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Learn about various tax subsidies for health care, including health insurance, out-of-pocket expenses, and arguments for and against tax exemptions. Explore charts and examples to grasp the impact and implications of these subsidies.
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A Primer on Tax Subsidies for Health Care Larry Levitt Kaiser Family Foundation December 5, 2008
Chart 1 Types of Tax Subsidies for Health Care • Health insurance subsidies • Employer contributions for insurance are exempt from taxes for employees • Section 125 plans subsidize worker contributions • Self-employed can deduct premiums • Subsidies for out-of-pocket health care expenses • HSAs • HRAs • FSAs • Deduction for expenses >7.5% of income
Chart 2 Tax Subsidies for Out-of-Pocket Health Spending • Health Savings Accounts • Minimum deductible of $1,150 single/$2,300 family; tax-free employer/individual contributions to cover out-of-pocket costs; portable and can be rolled over • Health Reimbursement Arrangements • Used with any type of plan; tax-free contributions by employers only; can generally be rolled over • Flexible Spending Accounts • Tax-free employer/individual contributions; use it or lose it • Deduction for medical expenses >7.5% of income
Chart 3 Tax Subsidies for Health Insurance • Employers can deduct cost of health benefits (just like any other business expense) • Employer contributions for insurance are exempt from taxes for employees • 1943: War Labor Board rules health benefits exempt from wage freeze • 1954: Revenue Act codifies exclusion of benefits • Worker contributions can be pre-tax (125 plan) • Self-employed can deduct premiums • Otherwise, generally no subsidies for individuals buying on their own
Chart 4 Example 1: Modest Income Family With and Without the Tax Exemption 15% of the premium Source: Kaiser Family Foundation calculations.
Chart 5 Example 2: Higher Income Family With and Without the Tax Exemption 28% of the premium Source: Kaiser Family Foundation calculations.
Chart 6 Cost of the Exemption • Acts like an entitlement • But, subsidies are “hidden” from workers and the budget • As a result, costs can only be estimatedEstimated federal cost = $224.7 billion in 2008 for active workers($134.3 billion for income taxes, $90.5 billion for payroll taxes) Source: Analysis by Jonathan Gruber for the Kaiser Family Foundation; figures for 2008 for active workers only.
Chart 7 Average Tax Exemption Per Worker (2008) Source: Analysis by Jonathan Gruber for the Kaiser Family Foundation; figures for 2008 for active workers only.
Chart 8 Arguments Made For and Against the Tax Exemption • For: • Encourages employer coverage and pooling • Reflects negotiated tradeoffs for benefits • Against: • Benefits are regressive; no subsidy for those without employer coverage • Encourages “over insurance” • Minimal ability to control federal cost
Chart 9 Illustration: What If the Tax Exemption Grew at Inflation? $3,430 B $580 B $2,850 B Source: Kaiser Family Foundation analysis based on CMS projections for insurance premiums and CPI. Assumes no change in the number of people with employer coverage over time or as a result of lower subsidies.