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According to an analysis conducted for this office by the non-partisan Congressional Research Service, between the 106th and 110th Congress, there were 41 cases in which the Senate approved the motion to proceed to a bill that the Senate eventually held a vote on final passage. Of those 41, 40 of the bills received Senate approval (S. 1805 in the 108th Congress was the lone exception). Based on these numbers, when the Senate votes to invoke cloture on a motion to proceed to a bill, that bill has a 97.6 percent chance of inevitably passing the Senate.
*This analysis excludes any bill that may have been pulled from the floor for whatever reason after the initial cloture votes or that may have passed by unanimous consent or a voice vote.
Top-Line Facts:
Spending: The cost of the bill is $2.5 trillion over 10 years of full implementation (2014-2023) (See attached).
Taxes Increases: Taxes will go up $493.6 billion-nearly half a trillion dollars.
Medicare Cuts: Medicare will be cut $464.6 billion-another half a trillion dollars.
Total Number of Pages: 2074
Abortion: The bill permits the use of accounting gimmicks that will, for the first time, allow federal dollars to go to plans covering abortion. The bill does not include the Stupak language, and as a result, National Right to Life describes the Reid bill language as "completely unacceptable" and said it would "result in coverage of abortion on demand in two big new federal government programs."
Government Plan: The bill includes a government run plan and provides states with the possibility of opting out of participating in that plan. According to CBO, the government run plan "would typically have premiums that were somewhat higher than the average premiums for the private plans in the exchanges."
Employer Mandate: The bill will impose $28 billion in new taxes on employers that do not provide government approved health plans. These new taxes will ultimately be paid by American workers in the form of reduced wages and lost jobs.
Additional CBO Background:
The bill would bend the federal cost-curve up. CBO says, "Under the legislation, federal outlays for health care would increase during the 2010-2019 period, as would the federal budgetary commitment to health care." The coverage expansion would drive a net increase in government spending on health by $160 billion over 10 years.
CBO scored the bill as reducing the deficit by $130 billion over FYs 2010-2019.
o However, CBO notes that the bill includes two budget gimmicks that hide the true cost of the bill. Doctors are assumed to get a 23 percent cut in 2011 which would carry into subsequent years. Fixing the SGR would cost $247 billion. Additionally, the CLASS Act generates $72 billion over the budget window, but later turns to deficits. Eliminating these two gimmicks means the bill would be $189 billion in the red. It would also put the real cost of the bill over a trillion dollars.
The start dates for the individual mandate, exchanges, and employer penalties were all moved from July 1, 2013, to January 1, 2014.
This is another budget gimmick to hide the true cost of the bill.
24 million people would be left without insurance
Unfunded mandates on the states: The bill mandates that states spend an additional $25 billion in Medicaid expenditures Taxes on uninsured individuals would total$8 billion.
Taxes on employers from the "free-rider" penalty would total $28 billion.
5 million Americans would lose their employer coverage.
Cuts to Medicare include: Permanent reductions in the annual updates to Medicare's payment rates for most services in the fee-for-service sector of $192 billion; $118 billion in cuts to Medicare Advantage; $43 billion in DSH cuts; $23 billion in unspecified cuts by the Medicare Advisory Board.
Only 19 million people will get a subsidy to help them buy health insurance.
None of the 162 million people with employer-based care will even be eligible for a subsidy.
The government plan would have higher premiums than private plans. CBO said the government plan would "typically have premiums that were somewhat higher than the average premiums for the private plans in the exchanges."
With the opt-out provision, two-thirds of Americans are expected to have a government plan available in their state.
Co-ops are included but would have "very little effect."
The CLASS Act would reduce deficits by $72 billion in the 10 year budget window, but "would begin to increase budget deficits" in the decade following 2029.
The IRS would need $5-$10 billion to expand and implement the provisions in the bill.
The costs of the subsidies in the exchange would grow at 8 percent a year.
The tax on high value plans will quickly be applied to almost all plans. CBO expects the revenues from the Cadillac plan tax to grow at 10-15 percent per year outside the budget window.
Includes a $15 billion "Prevention and Public Health Fund" slush fund.
CBO says it would be "difficult" to maintain the predicted savings over a long period of time-meaning that the plan will likely run deficits when savings do not materialize.
Summary of Tax Provisions
PDF Version: http://www.atr.org/userfiles/111809pr-comptaxreid.pdf
Full bill: http://www.atr.org/userfiles/ReidHealthBill.pdf
JCT score: http://www.jct.gov/publications.htm...hk=89e36c5d255daf8c39fb03bc42ae0a3c&no_html=1
COMPREHENSIVE LIST OF ALL TAX HIKES IN SENATE GOVERNMENT HEALTH BILL
Individual Mandate Tax (Page 324/Sec. 1501/Awaiting CBO score): Starting in 2014, anyone not buying "qualifying" health insurance must pay an income surtax according to the following schedule (capped at 8 percent of income):
Exemptions for religious objectors, undocumented immigrants, prisoners, those earning less than the poverty line, members of Indian tribes, and hardship cases (determined by HHS).
Employer Mandate Tax (Page 348/Sec. 1513/Awaiting CBO score): If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $750 for all full-time employees. Applies to all employers with 50 or more employees.
If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer).
Excise Tax on Comprehensive Health Insurance Plans (Page 1979/Sec. 9001/$149.1 bil): Starting in 2013, new 40 percent excise tax on "Cadillac" health insurance plans ($8500 single/$23,000 family). Higher threshold ($9850 single/$26,000 family) for early retirees and high-risk professions. CPI +1 percentage point indexed.
From 2013-2015, the 17 highest-cost states are 120% of this level.
Employer Reporting of Insurance on W-2 (Page 1996/Sec. 9002/Min$): Preamble to taxing health benefits on individual tax returns.
Medicine Cabinet Tax (Page 1997/Sec. 9003/$5 bil): No longer allowable to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin)
HSA Withdrawal Tax Hike (Page 1998/Sec. 9004/$1.3 bil): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent.
FSA Cap (Page 1999/Sec. 9005/$14.6 bil): Imposes cap on FSAs of $2500 (now unlimited).
Corporate 1099-MISC Information Reporting (Page 1999/Sec. 9006/$17.1 bil): Requires businesses to send 1099-MISC information tax forms to corporations (currently limited to individuals), a huge compliance burden for small employers
Excise Tax on Charitable Hospitals (Page 2001/Sec. 9007/Min$): $50,000 per hospital if they fail to meet new "community health assessment needs," "financial assistance," and "billing and collection" rules set by HHS.
Tax on Innovator Drug Companies (Page 2010/Sec. 9008/$22.2 bil): $2.3 billion annual tax on the industry imposed relative to share of sales made that year.
Tax on Medical Device Manufacturers (Page 2020/Sec. 9009/$19.3 bil): $2 billion annual tax on the industry imposed relative to shares of sales made that year. Exempts items retailing for <$100.
Tax on Health Insurers (Page 2026/Sec. 9010/$60.4 bil): $6.7 billion annual tax on the industry imposed relative to health insurance premiums collected that year.
Eliminate tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D (Page 2034/Sec. 9012/$5.4 bil)
Raise "Haircut" for Medical Itemized Deduction from 7.5% to 10% of AGI (Page 2034/Sec. 9013/$15.2 bil): Waived for 65+ taxpayers in 2013-2016 only
$500,000 Annual Executive Compensation Limit for Health Insurance Executives (Page 2035/Sec. 9014/$0.6 bil)
Hike in Medicare Payroll Tax (Page 2040/Sec. 9015/$53.8 bil): Current law and changes:
Wages (Employer/Employee)
Self-Employment Net Income
Current Law and New Rate on First $200,000 ($250,000 MFJ)
1.45%/1.45%
2.9%
New Rate on Amount Which Exceeds $200,000 ($250,000 MFJ)
1.45%/1.95%
3.4%
The 0.5% new rate addition is not deductible for the self-employment tax adjustment.
Blue Cross/Blue Shield Tax Hike (Page 2044/Sec. 9016/$0.4 bil): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services
Tax on Cosmetic Medical Procedures (Page 2045/Sec. 9017/$5.8 bil): New 5% excise tax on elective cosmetic surgery to be paid by the surgery patient
11/18/09 For more information, contact ATR Tax Policy Director Ryan Ellis at [email protected]
*This analysis excludes any bill that may have been pulled from the floor for whatever reason after the initial cloture votes or that may have passed by unanimous consent or a voice vote.
Top-Line Facts:
Spending: The cost of the bill is $2.5 trillion over 10 years of full implementation (2014-2023) (See attached).
Taxes Increases: Taxes will go up $493.6 billion-nearly half a trillion dollars.
Medicare Cuts: Medicare will be cut $464.6 billion-another half a trillion dollars.
Total Number of Pages: 2074
Abortion: The bill permits the use of accounting gimmicks that will, for the first time, allow federal dollars to go to plans covering abortion. The bill does not include the Stupak language, and as a result, National Right to Life describes the Reid bill language as "completely unacceptable" and said it would "result in coverage of abortion on demand in two big new federal government programs."
Government Plan: The bill includes a government run plan and provides states with the possibility of opting out of participating in that plan. According to CBO, the government run plan "would typically have premiums that were somewhat higher than the average premiums for the private plans in the exchanges."
Employer Mandate: The bill will impose $28 billion in new taxes on employers that do not provide government approved health plans. These new taxes will ultimately be paid by American workers in the form of reduced wages and lost jobs.
Additional CBO Background:
The bill would bend the federal cost-curve up. CBO says, "Under the legislation, federal outlays for health care would increase during the 2010-2019 period, as would the federal budgetary commitment to health care." The coverage expansion would drive a net increase in government spending on health by $160 billion over 10 years.
CBO scored the bill as reducing the deficit by $130 billion over FYs 2010-2019.
o However, CBO notes that the bill includes two budget gimmicks that hide the true cost of the bill. Doctors are assumed to get a 23 percent cut in 2011 which would carry into subsequent years. Fixing the SGR would cost $247 billion. Additionally, the CLASS Act generates $72 billion over the budget window, but later turns to deficits. Eliminating these two gimmicks means the bill would be $189 billion in the red. It would also put the real cost of the bill over a trillion dollars.
The start dates for the individual mandate, exchanges, and employer penalties were all moved from July 1, 2013, to January 1, 2014.
This is another budget gimmick to hide the true cost of the bill.
24 million people would be left without insurance
Unfunded mandates on the states: The bill mandates that states spend an additional $25 billion in Medicaid expenditures Taxes on uninsured individuals would total$8 billion.
Taxes on employers from the "free-rider" penalty would total $28 billion.
5 million Americans would lose their employer coverage.
Cuts to Medicare include: Permanent reductions in the annual updates to Medicare's payment rates for most services in the fee-for-service sector of $192 billion; $118 billion in cuts to Medicare Advantage; $43 billion in DSH cuts; $23 billion in unspecified cuts by the Medicare Advisory Board.
Only 19 million people will get a subsidy to help them buy health insurance.
None of the 162 million people with employer-based care will even be eligible for a subsidy.
The government plan would have higher premiums than private plans. CBO said the government plan would "typically have premiums that were somewhat higher than the average premiums for the private plans in the exchanges."
With the opt-out provision, two-thirds of Americans are expected to have a government plan available in their state.
Co-ops are included but would have "very little effect."
The CLASS Act would reduce deficits by $72 billion in the 10 year budget window, but "would begin to increase budget deficits" in the decade following 2029.
The IRS would need $5-$10 billion to expand and implement the provisions in the bill.
The costs of the subsidies in the exchange would grow at 8 percent a year.
The tax on high value plans will quickly be applied to almost all plans. CBO expects the revenues from the Cadillac plan tax to grow at 10-15 percent per year outside the budget window.
Includes a $15 billion "Prevention and Public Health Fund" slush fund.
CBO says it would be "difficult" to maintain the predicted savings over a long period of time-meaning that the plan will likely run deficits when savings do not materialize.
Summary of Tax Provisions
PDF Version: http://www.atr.org/userfiles/111809pr-comptaxreid.pdf
Full bill: http://www.atr.org/userfiles/ReidHealthBill.pdf
JCT score: http://www.jct.gov/publications.htm...hk=89e36c5d255daf8c39fb03bc42ae0a3c&no_html=1
COMPREHENSIVE LIST OF ALL TAX HIKES IN SENATE GOVERNMENT HEALTH BILL
Individual Mandate Tax (Page 324/Sec. 1501/Awaiting CBO score): Starting in 2014, anyone not buying "qualifying" health insurance must pay an income surtax according to the following schedule (capped at 8 percent of income):
Exemptions for religious objectors, undocumented immigrants, prisoners, those earning less than the poverty line, members of Indian tribes, and hardship cases (determined by HHS).
Employer Mandate Tax (Page 348/Sec. 1513/Awaiting CBO score): If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $750 for all full-time employees. Applies to all employers with 50 or more employees.
If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer).
Excise Tax on Comprehensive Health Insurance Plans (Page 1979/Sec. 9001/$149.1 bil): Starting in 2013, new 40 percent excise tax on "Cadillac" health insurance plans ($8500 single/$23,000 family). Higher threshold ($9850 single/$26,000 family) for early retirees and high-risk professions. CPI +1 percentage point indexed.
From 2013-2015, the 17 highest-cost states are 120% of this level.
Employer Reporting of Insurance on W-2 (Page 1996/Sec. 9002/Min$): Preamble to taxing health benefits on individual tax returns.
Medicine Cabinet Tax (Page 1997/Sec. 9003/$5 bil): No longer allowable to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin)
HSA Withdrawal Tax Hike (Page 1998/Sec. 9004/$1.3 bil): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent.
FSA Cap (Page 1999/Sec. 9005/$14.6 bil): Imposes cap on FSAs of $2500 (now unlimited).
Corporate 1099-MISC Information Reporting (Page 1999/Sec. 9006/$17.1 bil): Requires businesses to send 1099-MISC information tax forms to corporations (currently limited to individuals), a huge compliance burden for small employers
Excise Tax on Charitable Hospitals (Page 2001/Sec. 9007/Min$): $50,000 per hospital if they fail to meet new "community health assessment needs," "financial assistance," and "billing and collection" rules set by HHS.
Tax on Innovator Drug Companies (Page 2010/Sec. 9008/$22.2 bil): $2.3 billion annual tax on the industry imposed relative to share of sales made that year.
Tax on Medical Device Manufacturers (Page 2020/Sec. 9009/$19.3 bil): $2 billion annual tax on the industry imposed relative to shares of sales made that year. Exempts items retailing for <$100.
Tax on Health Insurers (Page 2026/Sec. 9010/$60.4 bil): $6.7 billion annual tax on the industry imposed relative to health insurance premiums collected that year.
Eliminate tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D (Page 2034/Sec. 9012/$5.4 bil)
Raise "Haircut" for Medical Itemized Deduction from 7.5% to 10% of AGI (Page 2034/Sec. 9013/$15.2 bil): Waived for 65+ taxpayers in 2013-2016 only
$500,000 Annual Executive Compensation Limit for Health Insurance Executives (Page 2035/Sec. 9014/$0.6 bil)
Hike in Medicare Payroll Tax (Page 2040/Sec. 9015/$53.8 bil): Current law and changes:
Wages (Employer/Employee)
Self-Employment Net Income
Current Law and New Rate on First $200,000 ($250,000 MFJ)
1.45%/1.45%
2.9%
New Rate on Amount Which Exceeds $200,000 ($250,000 MFJ)
1.45%/1.95%
3.4%
The 0.5% new rate addition is not deductible for the self-employment tax adjustment.
Blue Cross/Blue Shield Tax Hike (Page 2044/Sec. 9016/$0.4 bil): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services
Tax on Cosmetic Medical Procedures (Page 2045/Sec. 9017/$5.8 bil): New 5% excise tax on elective cosmetic surgery to be paid by the surgery patient
11/18/09 For more information, contact ATR Tax Policy Director Ryan Ellis at [email protected]
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