Comparing Subsidies for the House and Senate Health Care Bills

Comparing Subsidies for the House and Senate Health Care BillsStephanie Rennane, C. Eugene Steuerle

Reprinted with permission of Tax Analysts.

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Consider an employer who bears an equal cost for their employees and must choose between the proposed subsidy for those on the exchange and the current subsidy for those who get employer-provided health insurance. What are the consequences for the employee? This article discusses the results for the employee under the current health care bills in the House and the Senate.

The flurry of proposed health subsidies in Congress present alternatives to the current employer-provided health insurance system. Consider an employer who bears an equal cost for their employees and must choose between the proposed subsidy for those on the exchange and the current subsidy for those who get employerprovided health insurance. Under the exchange, this employer would be able to provide higher cash wages for their employees but would be subject to higher payroll taxes and would likely pay a penalty for not providing health insurance. Using the current system, the employer would pay out lower cash wages and payroll taxes, but would also be responsible for the cost of health insurance. And the employee?

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Tax Subsidies for Private Health Insurance : Who Currently Benefits and What Are the Implications for New Policies?

Leonard E. Burman, Cori E. Uccello, Laura Wheaton, Deborah Kobes, Claudia Williams

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

Note: This report is available in its entirety in the Portable Document Format (PDF).
Please also see TPC companion paper Tax Incentives for Health Insurance

Policy-makers are considering a variety of new tax credit proposals to expand health insurance coverage. Understanding how current tax subsidies work and their role in supporting employer-sponsored insurance (ESI) is important when designing such policies.

This brief presents essential information about the structure and distribution of existing tax subsidies for ESI and the implications for new policy options.

HOW DOES THE FEDERAL GOVERNMENT SUBSIDIZE PRIVATE HEALTH INSURANCE?

The largest subsidy is the tax exemption for employer contributions to ESI. When employers purchase or provide insurance for their employees, their contributions to the premium are exempt from income and payroll taxes.Employees' contributions to ESI are also tax-exempt if workers use flexible spending accounts (FSAs). Once established by employers, workers can use these tax-exempt accounts to set aside a portion of their income to pay for health insurance and expected medical expenses.People who buy insurance outside of work do not have the same tax advantages. They can deduct medical expenses, including premiums, that exceed 7.5 percent of their adjusted gross income. However, many people never reach that threshold. Special rules apply to self-employed people, who can deduct a portion of their health insurance costs without meeting the threshold. This year, these costs become fully deductible.

Note: This report is available in its entirety in the Portable Document Format (PDF).

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