There's much talk on Capitol Hill about the tax cuts included in the Republican health plans, but unless you are a frequent user of tanning beds or have personal wealth that puts you in the top 1 percent, you might not feel much effect from them.
Specifically, both the House and the Senate plan would change or eliminate more than a dozen taxes that were levied to help pay for the Affordable Care Act's insurance subsidies and to bolster Medicare and expand Medicaid. Republicans and other ACA critics have argued the taxes are onerous on businesses and families.
The Congressional Budget Office estimated that the Senate proposal would result in $700 billion in lost revenue from the federal Treasury over the next 10 years.
Here are three things you need to know about them:
- What are these taxes targeted for repeal?
The biggest ones fall into two buckets:
In the first bucket is a 0.9 percent increase in the existing Medicare payroll tax on income above $200,000 for individuals or $250,000 for couples.
There is also a 3.8 percent tax on net investment income — as in stocks, bonds, interest and capital gains — that kicks in after $200,000 for individuals and $250,000 for couples. As Senate leaders consider revisions to the bill, some senators — including Republican Bob Corker of Tennessee — suggest leaving the investment tax in place to provide more money for subsidies, but others object to that idea. It would also present a major difference from the House-passed bill.
Still, if both of those taxes in the ACA were repealed, high-income Americans together would pay $230.8 billion less in taxes over 10 years, according to the CBO analysis.
In the second bucket are taxes on the drug and medical device industry, which says those levies have a chilling effect on innovation, affect its ability to hire more workers or are passed along to consumers in the form of higher health care prices or premiums. Drug companies would experience an estimated $25.7 billion cut, while medical device makers would get about $19.6 billion in savings. Some of the cuts would start as early as this calendar year.
There's also relief for insurers. The GOP plans would eliminate a tax set on all insurers based on their market share. Congress waived it for this year, hoping the one-time move would help slow premium increases. The CBO analysis of the Senate bill, for instance, found it would save the industry $144.7 billion over the next decade.
Smaller — but not insignificant — cuts come from eliminating some other taxes, including a limit — $2,600 this year — on how much workers can annually set aside tax-free in flexible spending accounts (FSAs) to pay for things like over-the-counter medications, eyeglasses or copayments for doctor's office visits. The plans would also increase the amount people could put in tax-protected Health Savings Accounts (HSAs). The Senate proposal would also revert tax law back to pre-ACA days in setting the threshold for medical deductions at 7.5 percent of adjusted gross income; the ACA had boosted that to 10 percent. The House approach is even more generous.
And, of course, not to be forgotten, the GOP plans would delete a 10 percent tax on the use of tanning beds.
- You likely won't see a direct or big tax break unless you are wealthy.
The ACA significantly increased average taxes on high-income people mainly through the investment income tax and the Medicare payroll tax. The top 1 percent and other high earners are also the group that would benefit most from the repeal, according to several analyses, including one by the Tax Policy Center, a nonpartisan think tank in Washington, D.C.
Under the GOP proposals, the top 1 percent — those earning $875,000 a year or more in 2026 — would get an average tax cut of about $40,000, while middle-income people earning about $50,000 to $90,000 would see about a $300 cut, according to Howard Gleckman, a senior fellow at the center.
Still, those earning about $28,000 or less may get a boost from the higher cap on tax-protected FSA or HSA accounts or by being able to deduct medical expenses, possibly saving an average $180 annually, he said.
- How will the federal government offset the loss of tax revenue, and what will that mean for insurance or other programs?
Even though the tax cuts and other changes would reduce Treasury revenue by about $700 billion over the next decade, spending cuts exceed that amount, so the deficit actually goes down by $321 billion, the CBO says.
The biggest spending cuts hit the Medicaid program, which provides health coverage for low-income children and adults, including paying for nearly half of all births and much of the cost of nursing home care. Spending on Medicaid by 2026 would shrink by 26 percent compared with what it would be under the ACA.
As to other effects, the number of Americans without health insurance coverage would likely rise. Because the GOP proposals cut the tax people pay for not having insurance, the CBO estimates that far fewer people would enroll in coverage. That, coupled with smaller subsidies to help lower- and middle-income people buy their own insurance and cuts in Medicaid, could lead to 22 million fewer insured Americans by 2026, the CBO estimated. States could choose, however, to try to make up for federal Medicaid spending cuts and maintain current levels of coverage, but that would probably involve raising state taxes, cutting other budget items, such as education, or both.
This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.