How Congress might tax your health benefits

Fewer doctors' visits; more patients in hospitals.
Fewer doctors' visits; more patients in hospitals.

WASHINGTON — If you work at a company that reimburses employees for joining a gym, you pay income taxes on the value of that perk. If you get life insurance through work, there's a good chance that you pay taxes on a portion.

Health benefits could be next.

Lawmakers are considering taxing them to help pay for ambitious plans to overhaul the U.S. health care system, estimated to cost more than $1 trillion over 10 years. There's a lot of money at stake: Because health benefits are excluded from payroll and income taxes, the U.S. Treasury lost out on $226 billion last year, according to Congress's nonpartisan Joint Committee on Taxation.

Politically, it's not an easy sell. Polls show that the public isn't happy about the idea. For the most part, neither are businesses, which worry about the hassle of administering and explaining a new tax, and the potential exodus of young, healthy workers from coverage, which would drive up premiums for those who remain, said Blaine Bos, a principal with the benefits firm Mercer.

There's also "a lurking fear that the whole basis of employer-sponsored health insurance system may be at risk if we start fooling around with the tax exemption," Bos said.

President Barack Obama has said he shares that concern, and during his campaign he opposed the idea of eliminating the tax exemption. However, Senate Finance Committee Chairman Max Baucus, D-Mont., said last week that Obama had indicated a willingness to consider some modification in the tax rules when he met with Democratic senators.

How would all this affect you? Currently, workers who get health insurance from their employers don't pay income or payroll taxes on the cost of the policy. Self-employed people can deduct the cost of their insurance premiums. However, workers who buy their own policies because they don't get coverage through their jobs generally don't get a tax break.

Ideas for changing the policies fall into three broad categories: taxing health benefits above a certain dollar amount, taxing only wealthier people or replacing the tax break with a tax credit.


This would tax workers on the portion of their health benefits that exceeds a set amount. Determining that benchmark would be tricky. The higher it is, the less revenue the government would collect.

The benchmark could be the national average premium for comprehensive policies. That's $4,704 a year for single workers or $12,680 for family coverage, according to an annual survey of employers by the Kaiser Family Foundation. (Kaiser Health News is part of the foundation.)

Workers with policies that are priced higher than those amounts would be taxed on the difference. Those with premiums below the benchmark would owe nothing. About 48 percent of workers who have family health insurance have premiums at or above the national average, according to the Kaiser survey.

Some fairness issues arise.

For one thing, insurance premiums vary around the country, reflecting local costs, state requirements and other factors, so workers in some areas would pay more in taxes. Small companies and those with a disproportionate number of older or sicker workers also generally pay more for insurance.

"Does it make sense to say you will pay more if a co-worker gets hit by a car?" senior research associate Stan Dorn of the Urban Institute asked during a panel discussion of the tax issue last week.

Dorn suggested another way to set the benchmark: Tie it to a measure of the policy's value: what the insurer pays for claims. The benchmark could be set at, say, policies that pay 80 percent or 90 percent of approved medical claims. Less generous plans wouldn't be taxed.


How much you'd pay depends on your tax bracket and where lawmakers set the benchmark. Tax estimates are based on the total cost of the policy, even if you pay part of the premiums. That's because workers' contributions to the premiums are generally tax exempt.

If you earn $50,000, your employer offers a health policy that costs $3,500 a year and the benchmark is $5,000, you wouldn't owe any additional taxes.

On a $6,500 policy, you'd owe taxes on $1,500, the difference between the benchmark and your plan's cost, which would be considered income. In the 25 percent income tax bracket, that would amount to $375. If Congress also adds taxes for Social Security and Medicare, you'd owe another $115. States are likely to tax the income, too.

A worker who earns $180,000 would be in the 33 percent tax bracket and would owe $495, plus another $115 if Social Security and Medicare taxes are included.

The impact isn't clear for workers who are self-employed. Lawmakers may consider them employers and allow them to continue deducting health insurance costs as business expenses, or they may face taxes on all or part of those premiums.

Capping the tax break on a national premium benchmark and indexing it to the consumer price index could bring in $583.5 billion over 10 years, according to an analysis by the Lewin Group, a consulting firm that's part of Ingenix, a subsidiary of UnitedHealth Group.


This option would tax only those who have bigger salaries, higher-cost benefits or a combination of the two. Lawmakers would pick a premium benchmark, but the tax for policies above that amount would apply only to those with higher incomes. The exclusion could be dropped entirely for workers who earn more than a certain amount or phased out as income rises.

This idea holds some sway with labor unions — which oppose the tax based on premiums — as well as some economists and lawmakers.


The income threshold is key. The policy options paper that the Senate Finance Committee released suggested several scenarios, including taxing all or part of the health benefits of single filers with incomes above $200,000 and couples who earn more than $400,000.

If lawmakers choose to eliminate the tax exclusion completely for workers at those income levels, a single person who earns $200,000 a year with a policy near the national average of $4,704 a year would owe another $1,552 in federal income tax. A married couple earning $400,000 with a $12,680 policy would owe $4,438.

Still, taxing only the wealthy wouldn't bring in nearly as much money as option one. The Lewin Group report, assuming a gradual phase-out of the exclusion for people who earn $250,000 to $500,000 and then complete elimination of the tax break for those with more than $500,000 in income, estimates revenue of about $114 billion over 10 years.

To generate more revenue, lawmakers could drop the income threshold for taxation, said Jon Gruber, a professor of economics at the Massachusetts Institute of Technology.


A group of conservative Republicans, including Sen. Tom Coburn, R-Okla., and Rep. Paul Ryan, R-Wis., has introduced a bill that would end the tax exclusion for workers and replace it with a tax credit of $2,290 for individuals and $5,710 for families.

Another bill, co-sponsored by Sens. Ron Wyden, D-Ore., and Robert Bennett, R-Utah, would replace the tax break with a new standard tax deduction of $6,025 for individuals and $15,210 for families, plus $2,000 per child. The Wyden-Bennett bill also would require employers initially to boost wages by the same amount they would have paid in health benefits, money the workers could use on premiums for the employer-offered plan or to purchase different policies.

The Senate Finance Committee is studying proposals that would convert the tax break into a credit, deduction or a combination of the two.


Under the first Republican bill, if you're a single worker who's paid $50,000 and is covered by a $3,500 health insurance policy, you'd pay $875 in new taxes, but you'd get a $2,290 refundable tax credit. Net result: You'd have $1,415 to put toward your premium cost or into a special account earmarked for medical costs.

A couple earning $60,000 with a $10,000 family policy would owe $1,500 in taxes but would receive a $5,710 tax credit.

Last year, the Congressional Budget Office analyzed a similar proposal that would eliminate the tax break, replacing it with a refundable credit. The credit would begin to phase out starting at income levels of $80,000 for individuals and $160,000 for families. Over 10 years, that plan would generate an additional $606 billion, the CBO estimated.


Supporters say that changing it could:

  • Slow growth in premium costs by encouraging less-expensive health insurance.
  • Provide financing needed for a health overhaul bill.
  • End the advantage of those who get health insurance through their jobs tax-free over those who buy insurance on their own, who don't.
  • Critics say that changing it could:

  • Increase the number of uninsured people, if workers or employers drop coverage.
  • Result in higher deductibles or otherwise less-generous insurance.
  • Penalize people whose policies cost more simply because they work for small companies, live in high-cost areas or have a preponderance of sickly co-workers.
  • (Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care-policy research organization that isn't affiliated with Kaiser Permanente.)


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