Who knows what a final Senate health care bill will end up looking like? But, with the Senate Finance Committee having completed work on its version of a bill, we know some of the elements that are in play, and they are not good. Here is a rundown of some of the big problems with the Senate Finance Committee’s health care bill:
1. New health care entitlements created by the bill will grow at 8 percent per year, according to the Congressional Budget Office—faster than either the economy or tax revenues will grow. The federal government, meanwhile, is currently over $60 trillion short of fully funding the obligations it already has. Creating another entitlement won’t help.
2. The 10-year cost of the bill is $829 billion according to the Congressional Budget Office, but CBO’s estimate made an assumption that has already been demonstrated to be false: that Congress would allow planned cuts in Medicare reimbursements to doctors to take effect. In order to satisfy the doctors lobby, Congress has overridden those planned cuts every year since 2003. True to form, a bill has now been introduced in the Senate that will override the planned cuts for the next 10 years at a cost of $247 billion. By using a separate piece of legislation to increase doctors’ Medicare reimbursements, the Senate effectively rigged the CBO scoring of the health care bill. To its credit, the CBO saw this coming when it added the proviso: “These projections assume that the proposals are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation.” Indeed, the proposals look to remain unchanged throughout all of one week.
3. Much of the bill’s new health care spending will not begin in until 2013, which means that the CBO’s 10-year projection is closer to a six-year projection of the costs. According to estimates by Cato’s Michael Tanner, the cost of the bill over the first ten years of operation would be more like $1.3 trillion.
4. The cost to the federal government is not the total cost of the bill. By expanding Medicaid, the bill also adds $33 billion in costs to state budgets for the next decade. And then there is the cost of private sector mandates. Massachusetts health care reforms include many of the same elements that are now being proposed at the national level, namely reliance on health insurance exchanges and mandates on insurers. Cato’s Michael Cannon notes that the Massachusetts Tax Foundation has calculated that 60 percent of the cost of Massachusetts’s health care reforms have been paid by the private sector. If the same proportion held true for current proposals, then the 10-year cost exceeds $2 trillion.
5. The bill will impose a tax on some 3,000 medical devices. Those taxes, which will ultimately be passed on to consumers, are expected to bring in $180 billion over ten years. In effect, the bill taxes those who need medical care in order to subsidize the purchase of health insurance by the healthy.
6. Under the bill, people who don’t buy the type of insurance that the government says they should buy will have to pay a fine, and those who don’t pay the fine will go to jail, according to the Joint Committee on Taxation.
7. The bill effectively kills Health Savings Accounts through its requirements on actuarial value. Under the bill, all health insurance plans must cover 70 percent of the expected medical costs of those it insurers (based on demographics). But the requirement does not count HSA deposits toward a plan’s actuarial value. Currently 8 million people find HSAs attractive enough that they have decided to enroll in them. Under the bill, those people won’t get to keep the insurance they like.
8. The bill imposes a 40 percent excise tax on health insurance premiums that exceed certain levels ($8,000 annually for individuals and $21,000 annually for families). That tax, which will be passed on to consumers, is expected to bring in $201 billion over ten years. According to the Joint Committee on Taxation, 87 percent of the tax on “Cadillac plans” will be paid by those earning less than $200,000 per year, and 50 percent will be paid by those earning less than $100,000. The Heritage Foundation estimates that more than 570,000 families that pay no income tax or are in the 10 percent income tax bracket would be subject to the tax on “excessive” health benefits.
9. The bill would add up to 30 percentage points to the effective marginal tax rate facing low-income workers. The bill provides generous subsidies for those below the poverty line and then phases those subsidies out as income rises. The way James Capretta figures it, a family of four that increases its annual income from $24,000 to $48,000 would see its health care subsidies decline by $7,400 ($7,400 / $24,000 = 0.308). And, Capretta notes, if that implicit marginal rate is combined with that of the Earned Income Tax Credit (21 percent) as well as the individual income tax rate (15 percent) and payroll taxes (7.65 percent), then “the effective, implicit tax rate for workers between 100 and 200 percent of the federal poverty line would quickly approach 70 percent — not even counting food stamps and housing vouchers.” Even for middle-income families, according to former CBO Director Doug Holtz-Eakin, the implicit marginal tax rates produced by the bill’s subsidies would be quite high: 23 percent for a family of four earning $54,000 per year.
Oh, and one more problem with the Finance Committee bill: Given the way the legislative process works, it probably won’t get any better. As The Heritage Foundation’s Mike Franc puts it, “this legislative monstrosity is the Right Wall”:
Projecting ahead, one sees the potential for the Senate Finance bill to sprout new and even more hideous heads. It is entirely conceivable, for example, that the Senate will grant Senator Schumer his fondest wish and add a lethal public-plan option to the bill. A public option could become in short order our largest health-entitlement program, enrolling even more Americans than do those other out-of-control health entitlements, Medicare and Medicaid. Pressure to shelter more low-income Americans from the costs of the individual mandate could result in an even larger Medicaid expansion. And union-inspired objections could convince lawmakers to jettison the Senate Finance tax on high-cost Cadillac health plans (no bargain) and replace the lost billions with the House’s preferred option, a 5.4% surtax on the incomes of the wealthiest Americans (an even worse one).