On Thursday evening, House leadership released the text of a second-degree managers amendment making additional policy changes. That amendment:
- Delays repeal of the Medicare “high-income” tax until 2023;
- Amends language in the Patient and State Stability Fund to allow states to dedicate grant funds towards offsetting the expenses of rural populations, and clarify the maternity, mental health, and preventive services allowed to be covered by such grants;
- Appropriates an additional $15 billion for the Patient and State Stability Fund, to be used only for maternity and mental health services; and
- Allows states to set essential health benefits for health plans, beginning in 2018.
Earlier on Thursday, the Congressional Budget Office released an updated cost estimate regarding the managers amendment. CBO viewed its coverage and premium estimates as largely unchanged from its original March 13 projections. However, the budget office did state that the managers package would reduce the bill’s estimated savings by $187 billion — increasing spending by $49 billion, and decreasing revenues by $137 billion. Of the increased spending, $41 billion would come from more generous inflation measures for some of the Medicaid per capita caps, and $8 billion would come from other changes. Of the reduced revenues, $90 billion would come from lowering the medical care deduction from 7.5 percent to 5.8 percent of income, while $48 billion would come from accelerating the repeal of Obamacare taxes compared to the base bill. Note that this “updated” CBO score released Thursday afternoon does NOT reflect any of the changes proposed Thursday evening; scores on that amendment will not be available until after Friday’s expected House vote.
Updated ten-year costs for repeal of the Obamacare taxes include:
- Tax on high-cost health plans (also known as the “Cadillac tax”)—but only through 2026 (lowers revenue by $66 billion);
- Restrictions on use of Health Savings Accounts and Flexible Spending Arrangements to pay for over-the-counter medications (lowers revenue by $5.7 billion);
- Increased penalties on non-health care uses of Health Savings Account dollars (lowers revenue by $100 million);
- Limits on Flexible Spending Arrangement contributions (lowers revenue by $19.6 billion);
- Medical device tax (lowers revenue by $19.6 billion);
- Elimination of deduction for employers who receive a subsidy from Medicare for offering retiree prescription drug coverage (lowers revenue by $1.8 billion);
- Limitation on medical expenses as an itemized deduction (lowers revenue by $125.7 billion)
- Medicare tax on “high-income” individuals (lowers revenue by $126.8 billion);
- Tax on pharmaceuticals (lowers revenue by $28.5 billion);
- Health insurer tax (lowers revenue by $144.7 billion);
- Tax on tanning services (lowers revenue by $600 million);
- Limitation on deductibility of salaries to insurance industry executives (lowers revenue by $500 million); and
- Net investment tax (lowers revenue by $172.2 billion).