According to CNBC, 70% of Americans support Medicare for all, but the term is still murky for Americans. What does it actually mean and how could it affect Americans?
Implemented in its most historical meaning, Medicare-for-all would completely wipe out private coverage and replace it with a single-payer health insurance – a national government-run program that would cover every American. Under such a plan, deductibles, premiums, and co-payments would likely be things of the past. The government would deal directly with drug makers, which would lower prescription costs and streamline the administration process. Reuters defines it as “a publicly financed, privately delivered system with all Americans enrolled and all medically necessary services covered.”
How Much Would it Cost?
A study recently released by the Mercatus Center at George Mason University found that Sen. Bernie Sanders’ plan for universal healthcare, which is the highest-profile plan for Medicare-for-all, would increase government healthcare spending by $32.6 trillion during its first 10 years.
What Opponents Say
Supporters of Medicare-for-all are typically quick to point to Canada, which has successfully implemented a single-payer system, though Canadian citizens pay more in taxes than American citizens. Opponents argue that even as taxes and federal costs for health care rise, expenses for individuals and companies would drop, potentially canceling each other out. They’re also likely to refer to the Mercatus study for a different reason: the report suggests that national health expenditures – which include all national health spending (i.e. state Medicaid programs and private employees), not just government spending – could decline by $2 trillion over the first 10 years of implementation, though the author of the study admits that this is an unreliable number because it depends on too many variables.
What Critics Say
In 2016, the Urban Institute, a nonprofit research organization, came up with roughly the same number as the Mercatus study: $32.6 trillion over a 10-year period. Assuming both studies are correct, this would create an overwhelming financial burden on the federal government, requiring unprecedented tax hikes. Critics are also quick to liken Medicare-for-all to Medicaid rather than Medicare, claiming that if America is forced into a one-size-fits-all government program, patients will likely face long lines and delays in treatment. Moreover, the Mercatus study found that virtually any savings accrued from a single-payer plan would vanish if doctors and hospitals, who would be paid at least 10% less, wouldn’t agree to accept lower fees for patients who are now privately insured.
Healthcare reform is complicated, and the associated costs of Medicare for all have proven to be a stumbling block. Though Sanders’ plan is the most popular among Medicare-for-all advocates, he has yet to release a financing plan, so the potential impact on Americans and the healthcare industry as a whole is still uncertain.
Established in 2003, HSAs allow individuals with high-deductible health plans to pay for current healthcare expenses and save for future healthcare expenses on a tax-favored basis. Money is deposited pre-tax, it grows tax-free, and is distributed tax-free as long as the funds are used for qualified health care expenses. Aside from the obvious benefit of tax savings, below is a breakdown of advantages and disadvantages of HSAs to help you determine if it’s a good fit for you.
- Most HSAs come with a debit card to make paying for prescriptions and other expenses easy. Bills can be paid over the phone with this debit card, and you can access cash at an ATM.
- Long lasting and portable. If you change health insurance plans, change jobs, or enter retirement, funds left in your HSA remain available for use. They can be used for qualified medical expenses and continue to grow tax free.
- Roll-over funds. Unlike FSAs (Flexible Spending Accounts), any money left in an HSA at the end of the year automatically rolls over to the next year.
- In addition to personal contributions to your HSA, your employer and anyone else may contribute, and the recipient of the contribution receives the tax deduction for the amount contributed.
- High deductible requirement. Although you pay less in monthly premiums, you are responsible for all healthcare costs until the deductible is met.
- Unexpected healthcare expenses. It’s possible that healthcare costs could exceed your HSA savings.
- Savings ambition. The desire to save money versus the necessity for healthcare when you need it could set up an internal struggle.
- Recordkeeping. This time-consuming task is a necessity as you’ll have to keep receipts and prove that withdrawals were used for eligible healthcare expenses.
- Taxes and penalties. Withdrawing funds for non-qualified expenses before age 65 results in a 20 percent penalty and taxes owed; after age 65 you’ll pay taxes but no penalty.
- Fees. Some HSAs charge monthly maintenance or per-transaction fees, though typically not high. Sometimes if a certain minimum balance is maintained, these fees can be waived.
On the mind of many Americans in recent months is how our new President will alter the healthcare system. His promise throughout the campaign was that Obamacare would be “repealed and replaced” as quickly as possible. However, we all know the feeling when our time frame for getting things done doesn’t always work out, or how we envisioned a project would turn out isn’t often the final product either. Just last week, the House passed an initial bill that reconfigures the healthcare system as it is today; however, it still has to pass the Senate, and will likely go through many changes and amendments before being finally accepted into law. Although Trumpcare may not look exactly how President Trump imagined, nor has it “repealed and replaced” Obamacare as rapidly as he may have originally hoped, here are some key differences between his plan and our current system.
- Immediate repeal of the 3.8% net investment income tax, which taxes income from royalties, interest, rents, dividends, passive activities and gains for those with a gross income over $200,000.
- Immediate repeal of the individual mandate excise tax, or the tax owed if you did not have health insurance.
- Health savings account withdrawal penalties would drop from the 20% under Obamacare to what it was before, 10%. This penalty only occurs if you withdraw money from an HSA before 65 for non-medical expenses.
- Removal of the $2,500 cap on the amount of pre-tax funds allowed to be placed in a healthcare flexible spending account. Decisions to impose a cap or not would be left up to employers.
- Those with FSA’s or HSA’s would also be allowed again to utilize those pre-tax funds on over-the-counter meds.
- Lowers the rate for medical itemized deductions. If you were under 65, Obamacare only allowed deductions for medical expenses that exceeded 10% of your adjusted gross income, whereas Trumpcare would take it back down to the previous 7.5% of your adjusted gross income.
- While Trumpcare would eventually repeal the 0.9% additional Medicare surtax on those with gross incomes over $200,000, it would not do so until 2023, which is later than the first healthcare bill the House introduced.
For the time being, these are the tax adjustments in place, although these could presumably change once the bill works its way through the Senate. This version of Trumpcare certainly differs from the House’s first proposal, but Americans may see many months pass and many modifications occur before the healthcare system truly moves away from Obamacare.
If you have any questions, please feel free to contact me at firstname.lastname@example.org.
Take a look at my article on a similar topic: “The New GOP Healthcare Plan and What That Means for You”.
Our world is filled with seemingly constant changes and developments, however, most Americans have been paying close attention to the potential changes coming out of Washington. While President Trump made many statements about how he would revamp Washington if elected, one long-awaited claim has finally been revealed: his, and the GOP’s, promise to repeal and replace Obamacare. Now that their plan has been presented to the general public, questions many are asking include, what exactly does the plan entail? And how, or will, it affect me specifically, the taxpayer? Below are several points that will attempt to identify the main differences between the GOP’s plan and Obamacare, and what that truly means for you, the taxpayer.
- Changes the Insurance Mandate
Under Obamacare, individuals and employers are required to either buy or offer coverage, or else face a fine. The GOP’s plan would do away with those penalties for both individuals and employers. However, in an attempt to prevent individuals from simply adding coverage when they need care, the GOP’s plan would permit insurance companies to enforce higher premiums on individuals who do so for the first year of their coverage.
- Changes in Medicaid
Another major difference between Obamacare and the GOP plan is how they approach Medicaid. Many who gained coverage under Obamacare did so through Medicaid provisions, including an expansion that covered those within 138% of poverty levels, as well as a federal payout to those states that expanded their coverage and insured those newly eligible. The GOP plan would eventually eliminate the expansion, only giving states extra funding for those enrolled before 2020, and provide a set amount of money to states based on their enrollment numbers in 2016, rather than providing open-ended matching for Medicaid beneficiaries.
- Changes in Age-based Premiums
While Obamacare did allow insurance companies to vary their premiums based on factors such as location, tobacco use and age, there was a 3-to-1 limit based on age. Essentially, the premium for an older individual could not be more than three times the amount charged for a younger person purchasing the same plan. The GOP would alter this limit and allow insurance companies to charge older individuals up to five times the amount of those who are younger.
- Changes in Tax Credits
The tax credits under Obamacare subsidized insurance for those using government-run insurance exchanges, providing credits based on the enrollee’s income and cost of coverage in their area. The GOP’s plan would tie credits to age and income (rather than cost of coverage), and would look to end cost-sharing subsidies. Credits would start at $2,000 for those in their 20’s and increase gradually, reaching to $4,000 for those over 60. However, these credits would only be available to individuals making $75,000 or less and households making $150,000 or less.
The GOP’s bill would still allow adults under the age of 26 to be covered under their parent’s plans, as well as maintain the provision blocking insurers from denying coverage to those with pre-existing conditions. Because the plan has significant reviews to undergo , and most likely many amendments to be made, before American’s see a final proposal, many will want to wait and see before assuming they may qualify for specific credits or that their coverage may be affected based on age or income. Though change will certainly occur, taxpayers would be advised to maintain their current coverage until the final bill is passed.
If you have any questions about how the changes to the Health Care Laws may affect you, please contact me at dkittell@MKRcpas.com.
The Trump administration has wasted little time taking action on many of the promises that were made throughout the campaign. One major proposition made by President Trump was the immediate repeal and replacement of Obamacare. While the replacement of our current healthcare system seems to be pending, the repealing of the current system is certainly at the top of the administration’s list. Although the insurance aspect of the current system would seemingly stick around until the GOP and the Trump administration develop a suitable alternative, the tax aspects of Obamacare could be subject to immediate repeal. Thus, the insurance industry may have until 2018 or 2019 before they saw changes, but the tax industry (and therefore taxpayers) could see effects as early as this year.
How exactly the current administration chooses to repeal the tax aspects of Obamacare could be positive or negative for most taxpayers though. Under current law, there is an individual insurance mandate that penalizes monthly those who do not have insurance coverage, as well as an employer mandate penalizing employers (with more than 50 full-time employees) who do not offer affordable health care. However, if individuals obtain coverage through the state marketplaces and their income is between 100% and 400% of the federal poverty level, they receive a tax credit to assist in paying for their insurance premiums. Additionally, Obamacare levies a 0.9% Medicare tax and a 3.8% net investment income tax on certain high wage earners, or the wealthiest 2% of Americans.
Where repealing taxes associated with Obamacare could be positive for Americans is if Congress removed all taxes while maintaining the premium tax credit (until a replacement system is established). This would mean employers are no longer charged for not providing insurance coverage, taxpayers are not penalized for not having insurance and high wage earners will not be levied the additional taxes discussed above. If Congress chose this route, tax experts estimate that low to middle income wage earners could receive a tax break in the hundreds of dollars, whereas high end wage earners could receive a break in the thousands of dollars.
However, if Congress chose to repeal all tax aspects, including the premium credit, certain tax brackets would most certainly see negative effects. Without the credit, lower income brackets could see their taxes rise by an average of $4,000, middle income brackets could see their taxes rise by an average of $6,000, but higher income brackets would still see their taxes lowered by the thousands of dollars. But, these negative changes would only exist for lower or middle income brackets who currently claim the premium tax credit. Fortunately, at this point, Congress nor the Trump administration has made any claims about what they will do in terms of repealing Obamacare-related taxes, so Americans will simply have to wait and see what direction our nation’s leaders choose and how their wallets will be affected.
The Latest Tax Implications of the Affordable Care Act Update (Obamacare)
Did you know the health care law actually created two new taxes to help pay for the cost of the ACA? The first of the two taxes is the Net Investment Income Tax (NIIT).
It is a new Medicare tax that applies to certain types of income received by the taxpayer.
Income that is subject to net investment income tax are the following:
- Capital Gains
Income that is not subject to the net investment income tax are:
- Income from an active business (S-Corp flow through)
- Social Security
- Tax-exempt interest
- Self-employment income
- IRA & Pension Distributions
The tax will apply to taxpayers with Income above the following thresholds (Adjusted Gross Income):
- Married Filing Joint $250,000
- Married Filing Separate $125,000
- Single $200,000
The tax is 3.8% applied to the lessor of the following:
– Taxpayers net investment income
– The amount of AGI above the threshold amount
Example: Tommy is a single individual with an adjusted gross income of $210,000 which included $20,000 of interest and $20,000 in dividends.
Tax is computed as follows:
Net investment income of $40,000
Adjusted gross income of $210,000
Threshold for singles: ($200,000)
Lessor of A or B: $10,000
Taxable at 3.8%: $380
The second new tax is the Additional Medicare Tax
The Affordable Care Act also created a .9% tax called the Additional Medicare Tax, which is entirely separate from the 3.8% net investment income tax discussed earlier.
Taxpayers with wages and/or self-employment income above certain thresholds are subject to the additional tax.
The thresholds are the same as the net investment income tax.
- $250,000 for joint filings
- $125,000 for married separate filings
- $200,000 for singles
How is the tax calculated and paid?
Rudy is employed as a lawyer with Duey Cheatem and Howe. He is single and has the following annual earnings:
W-2 Wages $240,000
Total Income $270,000
Since Rudy’s wages exceed his threshold by $40,000 he is subject to the additional Medicare tax on this $40,000 or $360.00 ($40,000*.9%)
**Note he is also subject to the net investment income tax and will pay an additional $1,140 in NIIT. ($30,000*3.8%)
Now let’s address the individual medical insurance coverage mandate.
Effective January 1, 2014, individuals must maintain a minimum essential insurance coverage or pay a shared responsibility payment (penalty) on their tax return.
Here is what we think will happen at tax time since no specific guidance has been released yet:
During January 2015 when you are receiving all your other tax documents, your insurance company will send you a form for proof of insurance that you will need to provide your tax preparer. This form will show the type of coverage you have and the number of months during 2014 the policy was in place. If it was not in place the entire 12 months, then you are subject to the penalty for those months.
Without this proof of insurance information the penalty will be assessed.
Now, the time bomb no one is talking about.
Taxpayers who purchased health insurance policies through the exchange that was set up by the government could have surprises at tax time.
Part of the Affordable Care Act created a tax credit for lower income families and individuals depending on family size and geographic location. The lower the income the higher the credit. Sort of makes sense.
Here is the flaw:
During the application process one of the questions is “What do you think your 2014 income will be?” Based on the answer, it calculates your potential premium credit and asks if you want that applied to your monthly premium or wait and receive when you file your 2014 taxes.
What do you think has happened?
You think people figured out they could enter a lower amount for anticipated income and receive a larger credit? You got it! And of course they have applied it to their monthly premiums so they are paying a much lower amount than they should.
What happens next you ask?
At tax time we have to prepare a reconciliation of premium credits received already versus what they are entitled to, based on their actual income. If they have received too much in credits they are required to repay the excess credit. So taxpayers who usually get refunds will have balances due; these could be quite large, and as they are in the lower income bracket they will not have the money to pay them. What will the IRS do? No guidance on this one yet. Nobody is talking about it, but it is real.
Please contact us with your questions about this Affordable Care Act Tax Implications Update, or schedule your consultation by calling us at 317-549-3091.
We’re here to help you be prepared for next year and beyond for your personal and business tax needs.