PNHP

House bill includes transfer from wealthy

House of Representatives
July 14, 2009
H.R.____
To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.
SHORT TITLE.–This Act may be cited as the “America’s Affordable Health Choices Act of 2009”.
TITLE IV–AMENDMENTS TO INTERNAL REVENUE CODE OF 1986
Subtitle D–Other Revenue Provisions
PART 1–GENERAL PROVISIONS
SEC. 441. SURCHARGE ON HIGH INCOME INDIVIDUALS.
(a) IN GENERAL.–Part VIII of subchapter A of chapter 1 of the Internal Revenue Code of 1986, as added by this title, is amended by adding at the end the following new subpart:
“Subpart B–Surcharge on High Income Individuals
“SEC. 59C. SURCHARGE ON HIGH INCOME INDIVIDUALS.
“(a) GENERAL RULE.–In the case of a taxpayer other than a corporation, there is hereby imposed (in addition to any other tax imposed by this subtitle) a tax equal to–
“(1) 1 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $350,000 but does not exceed $500,000,
“(2) 1.5 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $500,000 but does not exceed $1,000,000, and
“(3) 5.4 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000.
http://energycommerce.house.gov/Press_111/20090714/aahca.pdf

Health insurance and health care are no longer affordable for average-income individuals. Any reform proposal that would make health care affordable for everyone must include a transfer from the wealthy to average- and low-income individuals.
The authors of the House tri-committee reform bill explicitly acknowledge this fundamental principle by including a policy for a surtax on high income individuals to help finance the subsidies that will be required to assist individuals of more modest incomes with the mandated purchase of health plans. Has this taken care of the affordability issue?
Let’s go through the numbers again. Average health care costs for a family of four with an employer-sponsored PPO are now $16,771. That is the average cost for a relatively healthy sector of society. Many with greater needs pay more than that. That is the average health care spending under the best of conditions in our current multi-payer system, and it doesn’t even include insurer administrative costs.
Under this legislation, no subsidies are provided for individuals or families over 400 percent of the federal poverty level. For a family of four, that threshold is an income of $88,200. Thus average costs would be 19 percent of family income, and more for those with greater needs. By no stretch could that be considered affordable.
It’s great that the concept of income transfer has been accepted by the policymakers in Congress, but they need to go back to the drawing board to craft a plan that would actually work. (Hint: Provide all necessary services for everyone, and pay for those services through a single universal risk pool that is funded equitably using progressive tax policies.)

House bill includes transfer from wealthy

House of Representatives
July 14, 2009
H.R.____

To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

SHORT TITLE.–This Act may be cited as the “America’s Affordable Health Choices Act of 2009”.

TITLE IV–AMENDMENTS TO INTERNAL REVENUE CODE OF 1986

Subtitle D–Other Revenue Provisions

PART 1–GENERAL PROVISIONS

SEC. 441. SURCHARGE ON HIGH INCOME INDIVIDUALS.

(a) IN GENERAL.–Part VIII of subchapter A of chapter 1 of the Internal Revenue Code of 1986, as added by this title, is amended by adding at the end the following new subpart:

“Subpart B–Surcharge on High Income Individuals

“SEC. 59C. SURCHARGE ON HIGH INCOME INDIVIDUALS.

“(a) GENERAL RULE.–In the case of a taxpayer other than a corporation, there is hereby imposed (in addition to any other tax imposed by this subtitle) a tax equal to–

“(1) 1 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $350,000 but does not exceed $500,000,

“(2) 1.5 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $500,000 but does not exceed $1,000,000, and

“(3) 5.4 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000.

http://energycommerce.house.gov/Press_111/20090714/aahca.pdf

Comment:

By Don McCanne, MD

Health insurance and health care are no longer affordable for average-income individuals. Any reform proposal that would make health care affordable for everyone must include a transfer from the wealthy to average- and low-income individuals.

The authors of the House tri-committee reform bill explicitly acknowledge this fundamental principle by including a policy for a surtax on high income individuals to help finance the subsidies that will be required to assist individuals of more modest incomes with the mandated purchase of health plans. Has this taken care of the affordability issue?

Let’s go through the numbers again. Average health care costs for a family of four with an employer-sponsored PPO are now $16,771. That is the average cost for a relatively healthy sector of society. Many with greater needs pay more than that. That is the average health care spending under the best of conditions in our current multi-payer system, and it doesn’t even include insurer administrative costs.

Under this legislation, no subsidies are provided for individuals or families over 400 percent of the federal poverty level. For a family of four, that threshold is an income of $88,200. Thus average costs would be 19 percent of family income, and more for those with greater needs. By no stretch could that be considered affordable.

It’s great that the concept of income transfer has been accepted by the policymakers in Congress, but they need to go back to the drawing board to craft a plan that would actually work. (Hint: Provide all necessary services for everyone, and pay for those services through a single universal risk pool that is funded equitably using progressive tax policies.)