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The Case for Taxing “Cadillac” Healthcare Coverage

Aug 4, 2009• 39

By CLAYTON MCWHORTER ClaytonMcWhorter1

With President Obama’s plan for healthcare reform recently being dealt a tough blow by the Congressional Budget Office over soaring federal deficit projections, I am beginning to wonder if it is time for the President to modify his stance against taxing “Cadillac” healthcare coverage offered by employers. It’s no secret what Senator Max Baucus, the Democratic Chairman of the Senate Finance Committee and one of the most powerful people in the healthcare reform debate, thinks President Obama should do. Senator Baucus has been a vocal advocate of taxing healthcare benefits. He recently told reporters that taxing employer-sponsored benefits is “the best way to raise money for an overhaul of the healthcare system.” He has also been somewhat critical of President Obama’s decision to not tax healthcare benefits by saying, “Basically, the president is not helping us.”

In recent days, the Congressional Budget Office (CBO) estimated that the House Democratic legislation would add more than $230 billion to the federal budget deficit. On the Senate side, Senator Baucus, who has been working with Senate leaders to formulate another plan, has pointed out the difficulties his committee has had with funding reform without some other type of significant revenue.

One way that raises enough revenue to cover well over the $230 billion figure projected by the CBO is through taxing employer-sponsored health benefits. The nonpartisan Joint Committee on Taxation estimates that taxing employer-sponsored benefits above the value of the Federal Employees Health Benefits Plan (FEHBP), adjusted for inflation, would generate nearly $420 billion over the next 10 years, which would easily fund the difference in the budget gap. Many other estimates place this number considerably higher. Furthermore, many experts believe that this policy is a key way to reduce costs, because tax-free benefits encourage more spending on health care.

About 18 months ago, as I worked with a committee that I chaired in Tennessee called the Rolling Hills Group to create a structural model for national healthcare reform, I ran into the same problem that President Obama is facing today. How do you pay for reform? After considering several options on how to finance universal insurance, our group kept coming back to the same, single solution – the same one that Senator Baucus is a proponent of, taxing “Cadillac” healthcare benefits.

Under our proposal, we created a basic level of coverage similar to what members of Congress are offered today, known as the FEHBP standard option plan. This plan is very generous and has been successful in holding down costs compared to other plans. In order to make sure our plan was budget neutral, we decided we would no longer allow what we consider “Cadillac” coverage benefits to be tax free. For example, in 2009, under our proposal, any individual policy worth more than $5,871.84 or any family policy worth more than $13,445.64 would be subject to a tax. Anything less than this amount would be tax free. For individuals, any amount above the base value of the plan would be considered income. While for companies, any amount above the base value of the plan would no longer be deductible as a business expense.

We had this idea vetted by the Moran Company, who said that our plan is actuarially sound and budget neutral for the federal government once fully phased in. Just as a note, in our plan we also derive revenue from Disproportionate Share Payments (DSH) and hold down up front costs by phasing in the reform over a 10 year period. Disproportionate Share Payments is funding that hospitals receive for treating indigent populations. Thus, it is reasonable to decrease DSH payments as the uninsured population decreases.

If taxing “Cadillac” coverage raises enough revenue to make healthcare reform budget neutral and encourages less spending on healthcare, why has such an attractive option for reform been pulled off the table amidst the President’s insistence on urgency? As is usually the case with healthcare reform, the answer may be in the politics.

In recent weeks, several articles have outlined strong opposition by labor unions to the taxation of their healthcare benefits. In the Washington Post, the AFL-CIO stated its opposition to taxing “Cadillac” coverage. Michael Sullivan, the President of the Sheet Metal Workers Union, has also adamantly stated his opposition to taxing healthcare benefits by saying, “Any bill that taxes health care benefits is dead on arrival.” Understanding these political difficulties, but still seeing the taxing of benefits as a viable way forward, lawmakers have demonstrated that there may be room for compromise. Senator Baucus himself has hinted that he might consider grandfathering in the taxation of health benefits that are part of a collective-bargaining agreement, which would allow union plans to remain tax-free until new contracts can be negotiated.

Labor unions are not the only ones who have come out against the taxation of “Cadillac” plans, as many large corporations have exhibited significant opposition as well. However, if healthcare reform is going to happen this year, Congress and President Obama may want to take a harder look at taxing “Cadillac” healthcare benefits as a means of raising revenue and achieving their other healthcare priorities. I think it is fair to say that if Obama explains to the American people that the Government is only going tax the most lavish of benefits, he might find greater support from the American public for the change in health care that he promised to bring and that this nation so desperately needs.

Clayton McWhorter is a former President and chairman of HCA and current chairman of Clayton Associates and the Rolling Hills Group. He is the founder of the group SHOUTAmerica, a Nashville based organization that uses social networking and other internet-based technologies to push for change in the healthcare system.

Are “Cadillac” health plans the problem?

Aug 4, 2009• 9

By BILL KRAMER

The debate over proposals to tax health insurance plans is confusing and frustrating. The proposals are usually described as a tax on “gold plated” or “Cadillac” health coverage. According to the media and many spokespeople on the Hill, these health plans with “overly generous benefits” supposedly encourage overuse of medical services and drive up the overall costs of health care. People express outrage that Wall Street executives have expensive tax-subsidized health benefits that include coverage for cosmetic surgery. Is this really a problem? If we fix this, will it raise lots of revenue and bend the cost curve? I don’t think so. The problem is not “Cadillac” coverage, whatever that is.

I know that some economists believe that people ought to have more “skin in the game” by paying a significant share of the costs of medical services they receive. I agree, but only up to a point. Health care services are not like other goods and services. If you give me more money, I might build a fancier house, buy a new car, go to more concerts, fly first class, etc., because I like all of these things. Frankly, I don’t particularly like going to the doctor, and I wouldn’t spend my extra income on more blood tests, CT scans, colonoscopies, or surgeries (ouch!). It’s fine to have modest copayments to discourage unnecessary doctor visits or to encourage use of generic instead of brand name drugs, but onerous cost sharing when someone is seeking medical care won’t solve our problem. A tax on “Cadillac” plans won’t raise much revenue, and it won’t bend the cost curve in any significant way.

Health-Care Reform and the “Culture Wars”

Aug 4, 2009• 13

By MAGGIE MAHAR

Friday, Politico.com editor Fred Barbash posed this question to “Arena” contributors: “Does the ongoing debate about healthcare reform reflect a :”kind of culture war” that can be traced to a “fundamental difference in world views?”

Barbash then pointed to a thought-provoking piece by Bill Bishop, titled “Health Debate Runs Along Familiar Lines” which was published on Politico.com in March. Bishop, who is the co-author of “The Big Sort: Why the Clustering of Like-Minded America Is Tearing Us Apart,” argues that “The health care discussion reveals that the country is still divided along lines drawn more than 100 years ago. . . divisions in the country were never about specific issues . . .. They were about ways of looking at this world (and the next), and those century-old differences are now shaping the health care discussion.”

Bishop frames the age-old religious debate this way: “Do you get to heaven by your good works, by what you do for your brothers and sisters on Earth? Or do you find salvation by your individual relationship with God? Does the world get better through public acts or private ones?“When Sen. Jim DeMint (R-S.C.) said recently that ‘this health care issue s D-Day for freedom in America’ he was talking from one side of this division. President Barack Obama says, ‘I am my brother’s keeper.’ That’s the view from the other bank. “This isn’t a policy issue or a disagreement about strategy,” Bishop adds. “It is a fundamental difference in worldview. It’s a division in what people expect out of life, and it’s been part of this country for more than 100 years.”

Senate Healthcare Bill Amendment Allocates Your Tax Dollars To Quacks

Aug 4, 2009• 37

By DR. VAL

With healthcare costs spiraling out of control, and major rationing efforts under consideration – can we really afford to allow purveyors of pseudoscience to use up scarce Medicare/Medicaid resources? It’s hard to imagine that Obama’s administration would approve of extending “health professional” status to people with an online degree and a belief in magic – but a new amendment would allow just that. What happened to our “restoring science to its rightful place” and why are we emphasizing comparative effectiveness research if we will use tax dollars to pay for things that are known to be ineffective?I hope someone reads and removes this amendment pronto (h/t to David Gorski at Science Based Medicine):Here’s the language that Sen. Harkin has slipped into the 615 page Senate version of the health care reform bill:

Within 3 launches new service

Aug 3, 2009

Op-Ed: Health in All Policies

Aug 3, 2009• 1

By SUSAN BLUMENTHAL, MD and DENIS CORTESE, MD

At the heart of current health care reform discussions – which focus on expanding access to care and establishing mechanisms to finance broader coverage as well as reduce rapidly escalating costs – must be the promotion of good health and the prevention of disease.

Good health is essential to the economic prosperity and wellbeing of the American people. Individually, we are less productive when we become ill; collectively, our nation is less secure when burdened with the high cost of disease. Today, with 45 percent of Americans suffering from a chronic condition and a national fiscal crisis, both our nation’s health and economic security are in peril.

Deteriorating health is a major driver of this crisis. One in five Americans smoke and 66 percent of adults are obese or overweight, fueling a chronic disease epidemic and skyrocketing health care costs. As childhood obesity rates dramatically rise, American children may, for the first time ever, live shorter lives and be less healthy than their parents.

Just as Americans are ailing, so too is our health care system. The U.S. health care system suffers from considerable fragmentation, inefficiencies and inequities. The United States spends nearly twice as much on health care, per person, as any other nation, and the health sector constitutes one sixth of our economy. Yet this significant investment delivers shockingly poor results. America ranks 49th on life expectancy worldwide, 37th on overall health status and performs the worst among industrialized countries at avoiding premature deaths through timely and effective medical care.

Online behavioral health on American Well’s platform, and a hint at Cisco/UHG

Aug 3, 2009• 6

By MATTHEW HOLT

As usual I am way behind on tech and Health 2.0 news but here’s one that was “thrown out with the trash” late last week because the service went live on Saturday. American Well has has added TriWest Healthcare Alliance as a client on its online service. Most significantly this is for behavioral health care (psychological counseling et al) for military families covered under Tri-Care—the program for the families of service personnel.

Given what the military has been through in the last decade you can imagine how badly this is needed. And it’s an extension of the current primary and urgent care services already being delivered online.

In fact beyond American Well there are a number of even smaller companies starting to aim at the behavioral health online market—which has a strong tradition of success in telemedicine and is ripe for expansion into the online arena.

However, where I’m really late is that a couple of weeks back Cisco—which does higher-end telemedicine—announced a program with United Healthgroup to provide its HealthPresence technology in mobile trucks for underserved populations. United’s Optum unit also recently announced that it too would be using American Well. So we’re seeing an extension of the use of both higher tech and web-based online care, and that for the first time health insurers are taking this very seriously.

Continue to watch this space as it looks like finally the technology is ready and the payers are finally coming on board. And (ahem) you’ll hear much more about this at the Health 2.0 Conference in San Francisco on October 6–7.

Sunday mumbles

Aug 2, 2009• 19

By Matthew Holt

If you can’t quite remember why we’re doing this health reform stuff, here’s a very amusing defense of the current health care system by Jonathan Adler at Newsweek (hat-tip to Jon Cohn).

Meanwhile by any measure July was the most read month on THCB with sitemeter telling us that there were some 129,000 visits. Thanks to everyone for coming, but to be fair while we could expect health reform month to ramp up the visits a little, this shows the power of Google. If you search “Obama health care”, this excellent article by Bob Laszewski comes up near the top of the front page… Hopefully some of the new readers will see that it’s 18 months old and stick around to catch the new developments. But kudos to Bob L for doing such a great job here and of course on his own blog Health Care Policy & Marketplace Review.

Say we get some sausage–then what?

Aug 1, 2009• 9

By MICHAEL PAINTER J.D., M.D

sausage (sô´sǐj)
n. A highly seasoned minced meat usually stuffed in casings of prepared
animal intestine.

Congress is obviously in the thick of the sausage making. The August recess is pending. Bills may or may not be moving. The legislative process, especially at this point, is not particularly pretty or, to be honest, as thoughtful as we all might hope. It is the process, though, right? There was essentially no way around something like this intestine stuffing, especially in an effort to fix health care–such a large sector of the American economy. And in spite of the messy work and depending on the day, the observer and the poll, it nevertheless seems likely that something will come out of the kitchen, right? It is also probably safe to say, though, that any reform law is not going to be the panacea–the ultimate health and health care fix. Instead, if a law indeed passes, it's clear that we're going to spend the next five, 10, 15 years adjusting, backtracking, redesigning and working toward better care. In other words, the implementation is going to matter, and it's going to matter a lot. On July 30 in Washington, D.C. at the Hart Senate Office Building, the RWJF-funded High-Value Health Care Project led by Mark McClellan of the Engelberg Center at Brookings hosted a panel discussion focused on just that–the implementation. Specifically, Mark, Carolyn Clancy of AHRQ, John Tooker of the American College of Physicians, Steve Findlay of the Consumers Union and Jim Chase of Minnesota Community Measurement talked to a large Capitol Hill audience about what it will take to make health care deliver sustainable high value.

California Moves Backward on Covering Uninsured Children

Jul 31, 2009

By JOCEYLN GUYER

During tough budget times, most states have maintained their commitment to covering uninsured children. At least eighteen states have even further strengthened coverage for uninsured children, despite budget problems, as the recession has increased the need.While many states have prioritized covering uninsured children, California lawmakers voted to deny coverage to nearly 800,000 children. This decision ignores strong public support for providing affordable health coverage to children and families. This decision also undermines California’s ability to access federal funds, just when the state needs them most. The Children’s Health Insurance Program Reauthorization Act of 2009 made the federal government an even stronger partner for states that prioritize covering uninsured children. California’s $144 million children’s coverage cut will cost the state $267 million in federal funds.This is a difficult time for state budgets but an even harder time for family budgets, and many states are responding to meet the need. Alabama, Washington, North Dakota, Colorado, Iowa, Kansas, Nebraska, Arkansas, West Virginia, and Montana have all expanded coverage; Oregon and Ohio are on the verge of doing the same. Other states have instituted reforms designed to make their CHIP and Medicaid programs more family-friendly, all with the goal of increasing access to affordable health coverage for children.California faces unique public policy challenges that have contributed to this step backward for children. The state was hit particularly hard by the economic and housing crises. More importantly, California has legal restrictions that put large shares of the state’s budget out of lawmakers’ reach, as well as supermajority requirements for passage of budget legislation.While the search continues for ways to help California restore affordable health coverage options for children and families and hope remains high that national health insurance reform will be enacted soon, California’s decision should not diminish the accomplishments of the other states. It is critical that states keep working to strengthen and maintain the gains they’ve made in offering affordable health coverage options to uninsured children and that the federal government remain a strong partner in their efforts.