Healthcare Promises [aka ACA]

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On the Affordable Care Act

By Rick Kahler MS CFP® ChFC CCIM www.KahlerFinancial.com

Rick Kahler CFP“I’m not sure what’s wrong or what kind of surgery you need, but we have to operate right now.”

If you heard this from your doctor, you’d jump off the examination table and run for the door. Yet that’s essentially the approach the President and Congress used three years ago to pass a bill, optimistically called the Affordable Care Act, which was the largest transformation of the U.S. health care system in our lifetime.

The Debate

During the frenzied debate our elected leaders made many promises as to the amazing benefits this legislation would bestow on Americans. After listening to speeches from President Obama, Speaker of the House Nancy Pelosi, and President of the Senate Harry Reid, I recounted those promises in this blog on March 21, 2010.

The Promises

Let’s revisit those promises.

  1. All Americans will now receive affordable, or free, quality health care.
  2. No one will ever be denied coverage.
  3. No one will ever go into bankruptcy because of the costs of health care.
  4. There will be increased access to health care for 95% of Americans.
  5. There will be no decline in the quality of health care.
  6. Health care costs will go down.
  7. Health insurance coverage will be affordable to the middle class.
  8. There will be no decline in Medicare benefits.
  9. Insurance premiums will decline for the middle class.
  10. It will unleash unprecedented entrepreneurial opportunity for the economy.
  11. The deficit will decline, saving taxpayers $1.3 trillion.
  12. It will cut $500 billion of waste, fraud, and abuse out of Medicare.
  13. No government funds will be used to fund abortion.

Are these promises coming true? Many of them are pending full implementation of the act in 2014. Others have fallen flat or encountered the law of unintended consequences.

Obama Care

Business Owner’s

I’ve heard recently from several owners of small businesses about their increased health insurance costs. In addition to premium increases of nearly 50% over the past two years, they are seeing increased administrative costs from what one person called the “insanity and complexity” of the new regulations.

Businesses with fewer than 50 employees aren’t required to provide health insurance. The incentive for owners of businesses close to that threshold is to keep employee numbers below 50, which means curtailing growth or even laying people off.

Those without employer-provided insurance are supposed to be able to shop for coverage in new health care exchanges, beginning this October. However, half the states have chosen to rely on the federal government instead of setting up their own exchanges.

This has brought criticism even from former supporters like Democratic Senator Max Baucus of Montana, who helped write the health care bill. He is concerned that the exchanges will not open on time and consumers won’t have the information they need to use them. He told the Huffington Post that Obamacare is headed for a “train wreck.”

ACA Cost Estimates

The proponents said the ACA would cost $938 billion over 10 years. In addition to the promised Medicare savings, this was to be covered by a total tax increase of $562 billion over 10 years. This included a Medicare tax of 3.8% on dividends, rents, interest, and investment income on individuals and small business earning over $250,000.

The Office of Management and Budget, however, places the cost at $1.8 trillion over 10 years, resulting in a shortfall of around $900 billion.

Assessment

Whether Obamacare becomes the wild success the proponents guaranteed is yet to be seen. However, what we’ve seen so far isn’t promising. We as consumers would be well advised to pay close attention and ask tough questions before we accept this drastic surgery.

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Conclusion

Are these promises coming true? Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Is Federal Tax Reform Even Possible?

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More On the National Commission on Fiscal Responsibility and Reform

By Children’s Home Society of Florida Foundation

In 2010, the National Commission on Fiscal Responsibility and Reform considered possible options for reforming the income tax system. The bipartisan commission was co-chaired by former Senator Alan Simpson and former White House Chief of Staff Erskine Bowles.

Bowles-Simpson

The Bowles-Simpson tax solution involved a substantial reduction in the rates by limiting itemized deductions or converting them to tax credits.

In response to the Simpson-Bowles proposal and those from members of Congress and presidential candidates, the Senate Finance Committee leadership met with the Joint Committee on Taxation (JCT). Committee Chair Max Baucus (D-MT) and ranking member Orrin Hatch (R-UT) requested a study by JCT of various tax reform options.

The JCT experiment discussed options if various tax expenditures were repealed. Based on the JCT analysis, there was only a small reduction in rates possible. However, other commentators noted that the JCT study did not consider all of the base-broadening strategies.

In response to the JCT study, Simpson and Bowles issued a joint statement and noted, “Nothing in the JCT analysis changes our belief that it is possible for tax reform to reduce rates and produce additional revenues if policy makers are willing to make the tough choices to eliminate or scale back tax expenditures.”

The Simpson-Bowles proposal showed a potential to reduce rates to 8%, 14% and 23% if there is a drastic reduction in other tax expenditures. The nonpartisan Committee for a Responsible Federal Budget (CRFB) also responded to the JCT study.

The Committee for a Responsible Federal Budget Responds

The CRFB analysis indicated that the Simpson-Bowles commission strategy could work if there is partial or total elimination of tax expenditures. Another CRFB analysis also indicated that there was a 2005 Treasury study by the President’s Advisory Panel on Tax Reform that claimed a combination of base-broadening and rate reduction is possible.

Assessment

CRFB staff noted, “Although these two analyses differ in some respect, both show that the full elimination of all tax expenditures would allow the top tax rate to fall to 23% while still putting aside more than $1 trillion for deficit reduction.”

Editor’s Note: Your editor and this organization take no specific position on these tax reform strategies. The proposed major rate reduction plans all require significant limits on itemized deductions. Most strategies also tax capital gains at 28%. These changes will be difficult to pass during the major tax reform expected in 2013.

Conclusion

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The Case for Major Tax Reform in 2013

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Tax Code is “Beast with Hundreds of Heads”

By Children’s Home Society of Florida Foundation

Senate Finance Committee Chairman Max Baucus (D-MT) has been holding a series of hearings in preparation for major tax reform in 2013. In an address on June 11 to the Bipartisan Policy Center, Baucus outlined the basic guidelines for major tax reform. He compared the current tax code to “Hydra, the mythical Greek beast with hundreds of heads.” Baucus noted that the last major tax reform of the entire code was 1986. Since that time, Congress has made 15,000 changes to the Tax Code. He suggested it is long past time to “get rid of the deadwood and simplify the code.” Baucus believes that the Tax Code needs to reflect the major changes in America since 1986.

Deficits and Debt:

There has been a rapid growth in both the deficit and the debt in the past decade. The public debt is now 73% of America’s gross domestic product (GDP). This is the highest level of debt since World War II. In addition, with the reduction in tax revenue from capital gains and other business revenue, the total receipts by the government are the “lowest they have been since World War II.” A combination of higher spending and lower revenues has created a serious debt and deficit problem. Tax reform will need to be accompanied by a sound budget that reduces the national debt and deficit. This will include both tax increases and spending reductions.

World Competition:

All of America faces major challenges because of the changing world. The U.S. economy has grown 88% since 1986. However, most of the gains have gone to upper-income individuals. In the past 15 years, America has 15% more college graduates. However, some of the other nations in the third world have increased their number of graduates by 90%. All of these new college graduates throughout the world are creating substantial competition for job growth. Families have also changed significantly. In 1986, there were more couples with one breadwinner. Now there are more single persons and working couples. There are fewer manufacturing jobs. The American economy has moved steadily from manufacturing to exporting financial services, software and engineering.

Finally, many foreign nations have acted aggressively to modernize their education systems, infrastructure and tax codes. Foreign companies increasingly have grown to join the members of the Fortune Global 500. Many of these large foreign companies have been acquiring U.S. companies and reducing the jobs in this nation. For example, when the European company Unilever acquired the U.S. company Alberto Culver, it closed an Illinois production facility and moved hundreds of jobs overseas.

A Solution?

Baucus foresees a four-part solution. A new tax code will be needed that has a focus on jobs, competition, innovation and opportunity.

1. Jobs.

The primary factor that will increase employment is to reduce personal income tax rates. This will require reducing or eliminating tax expenditures (such as deductions for medical care, retirement plans, mortgage interest, state and local taxes and charitable giving).

2. Competition.

The foreign nations have all reduced their corporate tax rates. America now has the highest corporate tax rate in the industrial world. The corporate tax rate will need to be reduced by eliminating many corporate deductions.

3. Innovation.

America will need to encourage research and new technologies with appropriate incentives.

4. Opportunity.

In the present world, education is more important than ever before. Therefore, a new tax code will need to facilitate higher education opportunities. Baucus stated that he is “making progress on a detailed tax reform proposal that will attract bipartisan support.”

Editor’s Note: Chairman Baucus and House Ways and Means Chair Dave Camp (R-MI) are both holding hearings. They believe that 2013 is the “once-in-a-generation” opportunity for them to craft comprehensive new personal and corporate tax codes.

Conclusion

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Why the White House Proposed Corporate Tax Reform

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Twenty-Five Years Since Last Revision

By Children’s Home Society of Florida Foundation

On February 22nd 2012, Treasury Secretary Timothy Geithner spoke to Congress and outlined the White House proposal for corporate tax reform. Geithner noted that there has not been a comprehensive corporate tax reform for 25 years. Since the last major corporate tax reform, there have been many significant events. These include the following changes.

  1. Internet is widely used.
  2. Cell phones are now common place.
  3. China and India have become significant economies.
  4. Global trade has greatly expanded.
  5. Nearly all other industrial societies have lowered their corporate rates.

The Five Elements of Reform

  1. Reduced Rates – The elimination of tax loopholes and subsidies will permit a reduction of the corporate tax rate from 35% to 28%.
  2. Manufacturing Incentives – The effective tax rate for manufacturing companies will be reduced to 25% through incentives.
  3. International Taxation System – Companies could pay penalties for shifting income overseas.
  4. Simplification – Small businesses would benefit from reduced complexity in the Tax Code.
  5. Revenue Neutrality – The reduced rates are achieved through eliminating various tax deductions.

Assessment

Treasury Secretary Geithner indicated that he plans to meet with Senate Finance Chair Max Baucus (D-MT) and House Ways and Means Chair Dave Camp (R-MI). He hopes that it will be possible to build a bipartisan consensus for corporate tax reform.

Editor’s Note: Sen. Baucus and Chairman Camp have been holding hearings and proposing corporate tax reform for the past year. With the White House announcement, that the President, the House and the Senate agree that there should be simplification and a lower corporate top rate. The challenge will come when the government grapples with the question of which major corporate deductions (such as bonus depreciation) will actually be removed in order to lower rates. Because of the magnitude of major tax reform, it is not likely that an actual bill could be passed before 2013.

Conclusion

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On the Proposed Tax Cuts

Senate Debate on Extending 2001/2003 Tax Cuts

By Children’s Home Society of Florida Foundation

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The Senate Finance Committee conducted a hearing on July 14, 2010 to discuss the potential extension of tax cuts. In the Economic Growth and Tax Relief Reconciliation Act of 2001 (EGTRRA) and the Jobs and Growth Tax Relief Reconciliation Act of 2003 (JGTRRA), there were tax reductions for nearly all Americans. The tax reductions continue through 2010, but are set to be repealed on January 1, 2011.

Proposals

The White House has proposed to extend these tax cuts for single persons with incomes under $200,000 ($250,000 for couples), but to increase the capital gain rate and top income tax brackets. Under the White House plan, the capital gain rate will increase from 15% to 20%, the 33% bracket increases to 36% and the 35% tax bracket is raised to 39.6%.

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The Senate

Senate Finance Chair Max Baucus (D-MT) opened the hearing by stating, “Americans are struggling to make ends meet, and we need to do all we can to put more money back in the hands of workers, middle-class families and small businesses so our economy can grow. I support extending the middle-class tax cuts permanently, as soon as possible, so working families can keep more of their hard-earned money.”

Sen. Baucus and the White House are both advocating a permanent extension of the tax cuts for low and middle-income taxpayers, with an increase in taxes for those in the upper brackets.

Ranking Member on the Senate Finance Committee Charles Grassley (R-IA) has repeatedly expressed concern about the increase of taxes on small business owners. He noted, “To those who are pushing the higher marginal rates, I say the burden is on you to show that you are not harming our primary job creators.” Sen. Grassley has noted that two-thirds of new jobs in the past decade have been created by the small business owners who will be subject to the higher taxes.

Editor’s Note: The hearings on taxes are the first step in creation of a tax bill. Because the failure to act this year would result in repeal of all of the tax cuts, it is probable that there will be a tax bill prior to the end of 2010. However, with the shortened legislative calendar due to the fall elections, the tax bill is quite likely to be deferred until after the election.

Conclusion

Douglas Holtz-Eakin is President of the American Action Forum and was formerly the Congressional Budget Office Director. He testified that approximately one-half of the $1 trillion in business income that will be reported in 2011 will be subject to the higher 36% and 39.6% tax brackets. In his opinion these higher rates will reduce the willingness of small businesses to hire new employees.

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Slow, Steady Progress on Estate Tax and Extenders

Increased Exemption Possible?
By Robert Giese
bob.giese@chsfl.org

Senate Finance Chair Max Baucus (D-MT) has been in intensive negotiations with Sen. Jon Kyl (R-AZ) and Sen. Blanche Lincoln (D-AR) over the estate tax. Sen. Kyl and Sen. Lincoln have proposed increasing the $3.5 million exemption that was applicable in 2009 to $5 million per person. In addition, the previous estate tax rate of 45% would be reduced to 35%.

Ongoing Negotiations

Negotiations have been ongoing for several weeks. On May 11, 2010, Sen. Kyl reported, “We have an agreement about how we would like to move forward and an agreement on many of the offsets.” He continued by observing that the offsets are still subject to discussion. It is estimated that the offsets will be from $60 billion to $80 billion.

An Option

While the details of the proposed compromise have not been released, several aides suggested that it may include an estate tax option in 2010. If the option is enacted, lawyers, financial and estate planners could choose either the repeal of estate tax and lose part of the step-up in basis under the 2010 rules or select the new compromise estate exemption and estate tax rate.

Assessment

It may occur that the tax extenders and the estate tax are combined in one legislative bill. Senate Budget Chair Kent Conrad (D-ND) observed this week, “You have got 13 legislative weeks. It seems to me it would be wise to put all the tax measures together.”

Conclusion

The House proposal for the offsets for the tax extenders (including the IRA charitable rollover) is to change the “carried interests” of hedge fund managers from being taxed at capital gain rates to ordinary rates. It now is possible that the change in the law will occur, but it may be phased in over a number of years.

Editor’s Note: The Senate continues to attempt to complete work on the estate tax and the tax extenders by early June. The estate planning community and the charitable community are both hopeful that the Senate will resolve the current great uncertainty in planning by passing compromise legislation in both areas.

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Healthcare Reform Articles from Kevin Pho MD

Aggregating Content – Disseminating Knowledge

By Ann Miller; RN, MHA

[Executive Director] Books

Here are five interesting new articles on the healthcare reform debates from colleauge Kevin Pho, MD. 

Kevin practices at the Nashua Medical Group near the Massachusetts border. He is board certified in internal medicine and provides both comprehensive adult and primary care services.

Related posts:

Give them a click, read em’ and comment now.

Assessment

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Say it Ain’t So Kathy Sebelius

More HHS Nominee Tax Problems

[By Staff Reporters]56359795

Although it’s sounding more and more like comedian Bill Murray’s movie “Ground Hog Day”, according to Tracy Staton, Health and Human Services department secretary-nominee Kathleen Sebelius, became the second appointee for the agency to admit underpaying her taxes.

Unintentional Problems

Sebelilus fixed three years’ worth of returns due to “unintentional” problems, and paid almost $8,000 in back taxes and interest. The snafu may not be serious enough to jeopardize her nomination, however. Senate Finance Chair Max Baucus issued a statement saying the errors were “minor” and accidental, and that he supported her confirmation (The committee’s ranking Republican Charles Grassley is reserving judgment until after her confirmation hearing).

A Daschle “Do-Over”

We all know that Senator Tom Daschle’s nomination to head up HHS hit the wall after a tax review found he owed some $140,000 in back taxes and interest. Is this a similar KS do-over; aka “mulligan”?

Industry Indignation Index: 45

Assessment

More importantly, are these so-called healthcare demagogues and gurus aware that “perception is reality”; especially in the healthcare space where integrity and trust matters most? Or, as ME-P Publisher Dr. David Edward Marcinko wondered aloud,

“Do politicians and/or those of us in healthcare really believe we are above it all?

Link: http://blogs.wsj.com/health/2009/04/01/sebelius-runs-into-tax-problems-but-daschles-were-bigger

Conclusion

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