Monday’s lead article reassures expats that they needn’t worry about the “tax” deemed constitutional by the Supreme Court. Thank you for the information. The airways are saturated with misleading spin about the effect of the court’s decision with dizzying innuendo. Republican spinmeisters have been calling the Affordable Care Act “the largest tax increase in the history of the world.” Politifact rates this FALSE. Repetition of falsehoods can make believers out of the unwary.
There are two tax issues, which mustn’t be confused or fused. First, there is the mandate penalty. Whether you call it an incentive to purchase affordable health insurance (96 percent bought insurance in Massachusetts), a fine, a fee, a tax, a penalty for opting out or an aardvark, only about 1 percent of people will have to pay and that excludes the poor. It only applies to those who can afford health care and decide to risk their health uncovered. If something catastrophic happens to them, we, the taxpayers, end up with the bill as we now do for the millions of uninsured who receive but can’t pay for emergency care.
The second tax issue is the overall cost of the entire package. Every government program is indeed paid for out of tax dollars, be it Medicare, Social Security, foreign aid, the military, Homeland Security, health insurance for legislators or farm subsidies. According to the Government Accounting Office, the bottom line on the Affordable Care Act is that it is revenue neutral. The largest tax increase in the law is on high earners ($250 k/year), who will see their Medicare payroll taxes increase by 0.9 percentage point and who will also pay a slightly higher rate on investment income. That raises more than $200 billion. There’s also the tax on unusually expensive health insurance plans, which raises $30 billion in the first decade, and much more in the second. There’s a $60 billion tax on insurance companies. It would not increase taxes on the middle class a cent. Its overall effect will be to lower the national debt and decrease the cost of health care. Repealing it will increase the national debt and accelerate the cost of health care.
One would hope that after a year and a half of debate, passage by the House, Senate and Supreme Court, the public would see that so-called Obamacare insures 30 million currently uninsured, allows for affordable coverage for people with preexisting conditions (being a women was deemed by many insurers as a preexisting condition justifying higher premiums), abolishes annual or lifetime limits on coverage, closes the donut hole that can cost seniors a fortune, advances communication of best practices among providers, decreases waste, increases training of generalist physicians, etc.. etc., without interfering with the relationship that the insured now have with their doctors and hospitals.
Lenny Karpman M.D.