Affordable Care Act’s Growing List of Tax Implications

The problem with introducing health care reform through changes in tax law is that it sets the ball rolling on the impact of the changes.


As the Affordable Care Act’s roll-out and implementation moves towards the second year, the tax implications of whatever was done in the first year are only now being felt.

Because the government handed a huge new group of customers to the heath care industry, they’re expected to pay some $8 billion worth of taxes which are due on Sept 30.

This is the first time this tax is being collected, and there’s an unintended consequence – the federal government is taxing itself and forcing state governments to pony up their share to cover the cost of the new tax imposed on the health care industry.

That’s because some private insurers have passed on the cost of the higher taxes to policy holders, and reimbursements for Medicare health plans have been hiked because of the increase in cost to plan enrollees.

States have to pick up part of the increased tab. For example, California’s cost has increased by $88 million, with the federal government paying $48 million and the State chipping in $40 million. In Florida, the cost is $100 million, with a 60-40 split.

Another issue that’s just popped up on the radar is that people who enrolled into a health plan through a federal or state marketplace may possibly face delays in filing their tax returns and getting refunds.

That’s because the HHS and state agencies have to send out Form 1095-A to help those who got their insurance from the marketplace and were eligible for tax credits made available under the ACA. That’s about seven million people.

The HHS has to send out these forms to people from 36 states who signed up through the federal marketplace. The remaining states which established their own marketplace will have to send out the form on their own to those who enrolled using the state’s marketplace and are eligible for tax credits.

Some people will also get too much in subsidies if their financial condition and income improves in the interim. This means the IRS will then be required to grab some of their refund to adjust for the extra health care tax credit granted.

Oh, and this isn’t just about ordinary people. A new “CEO tax” that’s one of the tax code changes introduced in the ACA has already collected tens of millions of dollars.

That’s because the deduction cap for compensation provided to a health care company’s top executives was brought down from $1 million to $500,000, and the new cap includes all forms of compensation including performance bonuses.

According to the Institute for Policy Studies, this new change in the tax law has by itself managed to raise $72 million in additional taxes last year from the 10 largest insurers.  

Army Reservist Major Linda Taberner, a health visitor, has been on Exercise ASKARI Serpent with 33 Field Hospital in outreach villages in Kenya. She said: “Health visitors do not exist in Kenya. I feel extremely privileged to have been invited to join a very worthwhile and rewarding exercise.”


Unlike children in the UK, who are monitored from birth to starting school, there is nothing in place in Kenya and therefore any development issues do not come to light. The main aim of a health visitor on this exercise is to provide guidance and record the development of children.


Major Taberner continues: “Most issues I have come across are teething problems, nappy rash and eye infections, which we have a simple solution to, but the biggest problem is the environment that the people live in; not something we can resolve but hopefully through giving advice, in the long term they will be able to help themselves.”


Photographer: Cpl Jamie Peters; Crown Copyright

(TPM) The Obama administration rolled out a plan on Friday to protect access to copay-free birth control for women in response to the Supreme Court’s Hobby Lobby ruling.

A new “proposed rule” by the Department of Health and Human Services lets female employees of for-profit businesses, like Hobby Lobby, obtain birth control directly from their insurer, at no extra cost, if their boss opts out of covering the service in the company’s insurance plan for religious reasons.

The move extends an accommodation that already exists for non-profit organizations, which are allowed to refuse to cover for birth control. In short, the religious owners can pass the cost on to the insurer so that they’re no longer complicit in what they view as sin.

"Women across the country deserve access to recommended preventive services that are important to their health, no matter where they work,” said HHS Secretary Sylvia Burwell. "Today’s announcement reinforces our commitment to providing women with access to coverage for contraception, while respecting religious considerations raised by non-profit organizations and closely held for-profit companies."

A little bit of good news for once.

The first time it was an ear, nose and throat doctor. I had an emergency visit for an ear infection, which was causing a level of pain I hadn’t experienced since giving birth. He looked at the list of drugs I was taking for my bipolar disorder and closed my chart.

“I don’t feel comfortable prescribing anything,” he said. “Not with everything else you’re on.” He said it was probably safe to take Tylenol and politely but firmly indicated it was time for me to go. The next day my eardrum ruptured and I was left with minor but permanent hearing loss.

Another time I was lying on the examining table when a gastroenterologist I was seeing for the first time looked at my list of drugs and shook her finger in my face. “You better get yourself together psychologically,” she said, “or your stomach is never going to get any better.”

If you met me, you’d never know I was mentally ill. In fact, I’ve gone through most of my adult life without anyone ever knowing — except when I’ve had to reveal it to a doctor. And that revelation changes everything. It wipes clean the rest of my résumé, my education, my accomplishments, reduces me to a diagnosis.

Low-income transgender people in Oregon will now have access to healthcare through the state health plan.

The Oregon Health Plan is a network offering medical services to low-income people in the state. This week, a health commission decided that the health plan would now cover care including hormone therapy and gender confirming surgery. Last year the plan also began covering psychotherapy, medical visits and puberty-blocking medications for trans and questioning youth.

"Up until now, many people have simply been out of luck when it came to this needed medical coverage," said Danielle Askini, policy director for Basic Rights Oregon. “For many individuals, this basically left them out of luck.” …

The move follows a 2012 bulletin from the Oregon Insurance Division, which forbade private insurers from including any categorical exclusions on the basis of a policy holders gender identity. Complaints have continued, however, from those saying they are still being denied covered for those conditions.

Incredibly important step. This will help so many people. 

At the age of 24 I began to ask my doctors if I could be sterilized. Year after year at my annual exam I would state my case — each year unchanged from the previous year. At each visit my physician told me that I was too young, what if I changed my mind? But the reality was that I didn’t change my mind. In fact, my desire to not have children grew and grew with each passing visit.

[…]I had asked for a procedure for six straight years with no break in my desires, opinions, or beliefs. Why did the medical community continue to deny me of my personal right to sterilization? I attempted to argue with her, citing examples of several men who were allowed vasectomies at the age of 21, but she wouldn’t budge. My anger was fueled by such blatant sexism. What is the difference from an adult man deciding he doesn’t want to procreate and an adult woman making the same choice? Why can’t I be the one to decide what’s best for my life? And why, with the advancements in healthcare and women’s rights issues, were women still being forced into conforming to the societal definition of how women should conduct their lives? Society has begun to recognize how the stereotypical nuclear family ideals are outdated, yet at the same time these ideals are perpetually imposed — harming those who choose to live outside of this box.

As I started my internship @ Oscar I had no idea what would be involved. I decided to focus my efforts on what I know best: people. I spent the week hopping on phone calls to tell people how amazing Oscar is. In this photo, I was able to sign up a family of 7 baby poms before I realized Oscar doesn’t cover pomeranians. I have a meeting with our CEO tomorrow to talk about pomeranian coverage.

Photo by Ton Koene

In Ramtha, Jordan, MSF’s Dr. Ben Gupta plays chess with a 14-year-old boy named Malik who lost one leg and sustained severe injuries to his other extremities when a bomb fell on a wedding party at his family’s home in Syria. See “The Reach of War,” a look at the human face of the conflict in Syria.

What can you say, except congratulations? Gov. Nathan Deal, Insurance Commissioner Ralph Hudgens, Attorney General Sam Olens and the Georgia Legislature have approached the implementation of ObamaCare with one overriding goal: Deny access to health-care coverage to as many uninsured Georgians as possible.

In fact, it was a year ago this month that Hudgens made it explicit: “Let me tell you what we’re doing (about ObamaCare),” he bragged to a crowd of fellow Republicans: “Everything in our power to be an obstructionist.”

Their effort has been wildly successful. In fact, if our leaders had been half as successful at, say, improving education, growing the economy or solving transportation as they have been at denying health coverage to their own citizens, Georgia would be in high cotton instead of in long-term decline relative to the rest of the country.

This week, we got a peek at the true scale of their success with the release of state-by-state data compiled by Gallup. The numbers tell us that a year ago, before implementation of ObamaCare, Georgia had the nation’s 7th highest rate of citizens without health insurance. Today, we have the 3rd highest rate of uninsured. Well done, gentlemen.