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zoom RSS 下院民主党案 富裕層への課税で医療制度改革/米国医療事情

<<   作成日時 : 2009/07/17 01:21   >>

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 下院民主党リーダーらは火曜日に、医療制度改革法案の詳細を公表した。メディケア医療費高騰を抑制し、高所得者の増税をし、被雇用者に保険提供しない雇用者に罰金を科して、ほとんどのアメリカ人に保険提供する。
 オバマ大統領が国内問題の最優先事項として民主党リーダーに要請し、今週3つの議会委員会は投票計画を発表した。
 2011年以降、年収50万ドルの家庭で追加所得税が1,500ドルとなる。年収100万ドルでは9,000ドルとなる。被雇用者に健康保険を提供しない雇用者に罰金が科せられ、40万ドル以上の給与支払いがある雇用者では賃金の8%に相当する。
 付加税は個人で年収28万ドル、夫婦で35万ドル以上の場合に課せられ、税率は1%〜5.4%となる。
 議会予算局による部分的・予備的な見積りでは、下院法案で提供されるように健康保険拡大することで10年間に1兆ドル以上の予算がかかるだろうとしていた。しかし、民主党は、そのコストが完全にメディケア(高齢者公的医療保険)と他の健康維持プログラムで提案された予算削減と、連邦税収引き上げ改正によって相殺されるだろうとしている。
 2019年までに無保険者を3,700万人減の1,700万人まで減らせると試算している。無保険者のほぼ半数が不法移民となるだろうという。
 付加税は10年で必要な予算の約半分の5,440億ドルをまかなうが、米国の家族のわずか1.2%の富裕層に影響する。メディケアなどの削減が達成できなければ付加税は2013年に増税となる。また、雇用者は法案により雇用コストが増大する。
 上院保健委員会は包括的な医療法を承認する最初の協議会にはならなかったが、財務委員会は財源確保のために未だ奮闘している。
 下院法案は政府管理健康保険計画を作成する予定であり、2013年から私的保険業者と競合することになる。個人は健康保険を持つ必要があり、持たない場合は新税を払う必要がある。雇用者健康保険プレミアが年収の11%以上なら、政府管理保険に参加できる。
 健康保険を提供しない雇用者への罰金は、25万ドル以下の給与支払いなら必要なく、25-30万ドルでは給与の2%、30-35万ドルでは4%、35-40万ドルでは6%である。
 オバマ大統領と議会の多くの民主党員は提案された政府保険計画を、医療費の増大を遅くし、保険会社を正直にしておくための要と考えている。
 他の医療業者へのメディケア支払い率はおおよそ同じだが、医師へのメディケア支払い率を+5%に最初は設定されるだろうという(プレミアを付けている?)。
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富裕層への増税で医療改革 下院民主党案/米国医療事情 オバマ政権
http://kurie.at.webry.info/200907/article_16.html
富裕層への増税で医療費捻出/米国医療事情 オバマ政権
http://kurie.at.webry.info/200902/article_44.html
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House Health Plan Outlines Higher Taxes on Rich
http://www.nytimes.com/2009/07/15/health/policy/15health.html
By ROBERT PEAR and DAVID M. HERSZENHORN
Published: July 14, 2009

WASHINGTON ― House Democratic leaders took a big step toward guaranteeing health insurance for most Americans on Tuesday as they unveiled a bill that detailed how they would expand coverage, slow the growth of Medicare, raise taxes on high-income people and penalize employers who do not provide health benefits to their workers.

A day after President Obama pressured Democratic leaders to speed work on his top domestic priority, three House committees announced plans to begin voting on the measure this week.

Starting in 2011, a family making $500,000 would have to pay $1,500 in additional income tax to help subsidize coverage for the uninsured. A family making $1 million would have to pay $9,000.

Employers who do not provide health insurance to workers would generally have to pay a fee or penalty to the government. The fee would be equal to 8 percent of wages for an employer with an annual payroll of more than $400,000.

After months of setbacks and uncertainty, House Democrats were jubilant as they introduced their proposal to achieve a goal that has eluded presidents for six decades.

“This is indeed a happy day, for today we are introducing historic and transformative legislation that will benefit all Americans, a health insurance act for the great middle class of America,” Speaker Nancy Pelosi said.

President Obama hailed the House bill, which he described as a product of “unprecedented cooperation” by three House committees.

Speaking from Warren, Mich., Mr. Obama said, “Don’t be fooled by folks trying to scare you by saying we can’t change the health care system. We have no choice but to fix the health care system because right now it’s broken for too many Americans.”

The surtax would apply to any adjusted gross income exceeding $280,000 a year for an individual and $350,000 for a couple filing a joint return. The tax rates would range from 1 percent to 5.4 percent.

A partial, preliminary estimate by the Congressional Budget Office said it would cost slightly more than $1 trillion over 10 years to expand coverage as provided in the House bill. But Democrats said the cost would be fully offset by proposed savings in Medicare and other health programs and by revenue-raising changes in federal tax laws.

Douglas W. Elmendorf, director of the budget office, said that by 2019 the bill could reduce the number of people without health insurance by 37 million, leaving 17 million still uninsured. Nearly half of the uninsured would be illegal immigrants, Mr. Elmendorf said.

In a letter to lawmakers, major business organizations described the 1,018-page bill as a job-killer. They said its coverage mandate would automatically increase the cost of hiring a new worker.

In a summary of the bill, House Democrats said their proposal for a surcharge, or surtax, would raise $544 billion over 10 years ― roughly half the cost of the bill ― and affect “only 1.2 percent of all households in the United States.”

The additional tax on high-income people could rise significantly in 2013 if the federal government did not achieve specified savings in federal health programs like Medicare and Medicaid.

On the other side of the Capitol, after more than three weeks of work, the Senate health committee was poised to become the first panel to approve comprehensive health legislation.

But the Senate Finance Committee is still struggling to find ways to pay for it all, and the chairman of the committee, Senator Max Baucus, Democrat of Montana, acknowledged that he had yet to secure the bipartisan support he had been seeking.

The House bill would create a new government-run health plan, which would compete with private insurers, starting in 2013.

Under the bill, individuals would generally have to maintain health insurance, except in cases of hardship as defined by the Treasury. Those without coverage would have to pay a penalty in the form of a new tax.

People could buy coverage on their own from the new government plan, and those with modest incomes could get federal aid. Workers who have access to insurance through their employers could sign up for the government plan if premiums for the employer coverage would take up more than 11 percent of family income.

While employers not providing coverage would generally have to pay a fee or penalty equal to 8 percent of wages, there would be some exceptions. For example, an employer with a payroll of less than $250,000 a year would not have to pay any fee or penalty.

The fee would be equal to 2 percent of wages for a company with an annual payroll of $250,000 to $300,000; 4 percent of wages for an employer with a payroll of $300,000 to $350,000; and 6 percent of wages for businesses with a payroll of $350,000 to $400,000.

In a new report, the Congressional Budget Office said that such “pay-or-play requirements” could result in the hiring of fewer low-wage workers.

“Employees largely bear the cost of health insurance,” the budget office said. But, it added, employers cannot reduce wages for workers receiving the minimum wage, so “a play-or-pay provision could reduce the hiring of low-wage workers.” The House Republican leader, Representative John A. Boehner of Ohio, said it was “criminal malpractice” for Democrats to be pushing “a new small-business tax.” But Democrats said small businesses would be among the bill’s prime beneficiaries.

Mr. Obama and many Democrats in Congress see the proposed government insurance plan as the linchpin of their efforts to slow the growth of health costs and keep insurance companies honest. The government plan would initially pay doctors at Medicare rates plus 5 percent, while for other health care providers, the initial rates would be roughly the same as what Medicare pays.

Jim Rutenberg contributed reporting from Warren, Mich.

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