A tax break that many workers don't even realize they have has become a pawn in the chess game of health care overhaul as lawmakers look for ways to pay for a reform that would reduce costs, boost quality and extend coverage to more Americans.
The tax exclusion for the value of workers' health benefits represents one of the most substantial sources of funding for comprehensive health overhaul efforts, many economists say.
As legislators scramble to come up with ways to finance the upfront cost, which is projected at around $1 trillion over 10 years, they are increasingly considering options for imposing a dollar limit on the amount of premiums for employer-sponsored coverage that can be excluded from taxable income.
When it comes to raising money for an overhaul, no other strategy comes close. The tax exclusion for employer-sponsored health benefits is set to reduce federal tax revenues by an estimated $3.5 trillion between 2010 and 2019, according to the Urban Institute.
No draft legislation calls for raising that whopping sum through total elimination of the tax exclusion. But capping it above a certain threshold to shore up a fraction of its potential value has bipartisan support, even though any kind of tax increase remains politically sensitive.
"Historically, this has been a sacred cow," said Michael Thompson, a principal with PricewaterhouseCoopers in New York. "But with the momentum we're seeing in Washington around health reform, I wouldn't be surprised if something moves forward that will dramatically change the way people think of the tax-related nature of health benefits."
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Capping benefits would present a dilemma for President Barack Obama, who promised he wouldn't raise taxes on workers earning less than $250,000 a year. On the campaign trail, he attacked Sen. John McCain's proposal to end the tax exclusion for employer-provided health benefits. But Obama also has said a health care overhaul must not increase the federal deficit, which puts the issue back into play.
Striking a balance between generating enough funds and keeping the tax bite manageable for workers while still being fair to workplaces with different characteristics is a tough job, said Paul Fronstin, director of the health research program for the Employee Benefit Research Institute in Washington.
"Taxing (benefits) will raise money, but it's a blunt instrument that won't necessarily only tax Cadillac plans," Fronstin said. "You're being taxed on price rather than being taxed on comprehensiveness. There are ways to make adjustments for it, but that affects how much money they can raise."
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"The bite is very small in the first year," Clemans-Cope said. "In 2010, the change in after-tax income for those who have an increase is less than 1%."
But over time, the cap would affect a growing share of the premium for a growing number of taxpayers. Even so, some of the tax bite may be offset by wage gains.
Under a moderate scenario that would raise an estimated $224 billion in income tax by indexing the cap to growth in the gross domestic product, about 38% of taxpayer households would face a tax increase in 2019, according to the Urban Institute's projections. The average tax increase would be 1.6%, equal to $1,260 in income and payroll tax. This example preserves 90% of the tax subsidies.
Tying the cap to growth in the consumer price index would raise twice as much money, an estimated $456 billion, but would take a bigger bite out of workers' earnings. It would affect about the same amount of taxpayer households, but the average tax hit would be $2,220, a nearly 3% change in after-tax income, according to the study. This scenario would preserve 80% of the subsidies.
Adjusting the cap to keep up with the rapid rise in medical expenses would generate the least revenue of the three options and would affect taxpayer households the least in the next decade. After-tax income would dip 0.7% on average, equal to $570 in income and payroll taxes, and only slightly more than 14% of taxpayer households would be affected. This example would raise $62 billion.
Continued: May go the way of life insurance
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