In the past week or so, the media—at least those outlets that still cover health reform somewhat regularly—offered up some reasonable journalism about Beltway health reform politics. There was just one problem: ordinary people outside the Beltway may have needed help understanding what it all meant. Stories tackled one part of the health reform story or another, but didn’t put it all together. A piece or two connecting all the dots would have come in handy.
A couple of weeks back, The Washington Post ran an illuminating story—one that Campaign Desk has long been urging the press to write—about Congress’s willingness to tax the value of employer-provided health insurance. Millions of workers who get insurance from their employers would have to pay income taxes on all or some of those benefits—a tax increase by any stretch of the phrase. Possibly some of those increases would be destined to fund insurance premiums for the uninsured.
Recall that, during the campaign, John McCain advocated such a tax, but Candidate Obama said in no uncertain terms that he opposed the idea. The Post reported that budget director Peter Orszag has said that taxing benefits “most firmly should remain on the table.” The paper noted that the Democrat-controlled Congress dismissed the idea when President Bush had proposed it. But now, according to the Post, some congressional Dems are signaling that Obama would now “accept a tax on employer benefits as long as he didn’t have to propose it himself.”
“It’s funny how this idea, so sharply attacked by Obama and the Democrats during the campaign, is somehow now considered perfectly appropriate with no discussion at all about the consequences,” Charles Idelson, communications director for the California Nurses Association, told me. One rationale for taxing benefits is to discourage employers from offering rich benefit packages to workers, which leads to the use of more medical services. Using more health care fuels inflation, some economists believe. About 25 million Americans are currently underinsured—a number that would certainly rise if workers get skimpier benefits that require them to pay a lot out-of-pocket. Here’s a good place to start connecting the dots.
Then last week the Los Angeles Times ran a similar story adding a few new voices to reflect the latest Congressional and advocacy group think. Michigan Sen. Debbie Stabenow said that while she didn’t want to penalize middle-income people who have good health care, she might nevertheless support what the paper called an income-based cap—aka a tax on employer-provided benefits. That’s a bit of jargon that every auto worker left in Detroit instantly understands, right? Len Nichols from the New America Foundation offered this: “Unless someone can write a really big check, there really is no other source of money that we can tap.”
That was the money quote that got my attention. What happened to Obama’s budget proposal of a $634 billion down payment that was to be funded in part by making wealthier people pay higher income taxes? Or the $175 billion that was to be saved by cutting the excess payments to Medicare Advantage plans over ten years? Ezra Klein’s blog gave a clue. The Senate draft budget doesn’t contain any actual money for health care. Instead, said Klein, there will be “space” for a health reform reserve fund. No taxing the rich—members of Congress beat up on that one. No trimming Medicare Advantage plans—insurers don’t like that.
The $634 billion figure was always too small to provide all the subsidies people will need if they are required to buy health insurance, which seems to be the direction the pols are going. But if Obama’s revenue source doesn’t survive the budget process, then where does the money come from? A savvy, interested reader might have to circle back to The Washington Post and the Los Angeles Times. Bingo! The money might just come from taxing the health insurance benefits of some of Debbie Stabenow’s auto workers—and everyone else who gets insurance from their boss.
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your dots do not add up to anything so far
there has been a change in the political environment
ideas of taxing employer health benefits can be spoken
employers still want to hold on to their control of employee health insurance even though they tell us that the cost of health care is making them uncompetitive
beyond what the administration has said we do not have a definitive picture of how the economics of health reform will be constructed,
the ball is in play
it is a big political issue and the administration and the congressionals are working on it
i think your hopes for the press on this story are unrealistic
the washington post and the new york times do not what it takes
think about it
the new york times seems to rely on reading the new england journal of medicine articles for points of view,
#1 Posted by jamzo, CJR on Mon 30 Mar 2009 at 06:02 PM
In Massachusetts, the petri dish for health care reform (it's really
difficult to use the words care or reform for the MA terror), the agenda
for taxing health benefits in the national plan was already set up.
MA employees must file a 1099-HC with their state tax return since the
mandated health insurance law kicked in two years ago. This is
verification that the employee is insured because in Massachusetts, it's
a crime to be uninsured, and such criminals are fined by a tax penalty
enforced by the MA Dept. of Revenue as income tax evasion. Imagine that.
You can't afford what the state decided you could afford, so you are
penalized at a rate as high as the maximum fine for domestic assault and
cruelty to or malicious killing of animals. Chances are, you can't
afford that either. Cheer up. If you can't afford it, you can go on the
D.O.R. payment plan complete with a Notice of Assessment, interest and
late fees. Eventually, your property will be liened, your bank account
seized or your paycheck garnished. If it's the latter, you probably
won't be able to afford to heat or eat, or worse, if you're already in
that boat.
Well, one afternoon, a friend pulled a copy of his wife's 1099-HC out of
his briefcase and said, "You know, they didn't pull this number out of
thin air especially for use in MA - 1099 is the standard number for
supplementary income." And it hit me smack between the eyes that what
was going on with this 1099 business was far-reaching. I had already
realized that the MA "experiment" was slated for the nation, not because
it was something that would work, but it was something that could be
marketed as the solution to America's health care crisis (although it
has little to do with access to care and everything to do with profits
for the insurance industry).
I then remembered that a neighbor told me a few weeks prior she had
signed up for a Tufts plan (I believe she said Tufts) a year ago - she
is always shopping around for something cheaper beause it's so
expensive. This plan had no copays. Wow! But, after the first of the
year - 2008 - she had received a 1099 from Tufts for a rather large
amount but didn't know why. So, she got on the hooter and inquired.
Turns out this was the amount of her "no-copays" and was taxable income.
Was she told about this at point of purchase? No. If she had been, she
wouldn't have had to make that call or might not have purchased this
policy. Did it occur to her to ask about this at point of purchase? No.
Who would have thought that they were going to receive a 1099 from a
health insurance company?
Nothing our government does - state or federal - surprises me anymore. I
just get more disgusted everyday. And Obama's hope and change piece? Too
many 180s already. Just last week, he was telling people at his virtual
town hall meeting that mandated health insurance is the same as mandated
motor vehicle insurance. Whoa! Romney tried that one already, and our
response was, "If you can't afford motor vehicle insurance, then you
don't drive. If you can't afford health insurance, do you move out of
the state?" So, President Obama, should we start making plans to get out
of Dodge?
#2 Posted by Dianne, CJR on Thu 2 Apr 2009 at 11:12 PM