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Dueling Health Plans In Senate



The drama on what, if anything, to do with the Affordable Care Act (ACA) aka Obamacare continues. There are two very different new proposal in the Senate. The GCHJ proposal might be voted on the week of September 25. We’ll see what happens.  I have a description of both the Republican GCHJ proposal and Senator Sanders’ S. 1804, Medicare for all Health Insurance bill below.

Graham-Cassidy-Heller-Johnson (GCHJ) Proposal, introduced on 9/13/17 as an amendment to H.R. 1628, would repeal the ACA and instead offer block grants (run through CHIP) to states. Sponsors claim the proposal treats everyone the same regardless of where they live.

Text (140 pages)

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S. 1804 (Sanders)- Medicare For All Health Insurance Proposal introduced in September.

Per Senator Sanders: “would create a federally administered single-payer health care program. Universal single-payer health care means comprehensive coverage for all Americans. Bernie’s plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs.”

Claimed cost savings – Senator Sanders notes that the we spend about $3 trillion annually or about $10,000 per person. He states that his plan will save middle-class families over $5,000 per year and employers over $9,400 per employee.

He estimates that the annual cost would be about $1.38 trillion.

Senator Sanders proposes to pay for the plan as follows:

  • 6.2% income-based premium paid by employers.
  • 2.2% income-based health care premium on income over $28,800 paid by households.
  • A more progressive income tax system. New marginal rates:
  • 37% on income between $250,000 and $500,000.
  • 43% on income between $500,000 and $2 million.
  • 48% on income between $2 million and $10 million. Per Sanders, this is about 113,000 households or the top 0.08% of taxpayers.
  • 52% on income above $10 million, which affects about 13,000 households.
  • Tax capital gains and dividends at ordinary tax rates.
  • For individuals with over $250,000 of income, limit the tax benefit for deductions to 28%. This would replace the AMT, and the phase-out for personal exemptions and itemized deductions.
  • Create more progressive estate tax rates.
  • Savings from the disappearance of health-related tax expenditures such as the income exclusion for employer-provided health care.

16 cosponsors at 9/21/17.

What do you think?

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Annette Nellen, CPA, Esq., is a professor in and director of San Jose State University’s graduate tax program (MST), teaching courses in tax research, accounting methods, property transactions, state taxation, employment tax, ethics, tax policy, tax reform, and high technology tax issues.

Annette is the immediate past chair of the AICPA Individual Taxation Technical Resource Panel and a current member of the Executive Committee of the Tax Section of the California Bar. Annette is a regular contributor to the AICPA Tax Insider and Corporate Taxation Insider e-newsletters. She is the author of BNA Portfolio #533, Amortization of Intangibles.

Annette has testified before the House Ways & Means Committee, Senate Finance Committee, California Assembly Revenue & Taxation Committee, and tax reform commissions and committees on various aspects of federal and state tax reform.

Prior to joining SJSU, Annette was with Ernst & Young and the IRS.

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