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>>  6.1 Federal Taxation Policies to Change Consumer Behavior
  • Increase the federal excise tax on cigarettes and small cigars from $1.01 per pack to $1.51 per pack starting in 2013 and adjust each year for inflation. [page 39] Read More >>
  • Equalize taxation of cigarettes and other tobacco products. Read More >>
>>  6.2 Tax Treatment of Health Insurance
  • Replace the Cadillac tax on high-cost employer-sponsored health benefits with a limit on the income-tax exclusion for employer-sponsored health benefits at the dollar amount equivalent to the 80th percentile of single and family employee-sponsored insurance premiums in 2015 (age- and gender-adjusted); these initial thresholds would be updated for gross domestic product (GDP) growth per capita through 2023 and by GDP growth per capita plus half a percentage point thereafter. [pages 74-77] [Private Payers] Read More >>
  • Limit the subsidy of employer-provided health insurance benefits by imposing a cap that would eventually be set to GDP growth rate; at a minimum, retain ACA provision on taxing high-premium insurance plans beginning in 2018. [page 26] [Private Payers]
  • Contingent on implementation of ACA's coverage expansion, limit the tax exclusion for employer-based health insurance. The income exclusion for families with incomes above $250,000 should be limited to the value of the silver level of coverage that will be subsidized in the new health insurance marketplaces, starting in 2018. [page 38] [Private Payers]
>>  6.3 Spending Targets
  • Promote quality and value through an improved, enrollment-based version of accountable care organizations (ACOs) called "Medicare Networks," formed and governed by providers. Read More >>
  • Eliminate SGR and transition from FFS-based system to Medicare Comprehensive Care (MCC). Read More >>
  • Form "accountable care states" with global targets for all health care spending by both public and private payers. Read More >>
  • Establish a target for total public and private spending (combined) to grow at a rate no greater than economic growth per capita, and adjust policies as needed if the target is exceeded; collect data to inform and enable state and local action and allow for focused policy responses in particular geographic areas if growth exceeds targets. [pages 30-31]
  • Implement a value-based withhold in Medicare in the event that expected savings do not materialize as an alternative to across-the-board provider cuts. Specify a reasonable amount of savings to be expected from certain specified delivery, payment, and market reforms. After five years, if the Centers for Medicare & Medicaid Services' Office of the Actuary finds that Medicare is not on a path to realize that level of savings, this policy would require that a percentage withhold be imposed on Medicare reimbursement. [page 11] [Medicare]
  • Rather than national targets, caps, or spending limits on federal programs, create a shared incentive to bend the cost curve across both the public and private sectors; alternatively, focus at the state level and include mechanisms to control costs across all sectors so that costs that are compressed in one sector will not simply be shifted to another. [page 28] Read More >>
  • Establish a cap on the growth of per beneficiary net federal commitment to health care to growth of GDP after 2018. Enforce cap through an equally divided combination of: reductions in Medicare provider payments implemented through a "value based withhold"; across-the-board increases in Medicare premiums; and a reduction in the value of the employer health exclusion that treats some percentage of the exclusion as ordinary income for income tax purposes. [page 9, page 63]
Source: Katie Horton, J.D., M.P.H., R.N., Mary-Beth Malcarney, J.D., M.P.H., and Naomi Seiler J.D., George Washington University Department of Health Policy.