Five Facts about the Small Business Health Care Tax Credit

The IRS wants you to know that, if you are a small employer, there is a tax credit that can put money in your pocket. The small business health care tax credit is available through the small business health options program, also known as the SHOP marketplace. Employers must have fewer than 25 full-time equivalent employees, pay an average wage of less than $50,000 a year, and pay at least half of employee health insurance premiums. The IRS offers these five facts about this credit:

  1. The maximum credit is 50% of premiums paid for small business employers and 35% for small tax-exempt employers.
  2. To be eligible, you must pay premiums on behalf of employees enrolled in a qualified health plan offered through a Small Business Health Options Program Marketplace or qualify for an exception to this requirement.
  3. The credit is for eligible employers for two consecutive taxable years beginning in 2014 or later. You may be able to amend prior year tax returns to claim the credit for tax years 2010 through 2013 in addition to claiming this credit for those two consecutive years.
  4. You can carry the credit back or forward to other tax years if you don’t owe tax during the year.
  5. You may get a credit and a deduction for employee premium payments. Since the amount of your health insurance premium payments will be more than the total credit, if you are eligible, you can still claim a business expense deduction for the premiums in excess of the credit.

Healthcare Issues Among Millennials

Transamerica Center for Health Studies (TCHS) finds that Millennials are struggling with the cost of healthcare while facing some health issues at a young age. The survey reveals the following:

  • The most common reason that the 11% of uninsured Millennials didn’t get coverage before the ACA deadline is that they did not know how to apply for insurance.
  • 60% of the uninsured are women; and 68% of the uninsured are unemployed.
  • 21% of Millennials can’t afford their routine healthcare expenses. An additional 26% can afford it, but with difficulty.
  • 70% say that cost is very important when looking for healthcare.
  • 66% of Millennials say that a $200 a month premium is not affordable.
  • Nearly half of Millennials skip care to reduce their healthcare costs.
  • More than half of Millennials have a chronic illness or health condition. The most common conditions are depression (17%), weight issues (15% overweight and 7% obesity), and anxiety disorders (14%).
  • 64% rely on their mom/step-mom as their primary source for health advice and healthcare guidance; 36% rely on their dad/step-dad; and 26% rely on their spouse or partner.

Obamacare Significantly Reduces Cost of Mental Health Care for Young Adults

The Affordable Care Act (ACA) has significantly reduced out-of-pocket behavioral health care costs for adults 19 to 25, according to a study published in the Psychiatric Services Journal. Young Latinos, African Americans, and other racial and ethnic minorities saw the greatest reduction in out-of-pocket behavioral health expenses. This demographic often has higher unemployment and lower salaries, so they are less likely to seek behavioral health services. The ACA’s dependent coverage provision has reduced the number of uninsured young adults by at least three million. The ACA allows young adults to remain on their family’s health plans until they turn 26. Because of this, the expansion of health care access is also expected to increase the number of users of mental health and substance abuse treatment services. Behavioral health conditions often emerge during the 19 to 25 year age range. Also, this age group has a higher rate of serious mental illness than other adults.

Californians with Individual Health Coverage Spent Significantly Less on Healthcare

California residents who bought insurance through the individual market spent significantly less on health care in 2014 than they did the year before. The year, 2014 marks the first year of the Affordable Care Act (ACA). The report by the California HealthCare Foundation reveals that median out-of-pocket spending for families with individual coverage dropped from $7,345 in 2013 to $4,893 in 2014. Thirty-five percent of Californians with individual coverage said that health care costs ate up more than 10% of their household income compared to 43% in 2013. The reduced spending is likely due to premium tax credits and cost-sharing subsidies available for the first time in 2014 through Covered California. Spending declines were more pronounced in California than in the rest of the country. In fact, it’s likely California’s spending declines helped pull down the national averages.

Group Proposes Replacement to Obamacare

With health care costs and insurance premiums rising, the National Center for Policy Analysis developed a plan to create accessible, affordable and high quality health care for many more Americans. NCPA senior fellow and author Devon Herrick said, “Our health care system is simply not sustainable under Obamacare. Reform is inevitable. The longer that takes, the more hard it will be on everyone, including consumers.”

Dr. Herrick outlines the following alternatives to the ACA:

  • Increased flexibility in health plan design.
  • Tax fairness regardless of where Americans get their health coverage.
  • Increased access to primary care by removing barriers to innovative medical practices and services.
    Reform of hospital regulations to better serve patients.
  • Reduced costs through price transparency to boost competition and innovation in medical services and prescription drugs.
  • Strengthened Medicare, Medicaid, and Veterans Health that better serve the needs of patients.
  • Changes in the financing of medical care so that people have control over their health care dollars and the means to pay for medical care over their lifetimes.

The Cost Implications of Private Exchanges

Private exchanges could encourage employees to select less-generous plans, according to a report by Rand. This could expose employees to higher out-of-pocket costs, but premium contributions would drop substantially, so net spending would decrease. On the other hand, employee spending may increase if employers decrease their health insurance contributions when moving to private exchanges. Most employers can avoid the ACA’s Cadillac tax by reducing the generosity of their plans, regardless of whether they move to a private exchange. There is not  enough evidence yet to determine whether private exchanges will become prominent and how they will affect employers and their employees.

Workers who choose less-generous plans could risk higher out-of-pocket costs. But their net spending would drop because premiums would drop substantially. Average employee spending could increase if employers lower their health insurance contributions when moving to private exchanges. Private exchanges are unlikely to significantly affect the ACA’s Small Business Health Options Program (SHOP) Marketplaces.

Exchange Consumers Are Becoming Savvy Shoppers

People who get health insurance through the public health insurance exchanges are increasingly confident about their ability to afford coverage. Also, they are just as satisfied with their coverage as are people with employer coverage, according to a Deloitte Consulting survey. Seventy percent of exchange consumers were able to manage their out-of-pocket expenses in the past year and only 25% had higher out-of-pocket costs than expected. However, lower-income people had a hard time paying for out-of-pocket costs.

Greg Scott of Deloitte said, “Health care consumers’ expectations for information and transparency are increasing, as is their interest in intuitive tools to access relevant information. Meeting these expectations should lead to increasingly more confident and satisfied customers.” Paul Lambdin of Deloitte said, “Out-of-pocket costs… are making exchange consumers pay close attention to the details of their coverage and changes in benefits and premiums.”

Knowing what costs to expect could also be increasing confidence. More exchange consumers understand the costs of their coverage than do people with employer insurance. Sixty-one percent of exchange consumers look at the total costs – not just premiums – when evaluating coverage options.

Also, more exchange customers are willing to accept network tradeoffs for lower payments than in 2015. These tradeoffs include a smaller network of hospitals (27% in 2016 as compared to 18% in 2015), a network that does not include their primary-care provider (26% in 2016 as compared to 16% in 2015), and a smaller network of doctors (26% as compared to 18% in 2015).

Sixty-six percent of exchange consumers used online tools to compare out-of-pocket costs compared to 58% of consumers with employer coverage. Scott said, “Exchange consumers continue to shop around for coverage and evaluate costs before making decisions and appear to be responding to messages about going online to look for health insurance information.”

Some States Pay Twice the Price for Health Care

Some states pay more than double of what other states pay for health care among the commercially insured, according to a report by the Health Care Cost Institute (HCCI). Some price variation is due to differences in wages or rent, but other variation is due to differences in market dynamics, such as a lack of transparency, market power, or the availability of alternative treatments. Alaska has the highest health care prices, followed by Wisconsin, North Dakota, New Hampshire, and Minnesota. In New Hampshire and Wisconsin, over 20% of health care services are twice the national average price. In Arizona, Florida, Maryland, and Tennessee, more than 90% of health care services are priced lower than the national average.

Prices vary more for some health care services. For example, states have similar prices for acupuncture while prices for cataract removal vary significantly. The greatest price variation is for imaging, radiology, and lab tests. Prices for services also vary widely among cities in the same state. For example, prices for knee replacements vary most in California, with a $27,243 average price difference between Riverside ($30,261) and Sacramento ($57,504). Price variation has a substantial affect on health care spending and patients’ cost sharing

One-Third of Doctors Consider Quitting After Passage of the ACA

Thirty-six percent of all doctors, and 45% of private practice doctors say they are more inclined to leave the medical profession because of the Affordable Care Act (ACA), according to a study by CompHealth. Fifty-one percent of doctors surveyed view the ACA unfavorably while 30% view it favorably. Physicians in private practice are most pessimistic, with 61% saying they view the law negatively. Doctors also say the following about practicing medicine after the ACA:

  • 47% say the ACA has improved access to healthcare and insurance.
  • 44% say the ACA has had a neutral effect on their patients’ quality of healthcare.
  • 76% of all doctors, and 86% of private practice doctors say they are not properly compensated by ACA reimbursements.
  • 38% say their salaries have decreased.
  • 44% spend less time with their patients.
  • 68% spend too much time entering data.
  • 59% spend too much time doing paperwork.

To cope with challenging circumstances, 40% of doctors are supplementing their income by filling in for other doctors, moonlighting, and consulting.

Is it a Myth that Health Care Costs Are Spiking Under the ACA?

Former White House spokesman Robert Weiner and analyst Daniel Khan argue that the Affordable Care Act has not caused massive spikes in healthcare premium. In a recent article in the Tallahassee Democrat, Weiner and Khan say that one of the biggest issues in the presidential election is a recurring Republican critique of the Affordable Care Act: the supposedly massive healthcare price spikes. Frontrunner Donald Trump said, “I don’t know if you have been watching lately — people’s premiums are going up 35, 45, 55%. Their deductibles are so high nobody’s ever going to get to use it. Obamacare is turning out to be a bigger disaster than anybody thought.” Weiner and Khan say the results speak otherwise.

The following are highlights of their arguments: It is true that employer-based insurance premiums increased 26% from 2009 to 2014, but before the passage of the ACA, they went up 34% from 2004 to 2009 and 72% from 1999 to 2004. So we are talking about half the increases compared to before the law. Twenty million more Americans now have health insurance through the Affordable Care Act, including nearly 8 million new Medicaid enrollees under Obamacare’s expansion, according to Obamcarefacts.com.

In addition, people will be living longer. According to a Harvard School of Public Health study of Massachusetts, “In each of the first four years of the state law, 320 fewer Massachusetts men and women died than would have been expected. That’s one life extended for every 830 newly insured residents.” Another study, by the American Journal of Public Health, shows that nearly 45,000 people die every year due to a lack of health insurance.

Yet the literally sickening (potentially to millions) refrain persists, “Repeal and replace Obamacare.” The House has now voted to repeal it 63 time (but never with the replace part, since they’d actually use Obamacare provisions).Even in Kentucky, with uninsured down to an all-time low 7.5% there, U.S. Senate Leader Mitch McConnell, Republican from Kentucky, takes credit for the insurance expansion by his state, but refuses to publicly acknowledge it’s because of and under Obamacare. It’s as though it came from the sky.

Florida’s great former congressman and senator, Claude Pepper, fought for national health insurance his whole life. He would be incensed at the opponents of Obamacare for trying to block the coverage for millions who now have it. Pepper, whose library and museum are at Florida State University in Tallahassee, said back in 1987, “What I’m talking about is a principle of insurance applied to health care. We insure our homes. We insure our businesses. Why can’t we insure something that’s even more important to us, our lives and our health?”

In 2013, Gov. Rick Scott, who knows health costs as a former hospital group administrator, was for Obamacare Medicaid expansion before he was against it. He said, “While the federal government is committed to pay 100% of the cost, I cannot, in good conscience, deny Floridians the needed access to health care.” Then he lost that “good conscience” to politics. He reversed after his Republican legislature refused to allow it for fear of giving Obama credit for anything.”

According to HHS.gov, if Florida were to expand Medicaid, an additional 848,000 uninsured people would gain coverage.” Even without, under Obamacare’s marketplace, a Gallup poll confirmed that the uninsured rate in Florida in 2014 was 18.3%, down from 22.1% in 2013.

Through healthcare.gov, customers can search for an array of plans based on their financial and health priorities. Customers are able to switch plans, which enables them to save a lot of money. According to the HHS, those who switched plans within the same metal tier (platinum, gold, silver, bronze) saved an average of nearly $400 on their 2015 annualized premiums after tax credits as compared to those who stayed in their same plans.

According to HHS, about 8 out of 10 returning consumers will be able to buy a plan with premiums less than $100 dollars a month after tax credits; and about 7 out of 10 will have a plan available for less than $75 a month.

A smart consumer can both achieve health care coverage and save money, without succumbing to the naysayers who either have not done their homework comparing plans or, for political purposes, do not want to credit the President for a major achievement.

Robert Weiner is a former spokesman for the Clinton White House and was Chief of Staff of Cong. Claude Pepper’s (D-FL) House Aging Committee and Subcommittee on Health. Daniel Khan is senior policy analyst at Robert Weiner Associates and Solutions for Change. Here is a link to article:http://www.tallahassee.com/story/opinion/2016/03/25/spiking-health-care-costs-aca-myth/82267170/

Last Updated 10/28/2020

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