By NextBestFitPhase 1: Enactment & build · Step 1.12
Set up the new taxes
Months 0–18 · Treasury, IRS, SSADiscuss this step
IRS and Treasury implement the employer health payroll tax (7.5%), the household income-based premium (4.0% above an exemption), and the top-end surtaxes, each phased in with the enrollment waves.
Legal vehicle
Universal Health Act, Title VII; Internal Revenue Code new chapters.
Who does it
Treasury, IRS, SSA
When
Months 0–18
In this step
Tasks
6 tasks
Design choice & alternatives
1 decisions with alternatives
Costs & calculations
15 cost items, each with its calculation
Trade-offs
2 pros · 3 cons · 3 trade-offs
Risks
2 risks with mitigations
What changes in the system
6 existing laws, programs, or institutions changed
Other countries
6 comparisons
Cost items
- Employer health payroll tax (new)$742.8B
- Income-based health premium (new)$512.2B
- Top-end surtaxes & financial transactions tax (new)$330.1B
- Federal employer health payroll tax (new)$30.0B
- State & local employer health payroll tax (new)$100.5B
- Remaining federal general revenue requirement$97.2B
- Household: Family of four, $100k, job-based coverage$12,459
- Household: Single worker, $45k, job-based coverage$3,458
- Household: Family of four, $60k, Marketplace plan$2,239
- Household: Retired couple, $50k AGI, Medicare + Medigap$11,900
- Household: Family of three, $30k, Medicaid$-1,414
- Household: High-earning family, $400k, job-based coverage$-12,190
- Household: Self-employed, $80k, unsubsidized Marketplace$2,175
- Household: Very high income, $3M AGI$-598,143
- Who gains and who pays more, by income (family of four with employer coverage)$240,000
Biggest risk for this step
Costs come in at the costly case. See risks.
Depends on
Nothing: this step can start first.
Steps that depend on this one