GOP(共和党)のヘルスケアプラン

March 13, 2017

GOPヘルスケアの提案により、2つの課税(投資による収入と賃金に対する課税)は廃止されるであろう。高額所得者には大きなメリットです。

 

トランプは「自分が大統領になったら、まずアフォーダブル・ケア・アクト(オバマケア)をやめる」と公約した。そこで問題はオバマケアに参加している国民のカバレッジを絶やすことなく、新しいプランに置き換えることができるか否かです(トランプ支持者には低所得層が意外にも多い)。

 

輪郭が見えたNewヘルスケアは“一括補助金”を利用したプランです。


アメリカの公的医療保険制度にはメディケアとメディケイドがあります。このうちメディケアは65歳以上の老人を対象とした公的医療保険制度です。メディケイドは低所得者層、とりわけ子供、妊婦、扶養家族がいる親などが対象です。オバマケアは、既に存在するメディケイドを連邦政府の資金でパワー・アップすることでカバーの範囲を広げました。

メディケイドは各州政府により運営されているので、幾らの予算を割くかは、それぞれの州政府が独自に決めます。そうして州政府が公的医療保険に費やした費用とおなじ金額を、連邦政府が助成することで予算を2倍にし、効果を上げてきました。

 

オバマケアにより現在ではいわゆる「貧困ライン」より138%上の家族、言い換えれば年間所得で2万8千ドルを上限とする低所得者層もメディケイドに参加できるようになっています。これで2013年以降、新たに1100万人が医療保険の恩恵をこうむることが出来ました。

 

オバマケアに参加するか否かは各州にゆだねられており、現在、31州がオプト・イン(=自ら進んで参加すること)しています。

これに対してNewヘルスケアは“一括補助金”として連邦政府が州政府にお金を渡し、州政府はその中からやりくりしてプランを運営するというもので、もし不足分が出た場合、一定の算式に基づいて連邦政府がそれを穴埋めします。

 

いずれにせよ、これまで漂流していたオバマケアの改変が、いよいよ動き出そうとしています。これは「早く税制改革の審議に取り掛かって欲しい!」と切望する投資関連団体にとっては朗報です。

なぜなら税制改革法案を通過させるためには、まず予算を策定する必要があり、予算案を可決するためにはオバマケア改変のコストが確定する必要があるからです。

 

コストが確定すれば税制改革法案の審議か通過するとのことであり、そうなれば、速やかに高額所得者層の税の削減に大きな効果が期待できます。しかしながらそのコストはどこから出るのか次の大きな課題、あるいは壁になると懸念します。

 

【以下、WSJ からの引用】

Top Earners Would Pay Less Tax Under GOP Health-Care Proposal

Two levies affecting high-income people would be repealed under the plan

 

Republican lawmakers included repeals of two taxes in their new health-care proposal. PHOTO: MICHAEL REYNOLDS/EUROPEAN PRESSPHOTO

AGENCY

By RICHARD RUBIN Updated March 7, 2017 1:25 p.m. ET

WASHINGTON—Households at the top of the U.S. income ladder would see taxes on their wages and investments drop under the House Republicans’ new health-care proposal.

 

As expected, the bill repeals a 3.8% tax on investment income and a 0.9% tax on wages. Both levies affect only the highest-earning households, those individuals making at least $200,000 and married couples making more than $250,000.

 

Republicans have opposed the taxes since they were created as part of the 2010 Affordable Care Act, and they included repeals in the plan they released Monday and plan to push through committee as early as Wednesday.

 

House Ways and Means Committee Chairman Kevin Brady (R., Texas) said he disagreed with the premise that repealing the ACA’s taxes would benefit the most affluent.

“You run down tax increase after tax increase—they hurt the economy, they hurt health care, they achieve nothing,” he told reporters on Tuesday. “We have an economy that’s struggling. …Part of this is to remove the damaging—we think job-killing—taxes in the ACA” to boost economic growth, he said.

      

MORE IN HEALTH CARE

Democrats blasted the repeals of the tax provisions, saying the measures would redistribute wealth from middle-class recipients of health-insurance subsidies to top earners.

“This bill sends a loud and clear message: tax cuts for special interests and the wealthy matter more than your health care,” said Sen. Ron Wyden of Oregon, the top Democrat on the Senate Finance Committee

 

In all, the GOP bill cuts almost $600 billion in taxes, according to estimates released Tuesday by the nonpartisan congressional Joint Committee on Taxation, including the major levies on high-income households and narrow provisions on indoor tanning and executive compensation at health insurance companies. Some provisions, including tax credits to assist people in purchasing health insurance, aren’t part of the estimates released Tuesday and will be included in a forthcoming study by the Congressional Budget Office.

The investment tax yielded $18.3 billion for the government in tax year 2015, and the wage tax produced $8.6 billion, according to IRS data released last week. Both taxes were paid by fewer than four million households, or roughly the top 2.5% of U.S. households. Repealing the investment tax will reduce federal taxes by $157.6 billion over a decade, while ending the wage tax will cut collections by $117.3 billion, according to the JCT estimates released Tuesday.

Unlike taxes on pharmaceuticals, medical devices and health insurance that were also enacted as part of the Affordable Care Act, the taxes on high-income households have a tenuous connection to health care. They were included in the 2010 health-care law to help pay for it. The wage tax is piggybacked onto an existing Medicare payroll tax.

But they operate economically just like any other taxes on high-income households, which get a significant share of their income from capital gains and dividends. Repealing the investment tax would boost after-tax income by 1.6% for the top 1% of households and give the top 0.1% an average tax cut of $165,000, according to the Tax Policy Center, a project of the Urban Institute and Brookings Institution.

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Under the House plan, the repeals would take effect in 2018 and would drop the top tax rate on capital gains and dividends to 20% from 23.8%. That decision means the highest-earning households wouldn’t get a windfall based on past decisions, but they could have some powerful reasons to make tax-based decisions this year.

For households in the top tax bracket, delaying a $1 million capital gain from 2017 to 2018 would yield $38,000 in tax savings. Research and experience shows that capital gains realizations are very sensitive to tax rates, with investors choosing to delay or accelerate asset sales to lower their taxes.

Similarly, companies would have an incentive to delay dividend payments, so that shareholders could benefit from the break.

People with the ability to choose when they earn wages could also delay those payments. Pushing a $500,000 bonus from 2017 to 2018 would save up to $4,500.

Repealing the taxes now would help households that haven’t yet been affected by the two taxes but could be in the future. Unlike most pieces of the tax code, the $200,000 and $250,000 thresholds were intentionally not indexed to inflation, meaning that both taxes are scheduled, under current law, to steadily expand their reach.

The GOP repeal bill also would end several taxes that are tied to health care and affect households at all income levels. The proposal would end caps on flexible spending arrangements, which let workers set pretax money aside to pay for out-of-pocket health costs; that limit is now $2,600. Flexible spending accounts could again be used to pay for over-the-counter medication without a prescription, reversing a piece of the 2010 law.

The GOP plan would also reinstate a lower limit—7.5% of adjusted gross income—above which taxpayers could claim an itemized deduction for medical expenses. The 2010 health law created a 10% floor for that deduction and repealing it would save taxpayers $34.9 billion over a decade, according to the Joint Committee on Taxation.

 

Republicans also want to repeal the industry-specific taxes embedded in the health law. Those include a 2.3% tax on medical devices and industrywide fees on pharmaceuticals and health insurance that were divided up among companies. Cutting those three provisions reduces taxes by about $189 billion over a decade.

Write to Richard Rubin at richard.rubin@wsj.com

 

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