Lawmakers Claim to 'Equalize Tax Treatment of Health Care' in New Proposal

May 21, 2009 ( - U.S. Senators Tom Coburn, (R-Oklahoma) and Richard Burr (R-North Carolina) and U.S. Representatives Paul Ryan (R-Wisconsin) and Devin Nunes (R-California) introduced health care reform legislation that they claim promotes universal access to quality, affordable health care without adding billions of dollars in new debt or taxes.

Saying the tax code favors the wealthy and those who get their health coverage through their employers, discriminating against the self-employed, unemployed, and small businesses, the lawmakers said in a summary of the bill that the Patients’ Choice Act of 2009 would restore fairness in the tax code and give every American, regardless of employment status, the ability to purchase health insurance by providing a refundable tax credit of $2,300 per individual or $5,700 per family with health care coverage.

The bill would also allow for health insurance premiums to be paid with health savings accounts (HSAs) without a tax penalty, allow preventative services to be covered by High Deductible Health Plans, and increase the amount of money an HSA owner may annually contribute to his or her account, the summary said.

The legislation also proposes to create affordable and accessible health insurance options by:

  • creating state health insurance exchanges to give Americans a marketplace to compare different health insurance policies and select the one that meets their unique needs;
  • giving Americans the same standard health benefits as members of Congress, so all Americans have a wide range of choices;
  • ensuring that no individual would be turned down by a participating Exchange insurer based on age or health;
  • creating a non-profit, independent board to risk adjust among participating insurance companies to penalize companies that “cherry pick” health patients and reward insurers that encourage prevention/wellness and cover patients with pre-existing conditions;
  • helping states expand coverage through auto-enrollment at state and medical points of service, for individuals who do not select a plan at the beginning of the year; and
  • giving states the ability to band together in regional pooling arrangements, as well as the creation of high risk pools, reinsurance markets, or risk adjustment mechanisms to cover those deemed “uninsurable.”

The Patients’ Choice Act of 2009 also includes provisions focusing on preventing diseases and promoting healthier lifestyles, modernizing the Medicaid benefit, ensuring compensation for injured patients, and establishing transparency in health care price and quality.

Some may recall that Senator John McCain, during his campaign for presidency, also proposed to eliminate the "bias" toward employer-sponsored health care, in part by replacing the current tax exclusions for employer-provided coverage with tax credits of $2,500 for individual coverage and $5,000 for family coverage (see Cover: Political Partings).

In a Q&A on the bill, lawmakers admit their proposal is similar to the McCain plan in this way, but contend that it is different in several key areas. They first claim that McCain's plan was expensive, costing taxpayers hundreds of billions of dollars over a projected budget window, and suggest their bill is revenue-neutral and budget-neutral.

The legislators also note that McCain proposed a federal marketplace to provide coverage options to Americans, while their proposal promotes state-based health exchanges.

The Q&A also contends that provisions focusing on prevention and wellness, Medicaid modernization, state health courts and review panels aimed at decreasing the number of lawsuits, and increased price and quality transparency are "outside the scope of Senator McCain's plan."

Links to bill summaries and the Q&A can be found here .