Understanding the process that has taken place to reconcile the Health Care Reform Act.
On December 24th, 2009 the Senate approved the Patient Protection and Affordable Care Act. A “side bill” was also issued called the Health Care and Education Tax Credits Reconciliation Act of 2010. Congress did this deliberately to bypass the filibuster provision which requires 60 Senate votes to pass a bill. By doing so the House was able to make the necessary changes and get enough votes by way of the budget-reconciliation rules. These rules allowed the Senate to pass the final package with 51 votes instead of 60.
This method essentially creates a loophole around the 60-vote super-majority requirement. It created a means for the House and Senate to vote on simple majority, straight up. Some would consider this “forcing the bill through” against traditional voting standards.
What Does the Bill Seek to Accomplish?
1) All individuals not covered by Medicaid or Medicare would be required to obtain health care coverage.
- In short, everyone must have healthcare coverage or fines will be imposed.
2) Lower-Income individuals will receive a credit or voucher to help pay for the cost of insurance.
- Based on your relationship of income to poverty level you may be eligible for advanced payment of the premium assistance tax credits.
3) Employers (with 50 or more employees) must offer qualifying coverage to employees or pay fines.
- Requires automatic enrollment for mid to large size employers
- Additional taxes are owed if healthcare coverage is not offered.
- If healthcare coverage is outside the affordable standards set forth (cost compared to income), a penalty of up to $3,000 per employee may be imposed.
4) Provisions that control insurance company practices.
- Prohibit insurance companies from using pre-existing conditions to deny coverage.
- There will be caps on deductibles and annual out of pocket spending is capped at $5,000.
- Policies can’t be cancelled when someone becomes sick.
5) Small employers will receive tax credits to offset the cost of insurance.
- A small employer is considered an employer with less than 25 employees and average annual wages of less than $40,000.
6) The creation of a reinsurance program for early retiree coverage.
7) Creates a national voluntary insurance program for purchasing community living assistance services and support.
8 ) Adoption credit becomes fully refundable and is increased to $13,170.
It seems that through tax credits to lower-income earners and small business’s, more wealth will be “redistributed” to provide everyone with healthcare. The taxes, which will be mentioned below, will subsidize healthcare coverage for lower income individuals and smaller businesses as well as other government run programs.
What About the Taxes to Pay For All of this?
1) An increased Medicare tax of .09 percent for individuals who exceed income thresholds ($200k single, $250k married).
- A flat tax of 3.8% on investment income subject to the same income thresholds.
2) An excise tax of 40% on employers whose premium payments exceed $10,200 for individual coverage and $27,500 for family coverage. The average cost per person is said to be about $10,700. This will not be in effect until 2018.
- Simply put, if your plan is above government standards you will pay a heavy price on the value over that standard.
- One could assume that employers will pass this cost down to their employees in the form of higher premiums.
3) Penalties on individuals who do not obtain coverage starting in 2014.
- The penalty is the greater of $95 or 1 percent of your income. This will increase to $695 or 2.5% of your income by 2016.
4) Excise taxes on medical equipment and pharmaceutical sales will be in effect in 2018
5) Penalties on non-qualified distributions from HSA’s will be increased from 10% to 20%.
6) The threshold for itemized medical deductions will rise from 7.5% to 10% starting in 2013.
As I outline the revenue raisers (new taxes) and provisions of the Health Care Reform act a couple of things stood out. I feel as though we are being indirectly squeezed into a standard of healthcare that the government now defines. If you don’t have coverage, you will be fined. If your coverage is exceeds the average, you will be fined. There is a valid concern that we will be pigeonholed into a certain standard of health care coverage. The other thing that stood out to me is the continuing policy to redistribute wealth.
There are many other facets to the bill. By 2014, states will have to set up Small Business Health Option Programs called “SHOP Exchanges,” where small businesses (under 100 employees) will be able to pool together to buy insurance.
More than 30 states have stated that they cannot afford the cost of requirements like this.
I am also concerned that this passive form of price control on the insurance industry will balance out in a negative fashion for the quality of our healthcare. I am happy that more people will be covered, that people with pre-existing conditions will have a way to obtain coverage, but are federal mandates on health care coverage unconstitutional? After all, you’re forcing a consumer to buy a product or pay fines.
Please comment with your thoughts and additional information I have missed. I am an expert in tax but not in politics or law. I have clients who are Doctors and Surgeons and I look forward to eventually picking their brains on their thoughts.
-Joe
Posted by Joe Arsenault