Obamacare’s Dirty Secret: 31 Million Still Can’t Afford Treatment
The president’s healthcare law sliced America’s uninsured rate down to historic lows by expanding coverage for tens of millions of Americans. At the same time, however, the number of insured people who still lack affordable, robust coverage is rising sharply as more people buy into high-deductible policies.
A new study from the Commonwealth Fund reveals that about 23 percent of Americans with coverage are considered underinsured—up from 12 percent in 2003. That means roughly 31 million Americans who bought health insurance still have trouble affording treatment under their policies.
The researchers at the Commonwealth Fund defined “underinsured” people as having out-of-pocket costs that total 10 percent or more of their annual income, or a deductible that is 5 percent or more of their income. The study concluded that high-deductible policies are likely the culprit behind this massive influx of underinsured people.
The findings are a huge problem for the Obama administration since the entire goal was to expand access to coverage to millions of Americans that they presumably would use instead of delaying treatment. But a handful of recent studies show that even people with health insurance are delaying treatment because they can’t afford it.
Related: High Deductible Plans Have More People Delaying Treatment
A December Gallup Poll showed at least 38 percent of insured, middle-income people, said they had delayed medical treatment because of the cost. “While many Americans have gained insurance, there has been no downturn in the percentage who say they have had to put off needed medical treatment because of cost,” Gallup’s Rebecca Riffkin wrote in a post on the pollster’s website.
The shift toward cost-sharing and high-deductible policies—defined by the Internal Revenue Service as those with annual deductibles of $1,300 or more for individuals and $2,600 for families--is widespread among exchange policies but also employer plans.
The Commonwealth Foundation’s study, unsurprisingly, reveals that low-income people with coverage are about twice as likely to be “underinsured” than people earning more than 200 percent of the poverty line.
Of course, it’s important to note that while affordability continues to be an issue, significantly more people do have health insurance because of the law.
Trump: Repeal the Obamacare Mandate to Cut the Top Tax Rate
President Trump repeated his call Monday to repeal the Affordable Care Act’s individual mandate as part of the tax bill. In a tweet — geotagged from Pennsylvania, not the Philippines , where Trump currently is — Trump added that the billions in savings from ending the mandate should be used to cut the top marginal rate to 35 percent and the rest on cuts for the middle class.
The Congressional Budget Office said last week that eliminating the mandate would save $338 billion over the next decade.
The current version of the House tax bill keeps the top individual income tax rate at 39.6 percent, while the Senate bill lowers it to 38.5 percent. However, mandate repeal is not currently part of either tax bill, and, as The New York Times notes, “repeal of the individual mandate was not on the list of 355 amendments that the [Senate Finance Committee] released on Sunday night.”
Tax Reform Is Hard, but the GOP Could Have Made This Easier
The Tax Policy Center’s William G. Gale writes that the GOP’s approach to the tax bill combines a $5.8 trillion tax cut with a $4.3 trillion tax increase to offset the costs. There may have been an easier way. “What if the House GOP simply tried to cut business and individual taxes by $1.5 trillion. No offsets needed. They could have distributed small tax cuts to middle-income individuals by, say, modestly expanding the earned income tax credit and raising the standard deduction. And they could have trimmed the top corporate tax rate by a few percentage points. It would not have been base-broadening tax reform, but neither is the current bill. ... Tax reform is never easy, but crafting the bill this way has vastly increased the challenge of passing it.”
Alan Greenspan: Deal with the National Debt Before Cutting Taxes
Former Federal Reserve Chairman Alan Greenspan is warning that sharply cutting taxes right now would be an economic “mistake.”
In an interview with Maria Bartiromo on the Fox Business Network Thursday, the 91-year-old Greenspan said it’s more important for President Trump and Congress to put the nation on a sustainable fiscal path by addressing rising entitlement spending driven by the aging of the U.S. population.
“Frankly, I think what we ought to be concerned about is the fact the federal debt is rising at a very rapid pace, and there’s nothing in this bill that will essentially stop that from happening," Greenspan said. "So my view is that we’re premature on fiscal stimulus, whether it’s tax cuts or expenditure increases. We’ve got to get the debt stabilized before we can even think in those terms.”
GOP’s Estate-Tax Repeal Details Would Save Super-Rich Tens of Billions Extra
It’s no surprise that the House Republicans’ tax bill includes the eventual repeal of the estate tax, a long-held GOP goal. But The Washington Post’s Glenn Kessler highlights an unexpectedly generous aspect of the current bill: It “allows the beneficiaries of estates to not pay capital gains taxes on the increase in value of assets held by the estates. That has not been a feature of most previous estate-tax bills.”
Currently, estates face a federal tax if they’re valued at more than $5.49 million for individuals or almost $11 million for couples. But, for tax purposes, the value of assets passed on to heirs gets “stepped-up” or reset to their value at the time of death. Kessler’s example: “Imagine a home that had been purchased for $250,000 but was now worth $1 million. The ‘stepped-up basis’ would be $1 million. If the heirs sold the house for $1.1 million, they would only owe capital-gains tax on the $100,000 difference, not the $850,000 difference from the original purchase price.”
The GOP bill repeals the estate tax, but also keeps the stepped-up basis — a seemingly small detail that creates a huge tax shelter. It means that heirs of large estates would save tens of billions of dollars a year when they sell assets that have appreciated in value over time — or, as Kessler puts it, that the bill will allow “tens of billions of untapped capital gains to remain beyond the reach of the U.S. government.”
Republicans Are Still Coming After Obamacare’s Individual Mandate
Speaker Paul Ryan said Sunday that House Republicans are still considering a repeal of the Obamacare individual mandate as part of their tax bill. "We have an active conversation with our members and a whole host of ideas on things to add to this bill. And that’s one of the things that’s being discussed," Ryan said on Fox News. President Trump touted the idea in a tweet last week, and Sens. Tom Cotton and Rand Paul have recently spoken in favor of using the tax bill to eliminate the mandate. The move would save the government $416 billion over 10 years as roughly 15 million people go without insurance due to lower spending on subsidies and health care services, according to the CBO. Those savings could be appealing as Republicans look for revenues in their revised tax bill. But if the controversial repeal of the mandate isn’t included in the tax bill, the White House is reportedly ready to roll out an executive order weakening the requirement that taxpayers provide proof of insurance to avoid paying a penalty.