The House voted to approve health care reform, moving the legislation now to an uncertain outcome in the Senate.
The bill, which passed by a 220-215 margin, includes a public option for health insurance and a variety of tax-related provisions.
H.R. 3962, the Affordable Health Care for America Act, imposes taxes on individuals who do not obtain "acceptable" health insurance coverage, as well as employment taxes on employers who do not provide acceptable coverage, in addition to excise taxes on failures to meet certain health coverage requirements.
For individuals who arent currently covered by their employer, and some small businesses, the bill would establish a new health insurance exchange where consumers could comparison shop from a menu of health care options that will include private plans, health co-ops, and a new public health insurance option. The legsilation promises to end increases in premiums or denials of care based on pre-existing conditions, race, or gender, and strictly limit age rating. The bill will also eliminate co-pays for preventive care, and cap out-of-pocket expenses to protect Americans from bankruptcy.
The bill would impose a surcharge on taxpayers with adjusted gross income in excess of $1 million for a married couple filing a joint return and $500,000 for a single individual at a rate of 5.4 percent.
For businesses, the bill delays implementation of worldwide interest allocation until 2020 and limits the eligibility for reduced treaty withholding rates. It codifies the economic substance doctrine and requires information reporting for payments made to corporations.
The legislation eliminates nontaxable reimbursements of over-the-counter medications from health savings accounts, health reimbursement arrangements, and health flexible spending accounts, and limits contributions to health FSAs to $2,500. The bill also increases the penalty for non-health-related distributions from HSAs from 10 percent to 20 percent.
It also eliminates the tax deduction for employers that receive a government subsidy for providing retiree prescription drug coverage, imposes an excise tax of 2.5 percent on medical devices used in the United States, and provides tax parity for employer-provided coverage for domestic partners and other non-dependents.
The bill also clarifies that an employees share of premiums for employer-provided coverage offered through a health insurance exchange may be paid on a pre-tax basis through a cafeteria plan. However, health insurance exchange coverage that is not employer-offered is not eligible to be offered through a cafeteria plan.
Small business tax credits are available for businesses with 10 or fewer employees and $20,000 or less in average wages. The credits phase out if the employer has 25 or more employees, or if average wages are $40,000 or more. The credits are available on rolling basis for the first two years that an employer offers qualified coverage.
Individuals are required to obtain health insurance coverage or pay a fee equal to the lower of 2.5 percent of their adjusted income above the filing threshold or the average premium on the health insurance exchange. Individuals and families below the income tax filing limit are exempt. Individuals may apply for a hardship waiver if coverage is unaffordable and selected exemptions from the mandate are provided in the statute. Those with coverage through the Veterans Administration or who are eligible for government-sponsored health care because they are a member of a tribe are considered to have fulfilled the requirement to obtain coverage.
Affordability credits provide financial assistance for premiums and cost sharing for individuals and families with incomes up to 400 percent of the federal poverty level. Affordability credits are offered on a sliding scale so that premiums range from 1.5 percent of income at the lowest tier to 12 percent at 400 percent of the federal poverty level.
The House passed several amendments before the final vote, including one that would restrict the use of affordability credits to pay for abortions. The amendment, sponsored by Rep. Bart Stupak, D-Mich., and Joe Pitts, R-Pa., would also prohibit the public insurance plan from paying for abortions, except in the case of rape, incest, or when the mothers life is at stake. The amendment also applies to private insurance bought through the health insurance exchange.
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