During a more tranquil time in
Washington, 1999, a pair of odd political bedfellows -- former
House Majority Leader Dick Armey (R.-Tex.) and Rep. Pete Stark
(D.-Calif.) -- co-authored an opinion piece in The Washington Post
in which they proposed a way to make health insurance more
affordable and available.
At issue, then as now, is the way the federal government
subsidizes the purchase of private health coverage. For decades,
employees have been able to exclude an unlimited amount of health
benefits from their income (thereby avoiding the tax on that
income), but only so long as that coverage comes from their
employers. This one tax provision gradually spawned an entire
industry, with employer-provided plans now covering 160 million
Americans and bestowing an average tax subsidy of $2,778 on each
covered employee. In 2006, its total value was estimated to exceed
$206 billion.
The problem is that Uncle Sam plays favorites. If your employer
doesn't offer coverage, or if you don't like the plan selected for
you, tough: You must pay for your policy with your own after-tax
dollars. The exclusion, moreover, is unfair. "The highly paid CEO
gets a more lavish health-care tax break," Armey and Stark noted,
"than the waitress earning the minimum wage."
The employer-based system also encourages companies to spend more
on health insurance than is necessary. Overly generous policies
encourage consumers to over-use medical services, fueling rampant
health-care inflation.
To Armey and Stark, the solution was obvious: Use the tax code to
help increase coverage. "We think Congress should create a new
refundable tax credit to enable all Americans to buy decent health
coverage." Other liberals agreed. Sen. Barbara Boxer (D.-Calif.),
and Reps. Barney Frank (D.-Mass.) and Jim McDermott (D.-Wash.)
sponsored legislation creating tax credits or deductions for
individuals to purchase health coverage.
Fast forward to this year's State of the Union address. President
Bush unveiled an ambitious proposal to shrink the ranks of the
uninsured by replacing the exclusion for employer-provided coverage
with a new standard deduction for the purchase of health insurance.
The deduction would be set at $7,500 for individuals and $15,000
for families and indexed to inflation. Consumers could claim the
entire deduction no matter how much, or little, they actually spent
on their plan. Spend more, and you would pay tax on the excess
amount. Spend less, and you would pocket the difference. For the
first time, every American, including the 82 percent of the
uninsured who work or live in households with a worker, could claim
some tax relief for their health coverage.
Bush believes limiting the tax-free status of the health insurance
will lead employers to disclose health costs to employees and
encourage workers to demand better value for their money, as they
do when buying a car or negotiating a mortgage. Greater consumer
pressure on the health industry would restrain the growth in
costs.
The second part of Bush's plan focuses on the millions of
uninsured Americans with incomes so low that they pay little or no
taxes. According to the nonpartisan Tax Foundation, over 50% of the
uninsured paid no income tax in 2004 (the most recent data
available) and two-thirds paid less than $1,000. Because a tax
deduction would offer little help to them, Bush wants to make other
federal health programs more flexible so that they complement,
rather than hinder, state reform efforts.
For instance, instead of sending billions to hospital emergency
rooms and other providers to treat the uninsured after they get
sick (the current practice), states could use the funds to help the
poor obtain the sort of private coverage available to the rest of
us.
Because family coverage costs about $11,000 annually, the $15,000
cap Bush proposes is quite generous. In fact, 80 percent of mostly
lower-wage workers would see their taxes fall under the plan.
Among conservatives, the president's plan won plaudits. But
liberals rejected his bid for a bipartisan solution. Stark refused
to even hold hearings on it in the health subcommittee he chairs,
saying the plan was "designed for disaster." Rep. Charles Rangel
(D.-N.Y.), dismissed it as "a dangerous policy that … shifts
cost and risk from employers to employees."
This knee-jerk opposition prompted some journalists to scold
Democrats. The Post's Steve Pearlstein noted that the plan
"actually involves raising taxes on the rich and lavishly insured
and giving the money to the working poor and the uninsured. Given
that, you'd think Democrats would have welcomed a politically
courageous proposal to put a cap on one of the biggest and most
regressive features of the individual income-tax code." Instead,
"they've shifted reflexively into partisan attack mode,
mischaracterizing the impacts of the proposal and shamelessly
parroting the propaganda from the labor dinosaurs at the
AFL-CIO."
Michael Franc who has held a number of positions on Capitol Hill, is vice president of Government Relations.
First appeared in Human Events