Thread: Health Care Timeline

http://republicans.waysandmeans.hous..._timelinel.pdf


Timeline of Major Provisions in the Health Care Package
•2‐year tax credit (total cap of $1B) for new chronic disease therapy investments
•Medicare cuts to hospitals begin (long‐term care (7/1/09) and inpatient and
rehabilitation facilities (FY10)) 2009
•States and Federal officials review premium increases
•FDA authorized to approve "follow‐on" biologics
•Increase brand name pharmaceutical Medicaid rebate (from 15.1% to 23.1%)
•Medicare payments to physicians in primarily rural areas increase (2 years)
•Deny "black liquor" eligibility for cellulosic biofuel producers credit
•Tax credits provided to certain small employers for health care‐related expenses
•Increase adoption tax incentives for 2 years
•Codify economic substance doctrine and impose penalties for underpayments
(transactions on/after 3/23/10)
•Provide income exclusion for specified Indian tribe health benefits provided after
3/23/10
•Temporary high‐risk pool and high‐cost union retiree reinsurance ($5 B each for 3.5
years) (6/23/10)
•Impose 10% tax on indoor UV tanning (7/1/10)
•Medicare cuts to inpatient psych hospitals (7/1/10)
•Prohibits lifetime and annual benefit spending limits (plan years beginning 9/23/10)
•Prohibits non‐group plans from canceling coverage (rescissions) (plan years
beginning 9/23/10)
•Requires plans to cover, at no charge, most preventive care (plan years beginning
9/23/10)
•Allows dependents to stay on parents’ policies through age 26 (plan years
beginning 9/23/10)
•Provides limited protections to children with pre‐existing conditions (plan years
beginning 9/23/10)
•Hospitals in "Frontier States" (ND, MT, WY, SD, UT ) receive higher Medicare
payments (FY11)
•Hospitals in “low‐cost” areas receive higher Medicare payments for 2 yrs ($400
million, FY11)
2010
•Medicare Advantage cuts begin
•No longer allowed to use FSA, HSA, HRA, Archer MSA distributions for over‐thecounter
medicines
•Medicare cuts to home health begin
•Wealthier seniors ($85k/$170k) begin paying higher Part D premiums (not indexed
for inflation in Parts B/D)
•Medicare reimbursement cuts when seniors use diagnostic imaging like MRIs, CT
scans, etc.
•Medicare cuts begin to ambulance services, ASCs, diagnostic labs, and durable
medical equipment
•Impose new annual tax on brand name pharmaceutical companies
•Americans begin paying premiums for federal long‐term care insurance (CLASS Act)
•Health plans required to spend a minimum of 80% of premiums on medical claims
•Physicians in "Frontier States" (ND, MT, WY, SD, UT ) receive higher Medicare
payments
•Prohibition on Medicare payments to new physician‐owned hospitals
•Penalties for non‐qualified HSA and Archer MSA distributions double (to 20%)
•Seniors prohibited from purchasing power wheelchairs unless they first rent for 13
months
•Brand name drug companies begin providing 50% discount in the Part D “donut
hole”
•10% Medicare bonus payment for primary care and general surgery (5 years)
•Employers required to report value of health benefits on W‐2
•Steps towards health insurance administrative simplification (reduced paperwork,
etc) begins (5 yr process)
•Additional funding for community health centers (5 years)
•Seniors who hit Part D “donut hole "in 2010 receive $250 check (3/15/11)
•New Medicare cuts to long‐term care hospitals begin (7/1/11)
•Additional Medicare cuts to hospitals and cuts to nursing homes and inpatient
rehab facilities begin (FY12)
•New tax on all private health insurance policies to pay for comp. eff. research (plan
years beginning FY12)
2011
•Medicare cuts to dialysis treatment begins
•Require information reporting on payments to corporations
•Medicare to reduce spending by using an HMO‐like coordinated care model
(Accountable Care Organizations)
•Medicare Advantage plans with a 4 or 5 star rating receive a quality bonus payment
•New Medicare cuts to inpatient psych hospitals (7/1/12)
•Hospital pay‐for‐quality program begins (FY13)
•Medicare cuts to hospitals with high readmission rates begin (FY13)
•Medicare cuts to hospice begin (FY13)
2012
•Impose $2,500 annual cap on FSA contributions (indexed to CPI)
•Increase Medicare wage tax by 0.9% and impose a new 3.8% tax on unearned , nonactive
business income for those earning over $200k/$250k (not indexed to inflation)
•Generally increases (7.5% to 10%) threshold at which medical expenses, as a % of
income, can be deductible
•Eliminate deduction for Part D retiree drug subsidy employers receive
•Impose 2.3% excise tax on medical devices
•Medicare cuts to hospitals who treat low‐income seniors begin
•Post‐acute pay for quality reporting begins
•CO‐OP Program: Secretary awards loans and grants for establishing nonprofit health
insurers
•$500,000 deduction cap on compensation paid to insurance company employees and
officers
•Part D “donut hole” reduction begins, reaching a 25% reduction by 2020
2013
•Individuals without gov't‐approved coverage are subject to a tax of the greater of
$695 or 2.5% of income
•Employers who fail to offer "affordable" coverage would pay a $3,000 penalty for
every employee that receives a subsidy through the Exchange
•Employers who do not offer insurance must pay a tax penalty of $2,000 for every fulltime
employee
•More Medicare cuts to home health begin
•States must have established Exchanges
•Employers with more than 200 employees can auto‐enroll employees in health
coverage, with opt‐out
•All non‐grandfathered and Exchange health plans required to meet federallymandated
levels of coverage
•States must cover parents /childless adults up to 138% of poverty on Medicaid,
receive increased FMAP
•Tax credits available for Exchange‐based coverage, amount varies by income up to
400% of poverty
•Insurers cannot impose any coverage restrictions on pre‐existing conditions
(guaranteed issue/renewability)
•Modified community rating: individual or family coverage; geography; 3:1 ratio for
age; 1.5 :1 for smoking
•Insurers must offer coverage to anyone wanting a policy and every policy has to be
renewed
•Limits out‐of‐pocket cost‐sharing (tied to limits in HSAs, currently $5,950/$11,900
indexed to COLA)
•Insurance plans must include government‐defined "essential benefits " and coverage
levels
•OPM must offer at least two multi‐state plans in every state
•Employers can offer some employees free choice vouchers for health insurance in the
Exchange
•Government board (IPAB) begins submitting proposals to cut Medicare
•Impose tax on nearly all private health insurance plans
•Medicare payment cuts for hospital‐acquired infections begin (FY15)
2014
2015 •More Medicare cuts to home health begin
2016 •States can form interstate insurance compacts if the coverage with HHS approval (2016)
•Physician pay‐for‐quality program begins for all physicians
•States may allow large employers and multi‐employer health plans to purchase coverage
in the Exchange.
•States may apply to the Secretary for a limited waiver from certain federal requirements
2017
•Impose "Cadillac tax on “high cost” plans, 40% tax on the benefit value above a certain
threshold: ($10,200 individual coverage, $27,500 family or self‐only union multiemployer

Americans begin paying premiums for federal long‐term care insurance (CLASS Act)
What is this ?

•Increase Medicare wage tax by 0.9% and impose a new 3.8% tax on unearned , nonactive
business income for those earning over $200k/$250k (not indexed to inflation)

The .9% increase is an incewase for everyone Correct? So another tax increase for an entitlement.

Impose $2,500 annual cap on FSA contributions (indexed to CPI)

this does not affect me, but this seems to hurt those who the bill proclaims to help. This is used to get pre-Tax dollars for medical expences. Families and people with cronic conditions that require large reoccuring expecenses benifit from this. Not good, in my opinion.

•Employers required to report value of health benefits on W‐2

This seems to be a big one, but I am not sure?
Does this mean employer paid medical benifit will now be taxable income?
Does the employee payment for health Insurance, Life insurance, Dental insurance Vision. Is tjhis now going to be taxable? Rather than deducted from your check (PRE TAX) ?

That is a mean nasty Tax increase
I always though it was unfair that independent persons had no easy means to deduct expences for Insurance and medical expences from gross income for federal tax perposes. Seem like they have gone the oppisite direction?

WHAT THE FUCK IS AN ALLOT?

Originally Posted by doughboyshredder

WHAT THE FUCK IS AN ALLOT?

That is your only reaction to this thread?

You want to go after my spelling / Typing?

Predictable

Are the items posts facts?

For comparison, could you break down the costs that each American will pay for this and then do the same for the war?

for the most part, that sounds about accurate. Wa fucking wa wa. OMG, they raised taxes to make health care accessibility a little bit more equal. Cry me a fucking river.

Is all you care about money? There are a few things that are more important. Life is one of them, but I forget that the only lives that are important are that of the unborn and the terminally that want to end their own lives.

Originally Posted by MTT

•Employers required to report value of health benefits on W‐2

This seems to be a big one, but I am not sure?
Does this mean employer paid medical benifit will now be taxable income?
Does the employee payment for health Insurance, Life insurance, Dental insurance Vision. Is tjhis now going to be taxable? Rather than deducted from your check (PRE TAX) ?

That is a mean nasty Tax increase
I always though it was unfair that independent persons had no easy means to deduct expences for Insurance and medical expences from gross income for federal tax perposes. Seem like they have gone the oppisite direction?

For now, anyway, this appears to be mostly for information purposes and not for withholding taxes. I.e., for ensuring compliance with minimum coverage and/or for excise coverage under Cadillac plans as well as increasing transparency?

It will be a pain in the ass at first from the perspective of record keeping for employers but it also has the benefit of letting employees know how much of their wages ACTUALLY go towards health care costs instead of just seeing the relatively small amount that is taken out of their paycheck each month because of the regressive tax incentives from government to businesses.

In fact, Bush proposed adding health costs to W-2 statements for these very reasons:

Such disclosure is necessary because many employees “are unaware” of the value of coverage, the administration said of the idea that was included in its fiscal 2009 budget proposal released Monday, February 4

The current lack of transparency may result in “inefficient choices of health coverage, including overconsumption of health coverages by employees,” the administration said.

While there is a lot to dislike about the Healthcare Act, there is a lot to like too. Especially freer market things like greater transparency in the case of knowing your real insurance costs with W-2s, as well as legally mandated transparency when it comes to the costs of actual medical procedures and in some cases outcomes. It's hard to argue against being better informed. The exchanges also have the potential to increase free market competition with insurance companies and with health care providers.

Coming soon, Value Added Tax. Woo Hoo. My guess is in the range of say 20%. I doubt it will only be on the top 1%. Good guess,no?

Originally Posted by bushman

Coming soon, Value Added Tax. Woo Hoo. My guess is in the range of say 20%. I doubt it will only be on the top 1%. Good guess,no?

Taxing income is dumb. It makes a lot more sense to REPLACE income taxes with consumption taxes or at least make deep cuts in income and capital gains taxes by relying more on consumption taxes, instead.

Whoa big fella, never a mention of replacing income tax. The VAT I speak of will be in addition too. Ya thinks?

Meh. Who knows? If Republicans were to campaign on phasing out Federal income taxes by replacing them with consumption taxes, the Dems might find it difficult to oppose such a plan—and may well support it—if the right narrative could be found and the electorate were to buy in.

That's the great thing about elections, the majority gets to set the agenda, so the idea is only crazy if you think, 1) Republicans (and/or Democrats too) will never go for it, and 2) if you think Republicans will never again be the party in power.

As you well know, there has been certain amount of talk about a VAT tax in Congressional circles and in editorials so the real question is whether Republicans will chose to demonize consumption taxes or embrace and extend the concept.

Originally Posted by doughboyshredder

for the most part, that sounds about accurate. Wa fucking wa wa. OMG, they raised taxes to make health care accessibility a little bit more equal. Cry me a fucking river.

Is all you care about money? There are a few things that are more important. Life is one of them, but I forget that the only lives that are important are that of the unborn and the terminally that want to end their own lives.

DBS, there are other reasons to opose tax increases other than personal greed. When AT+T says it's going to cost them a $1,000,000,000, Catarpiller $100,000,000 on and on.....What do you think that does to their ability to compete around the world? What about small business who traditionally created most jobs coming out of a recession?
What will be their reaction to that cost?

It won't be to hire more people. They will have a nice big round of layoffs.
It will be to raise prices and make everyone else pay.
It will be to move more production to a place that allows them to be more competitive.

I read an economist (that I can't find right now) who said this bill will raise our definition of full employment by 4%. That will make labor cheaper DBS. That means we will make less while prices climb and we will have a permanently lowered standard of living. Will that help us afford health care for everyone? No. We will go bankrupt and the Chineese will be telling us what to do in the not so distant future. Where does thier health care system rank? Probably real high, like cuba where everyone is a prisoner.