If it’s December, it must be time for a massive, one-time, all-or-nothing annual spending bill. That’s just what has become of Congress’s core function over the past decade. This year’s version includes a 2,009 page omnibus appropriations bill and a 233 page tax bill mostly extending various “temporary” tax preferences and other provisions.
Republicans have majorities in both houses, so this bill reflects their priorities on the whole. But on health care, it’s actually most interesting for what it suggests about the Democrats—some meaningful number of whose votes are after all necessary for passage.
A group of state insurance commissioners is developing a proposal to limit the amount that health insurers might have to pay out under the Affordable Care Act’s risk adjustment program, New Mexico Insurance Superintendent John Franchini told SNL.
The plan would install a so-called circuit breaker to prevent companies from paying more than 2% of their premium revenue into the program each year. That boundary would make insurers’ financial obligations more predictable and avoid the kinds of surprise payouts that contributed to the destabilization of several health plans in 2015.
On December 14, former Secretary of the Department of Health and Human Services Kathleen Sebelius made news by calling the decisions of Kansas and Missouri to turn down the Medicaid expansion contained in the Affordable Care Act “morally repugnant and economically stupid.”
Heated political rhetoric does not alter the fact that a state’s decision to expand Medicaid involves complicated tradeoffs.
The Senate voted overwhelmingly today 65-33 in favor a $1.8 trillion package of spending bills and tax breaks, sending the legislation to President Obama’s desk for his signature. Included in the two bills are provisions trimming some of the levies that help finance ObamaCare. A tax on medical devices would be suspended for two years, a levy on health insurers would stop for a year and a tax on higher-cost insurance policies would be postponed two years until 2020.
It has been called into question whether it’s true that Sen. Marco Rubio is responsible for the provision (inserted into last year’s annual spending bill and now again into this year’s) that requires the risk-corridor program in ObamaCare to be budget neutral. Like this year’s giant spending law, last year’s omnibus bill was the result of a leadership-driven process that drew on substantive expertise from the relevant committee staffs but did not much involve most members of either house. But Rubio was without question the first and most significant congressional voice on this subject, and if he hadn’t done the work he did, the risk-corridor neutralization provision would not have been in last year’s (or this year’s) budget bill.
The House voted 318-109 to send a $680 billion tax-extenders bill to the Senate, which is expected to approve the legislation alongside the omnibus spending measure. The tax legislation, which would make permanent some tax credits and extend several others, is the product of a deal reached by Democratic and Republican leaders earlier this week.
“With this tax bill, families and businesses are going to have the long-term certainty that they need, instead of scrambling year after year to find out what’s next,” House Speaker Paul Ryan (R-Wis.) told reporters on Thursday before the vote.
A federal budget proposal brought good news Wednesday for Minnesota’s medical device companies by freezing for two years a tax on products like pacemakers and ventilators that they have long opposed. The package of tax cuts and spending cued up for final votes in Congress this week would suspend the 2.3% excise tax on those devices, ultrasound machines and more that took effect in 2013 as part of the funding mechanism for President Barack Obama’s health care law.
In a big package of tax and spending legislation that Congress is likely to approve this week, Republicans have forced President Obama to swallow three changes that undermine his signature health care law, including a two-year delay of a tax on high-cost insurance plans provided by employers to workers.
In an interview on Wednesday, Mr. Obama’s first budget director, Peter R. Orszag, a leading supporter of the Cadillac tax, said, “The two-year delay is likely to be equivalent to repeal of the tax because people will expect it to be deferred again and again.”
The Cadillac tax contained in the Affordable Care Act represented an attempt to remedy a major problem with health care and tax policy – the exclusion of the cost of employer-sponsored insurance from both income and payroll taxes. Regardless of political leanings, economists generally agree that the exclusion causes employers to offer overly expansive insurance. This depresses wages and increases overall health care spending. Moreover, the exclusion provides a disproportionate benefit to the wealthy.
It goes without saying that delaying a scheduled tax increase is a tax cut. According to the Joint Committee on Taxation, a two year delay of the Cadillac tax combined with deductibility will save taxpayers $20 billion over the next decade. Conservatives are for tax relief.
Conservatives are for repealing ObamaCare, in whole or in part. The Cadillac Plan excise tax is a part of how ObamaCare’s latticework of subsidies and regulations is supported. Delaying on the road to repealing parts of the ObamaCare law is good public policy. Eventually, we want to repeal and replace all of ObamaCare.