WASHINGTON – Get health insurance through your employer? The average cost of a family policy is about $11,500, low enough to get you a tax break under President Bush's new health care initiative.
If an employer-provided plan covers you alone, the policy costs just under $2,500 on average, still low enough for a tax cut.
The administration says its proposal would enable more Americans to afford health insurance, reducing the ranks of the uninsured — now estimated at 46.6 million — by 5 percent to 10 percent.
The president hit the road Thursday to sell his health care plan, talking it up at a conference in Lee's Summit, Mo. But it has received a cold response from key Democrats in Congress.
The plan would do two things: For the first time, the cost of an insurance policy would be treated as taxable income. The cost includes both the employer's and the employee's payments. The result is that workers' taxable wages would shoot up dramatically.
But, then, the president calls for a standard tax deduction for those who buy health insurance — $15,000 for family coverage and $7,500 for individual coverage. So, the key to getting a tax cut will be to keep the cost of the policy below the size of the new deduction.
The result of the proposed change would be that, initially, about 80 percent of workers who get insurance through their jobs would be in the camp that gets a tax cut. About 20 percent would see a tax increase.
About 160 million people get health coverage through their employers.
A smaller group of Americans, about 17.8 million, buy health insurance on their own because their job doesn't provide it or they can't afford the coverage their employer offers. Almost all of them would experience a substantial tax cut.
That's because they don't have a boss fronting the cost of their insurance on a tax-free basis. They pay for it themselves, and get little tax help unless they spend at least 7.5 percent of their adjusted gross income on health care.
Karen Davis, president of the Commonwealth Fund, said the people who buy insurance on their own are typically baby boomers. Of the 12 million adults in the individual market, 40 percent of them make more than $50,000 a year.
They would save, on average, about $2,500 when buying individual coverage, and $5,000 on family coverage, she said.
"I definitely think it is fiscal relief" for those in the individual market, Davis said.
That relief is much more mixed when it comes to people who get health insurance through their work, she said.
Just how much one pays or saves depends upon which income tax bracket they're in. The administration projects that the greatest benefit would go to the middle class.
The wealthy tend to have the most expensive policies, and many of them can expect to pay higher taxes. Meanwhile, the poor generally don't pay any income tax, so the help they get would be limited to lower payroll taxes.
The administration has referred to health insurance policies exceeding $15,000 for a family or $7,500 for an individual as gold-plated, but many disagree with that assessment.
"Not all these policies are gold-plated. What you get depends on where you live, where you work and what the cost of insurance is in that area," said Diane Rowland, executive vice president of the Kaiser Family Foundation.
Workers in established manufacturing industries, such as the auto and steel industry, tend to have generous health insurance benefits, so they could see their taxes go up if they stick with their current policy. So could many government workers.
Also, large firms tend to have better, more expensive policies than do small businesses. Davis said that large businesses tend to treat the great majority of employees equally.
"Typically, the person working in the mail room has the same health coverage as the person working as an executive," Davis said.
But John Goodman, president and CEO of the National Center for Policy Analysis, disagreed. He said executives at large corporations often get extra benefits on top of the insurance that everyone else at the company gets. They'll get annual checkups and undergo screenings at the most renowned medical facilities such as the Mayo Clinic, or in his home town of Dallas, the Cooper Clinic. It makes little sense for the government to subsidize such health insurance plans, he said.
"It's not unusual at all to find the guys at the top with the most lavish plan," Goodman said.
While more than 100 million people would get a tax break, the administration estimates, more than 55 percent of the uninsured — about 25 million people — have such low incomes that they pay no income taxes, Davis said. So the tax changes would not make insurance any more affordable for them, she said.
The president's plan would not kick in until 2009. Over the years, the standard deduction would increase at the rate of overall inflation. But some tax analysts warn that the deduction would still lose value as a result.
That's because health insurance premiums have been going up much more quickly than inflation, so, eventually, more taxpayers will fall into that camp whose health insurance cost more than the deductible. When that happens, they have two choices, pay more taxes or select more basic, less expensive insurance plans.
The administration says it believes that people will seek out more basic coverage to avoid tax increases.
"We think that will bring down national health spending," said Katherine Baicker, who serves on the president's council of economic advisers.
Some analysts also worry that more small businesses will drop coverage if they know their workers can get coverage on the individual market, thanks to the new tax breaks for people buying insurance on their own.
Coverage in the individual market is generally cheaper than coverage in the group market, but many Americans, particularly those with pre-existing health conditions, will find it difficult getting a company to sell them a policy, said Len Burman of the Tax Policy Center, a joint program run by the Urban Institute and the Brookings Institution.
"For many, the nongroup market doesn't work well," Burman said. "It works fine for people who are healthy. It just doesn't work well for people who are sick."