proposed change that could eliminate federal income taxes on tips.

The tax bill costs: The changes included in the House package could cost hospitals $424 billion, the pharmaceutical industry $241 billion, physicians $120 billion and other providers $275 billion, according to projections from analysts at the Robert Wood Johnson Foundation and the Urban Institute.

The cuts would average about $100 billion.

Updated estimates based on tax bill section drafts created by the Senate Finance Committee and the Senate Health, Education, Labor and Pensions Committee are not yet available.

The backdrop: The impact of the House bill changes would be big, but U.S. health care spending is bigger.

A $100 billion reduction in federal health program spending would to 10% of what the Congressional Budget Office estimates the federal government will spend on means-tested health care programs from this year through 2035.

The cuts would equal about 1.4% of the $7 trillion that Centers for Medicare and Medicaid Services actuaries think the United States will spend on all kinds of health care products and services each year.

But the cuts would amount to about 7% of the $1.5 trillion that U.S. employers and plan participants are spending on health coverage each year.

The possible impact: Will health care services and products try to add 7% to employer plan bills, on top of the usual price increases, to offset the impact of the big federal tax and budget bill?

At press time, predictions about cost-shifting effects were hard to find.

Cost-shifting history: Analyses of the impact of existing legislative changes on cost-shifting are also scarce.

In 2019, a KFF reporter reported that several states believed hospitals had used Affordable Care Act-related improvements in revenue to improve their finances rather than to reduce costs for commercial plan patients.

State officials and analysts argued that hospitals were shifting more costs for caring for uninsured patients and patients with government plan coverage into the bills for commercial plan patients, not less.

In 2021, researchers at KFF estimated that the Affordable Care Act — a two-law package that had many provisions taking effect in 2014 — cut the cost of treating patients who were completely uninsured to about $42 billion per year from 2015 through 2017, from $63 billion per year from 2011 through 2013.

Related: Obamacare cut uncompensated care costs by one third, KFF study says

Commercial health insurance price increases moderated around that time, but the KFF analysts did not try to determine whether a drop in the cost of care for people without health coverage was responsible for the slowdown in price increases.