Suit Against Subsidies Could Derail ObamaCare

Did you hear about the court decision in Halbig, et al v Sebelius? The suit was brought by six businesses against the employer mandate under ObamaCare. The federal District Judge, Paul Friedman, refused a preliminary injunction against the government, but he did say the case would be decided on an expedited basis.  That court joins Pruitt v. Sebelius, a case from Oklahoma. There is yet another suit to be heard by month-end in Richmond, Virginia.

What is going on?

They are suing over the employer penalty under ObamaCare - the $2,000 or $3,000 penalty, depending upon whether the employer offers insurance and whether the insurance meets politically correct criteria. The employer penalty triggers when an employee qualifies for a subsidy on the public exchange (the “Marketplace”). One qualifies if one’s income is below 400% of the federal poverty line and meets other criteria. The employer would then be required to subsidize some of the cost through that $2,000/$3,000 penalty.

What does it take to qualify for an individual subsidy?

Let’s do something that Congress apparently did not do when this passed this law: let’s read it:

Let’s start with Section 1311(b):

          Sec 1311(b) AMERICAN HEALTH BENEFIT EXCHANGES.—

(1) IN GENERAL.—Each State shall, not later than January 1, 2014, establish an American Health Benefit Exchange (referred to in this title as an ‘‘Exchange’’) for the State that…

We read that each state is to establish an Exchange.

What if the state fails to establish an Exchange?

         

Sec 1321 (c) FAILURE TO ESTABLISH EXCHANGE OR IMPLEMENT REQUIREMENTS.

(1) IN GENERAL.—If—

(A) a State is not an electing State under subsection (b); or

(B) the Secretary determines, on or before January 1, 2013, that an electing State—

(i) will not have any required Exchange operational by January 1, 2014; or

(ii) has not taken the actions the Secretary determines necessary to implement—

(I) the other requirements set forth in the standards under subsection (a); or

(II) the requirements set forth in subtitles A and C and the amendments made by such subtitles;

the Secretary shall (directly or through agreement with a not for profit entity) establish and operate such Exchange within the State and the Secretary shall take such actions as are necessary to implement such other requirements.

We read that the Secretary will establish the Exchange.

How does an individual get to a subsidy?

SEC. 1401. REFUNDABLE TAX CREDIT PROVIDING PREMIUM ASSISTANCE FOR COVERAGE UNDER A QUALIFIED HEALTH PLAN.

(a) IN GENERAL.—Subpart C of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 (relating to refundable credits) is amended by inserting after section 36A the following new section:

SEC. 36B. REFUNDABLE CREDIT FOR COVERAGE UNDER A QUALIFIED

HEALTH PLAN.

(a) IN GENERAL.—In the case of an applicable taxpayer, there shall be allowed as a credit against the tax imposed by this subtitle for any taxable year an amount equal to the premium assistance credit amount of the taxpayer for the taxable year.

(b) PREMIUM ASSISTANCE CREDIT AMOUNT.—For purposes of this section—

(1) IN GENERAL.—The term ‘premium assistance credit amount’ means, with respect to any taxable year, the sum of the premium assistance amounts determined under paragraph (2) with respect to all coverage months of the taxpayer occurring during the taxable year.

‘‘(2) PREMIUM ASSISTANCE AMOUNT.—The premium assistance amount determined under this subsection with respect to any coverage month is the amount equal to the lesser of

(A)   the monthly premiums for such month for 1 or more qualified health plans offered in the individual market within a State which cover the taxpayer, the taxpayer’s spouse, or any dependent (as defined in section 152) of the taxpayer and which were enrolled in through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act, or

(B)    the excess (if any) of— ‘‘(i) the adjusted monthly premium for such month for the applicable second lowest cost silver plan with respect to the taxpayer, over ‘‘(ii) an amount equal to 1/12 of the product of the applicable percentage and the taxpayer’s household income for the taxable year

Whoa. If the nuns taught me how to read English, I see that the taxpayer has to be enrolled in an Exchange pursuant to Section 1311. Section 1311 requires “each state” to do something, otherwise Section 1321 kicks in.

Question: What if a state does nothing (thereby removing Section 1311) and the federal government steps in under Section 1321. Would someone in that state be receiving a subsidy as defined under Section 1401 or not?

Can the federal government be a “state?”

Let’s look at Section 1304(d):

Sec 1304(d) STATE.—In this title, the term ‘‘State’’ means each of the 50 States and the District of Columbia.

Looks like the answer is “no.”

Considering that there are approximately three dozen states that did not set-up their own Exchange, how does the federal government propose to get an employer to pay that $2,000/$3,000 penalty despite the language in Sections 1401 and 1311?

The IRS comes to the rescue by proposing the following Regulation:

         

a taxpayer is eligible for the credit for a taxable year if . . . the taxpayer or a member of the taxpayer’s family (1) is enrolled in one or more qualified health plans through an Exchange established under section 1311 or 1321 of the Affordable Care Act . . .”

         

Good grief! Well, one thing about Tony is that he could always count on Paulie and Christopher to back him up.

Does law mean nothing to this crowd? Perhaps the law is flawed, perhaps it was poorly drafted, but it still law. How many times have I read about unintended consequences of the alternative minimum tax or about some poor taxpayer being hung out to dry because he/she did not get that “special” piece of paper the IRS wanted in order to substantiate a transaction?  How did the IRS invariably defend its position? By arguing that the law is the law and that Congress should remedy any inequity.  

In a swell of self-importance, the Administration and its enablers refuse to accept that the same law that applies to you or me also applies to them. Instead they argue that:

         

(1) Justice Roberts decided that the penalties are a tax. The Anti-Injunction Act precludes plaintiffs from challenging the imposition of a tax before it is actually assessed.

(2) The plaintiffs lack standing due to the speculative nature of any claimed injuries.

(3) Following the White House announcement of the one-year delay of the employer mandate, the court should also delay its consideration.

(4) The language around subsidies represents but one of the ACA’s many drafting errors.

(5) Congress clearly intended to have tax credits available in all the states.

Let me get this straight: their argument is that Tony did not clearly intend for me to defend myself until after I was shot, because before then any self-defense would be speculative and contingent on the actions of someone for whom English is a second language. 

Really?

Let us review history to understand how we got into this mess. The House had a bill. The Senate had a bill. The bills were different. The Senate wanted to force the states to absorb the Exchanges, but it ran into a problem with Pritz v United States (1997):

[T]he Federal Government may not compel the states to implement, by legislation or executive action, federal regulatory programs.’’

The Senate instead added a provision for federally established exchanges as a backup option for states that refused to set up exchanges.

Remember that bill could not obtain bipartisan support, and it was passed on a Saturday night at late hour, after the Louisiana Purchase, the Cornhusker Kickback and who-knows-what-else. The Democrats had lost their Senate 60-vote majority in January 2010, meaning they could not override the expected filibuster.  To push the bill through the Senate, Reid forced a reconciliation vote - a tactic normally reserved to limit debate on budget bills. This tactic however did not allow for a normal Senate-House joint committee process to reconcile burrs in the law. How could it? It was designed for budget and debt ceiling items, not for something like this.

Let’s see what happens in Halbig and Pruitt. Judge Paul Friedman hopes to have his opinion out by February.

How Will You Report The ObamaCare Subsidy On Your Tax Return?

It is called the “premium assistance tax credit,” and it refers to the subsidy that people will receive under the ObamaCare individual mandate. It will begin in 2014, and it is supposed to make insurance more affordable for people under 400% of the federal poverty line (FPL). I am not really sure how the politicians came up with 400%, as many if not most of us would agree that 4 times the poverty line is nowhere near poverty. For example, if you are married and have a child, 400% of the FPL is $78,120. That picks up a lot, if not the majority, of people in the Cincinnati area. 

OBSERVATION: I did not realize that Washington views the average Cincinnatian as impoverished and in need of their help.  How did we ever survive this blight before?

Starting next year, you have to address your health insurance, either by receiving it through work, remaining on your parent’s policy, buying it in the private marketplace or on the public exchange. If you don’t, tax advisors are supposed to calculate a tax penalty when preparing your 2014 taxes in April 2015. If you do, then tax advisors may have to go through a separate calculation to determine whether the government paid too much or too little subsidy toward your health insurance. As a tax advisor, I say … whoopee. You would think the government could at least put me on its 401(k) plan for doing its yeoman work.

So how do you calculate whether the government paid too much or too little? That is our topic this week.

We will need two tables to do this. The first is the FPL table by household size.

The second table provides the phase-out of the subsidy as one’s income increases through the FPL table.

When you and I meet in April 2015, I will know your 2014 adjusted gross income (AGI), which starts off this exercise. A good definition of AGI is the amount of money you made before you deduct your house, taxes, contributions and kids. I will then have to make some adjustments to it, if you have certain items on your return:

·        I will add tax -exempt interest

·        I will add the untaxed portion of your social security

·        If you worked overseas I will add the exempted portion of your salary

You now have something called modified adjusted gross income (MAGI).

Let’s say that you are married, have a toddler and your MAGI is $55,000. You have a modest home, an older car and are living the dream. 

The table tells me that you are under 400% of the FPL (which is $78,120 for a family of 3), so we next talk about your health insurance. You tell me that you do not have insurance at work. Your wife is staying at home and being a mom. You went and bought a health policy on the public exchange. You purchased an Anthem bronze plan costing $715 per month. That $715 however was before the subsidy, to which we will return in a moment.

We now have your actual 2014 income, and we have to settle-up with the government. If you were under-subsidized, you will get a check. If you were over-subsidized, you have to return the money. 

NOTE: The subsidy is being paid directly to the insurer. You never see this check. It is very possible that you never even paid attention to the subsidy amount, as you were focusing only on your out-of-pocket.

At MAGI of $55,000, you are at 282% of the FPL ($55,000/$19,530). We now go to the next table. There is a sliding scale between 250% and 300% FPL, going from 8.05% to 9.5% of MAGI. You are somewhere in the middle, so we have to do some math:

            282 – 250 = 32

            32/50 = 64%

            9.5% - 8.05% = 1.45%

            1.45% * 64% = 0.93%

            8.05% + 0.93% = 8.98%

Your premiums are limited to 8.98% of your MAGI. As we said, your income was $55,000. That means your share of the premiums caps-out at $4,939.

How much was your subsidy? Total annual premiums were $8,580 ($715 * 12 months). Your cap is $4,939. The difference is $3,641, or $303 per month. If your subsidy was less than $303/month, I have good news for you. If it was more, then I have bad news, as you will be writing the government a check.  How do we know the subsidy? There will be a new tax form – Form 1095-A- that will be issued about the same time as your W-2. You will have to bring that form to me when preparing your taxes.

There are limits on how much you have to repay the government:

·        If you are below 200% of the FPL, the most you have to pay back is $600

·        Between 200% and 300% the maximum is $1,500

·        Between 300% and 400% the maximum is $2,500

The $600/$1,500/$2,500 limits are for a family. It is one-half that amount if you are single.

By the way …. IF your MAGI exceeds 400% FPL, then you have to repay ALL the subsidy with your tax return.

The above limits ($600/$1,500/$2,500) do not apply if the government owes you. This could happen if your income dropped significantly, such as your employer moving you to part-time.

You may have read that the White House delayed the employer reporting for one year. It will now start in 2015 (for 2014), rather than 2014 (for 2013). The White House believes that it has limited the potential for fraud because of the requirement to settle-up the individual mandate when filing the individual income tax return. You can see their point.

I am very uncomfortable with this action, however. Since when does a White House get to decide which laws it wants to enforce and which laws it does not? What if the next president decides to “suspend” the corporate tax for a year? This White House is creating precedence for that White House to do so.

What we have now are three categories of health consumers:

(1) Over 400%: you pay full boat. The exchanges and subsidies mean nothing to you.

(2) Between 133% and 400% of the FPL: you may be subject to the above, depending upon your insurance situation at work.

(3) Below 133%: you are likely enrolled in Medicaid and pay no premiums at all. This however will vary by state, as many states did not participate in the Medicaid expansion under ObamaCare.

You cannot deduct the portion of your health insurance that is being subsidized. However, since the medical deduction threshold is increasing to 10% (from 7.5%) of AGI, it is highly unlikely that you will ever deduct medical expenses again, unless you have exceptional circumstances. 

And there is how the government intends that people will settle up their ObamaCare if they qualify for a subsidy. Seems reasonable, as in I-haven’t-been-in-the-real-world-and-earned-a-real-paycheck-for-many-years-now and how-hard-can-it-be-to-build-a-website sort of way.

After all, what could possibly go wrong?