First, there is the $20 billion to be squeezed out of patients who need medical devices:
Manufactures and importers of certain medical devices will be taxed 2.3% of the price of the product. Devices will not include retail objects like corrective lenses or hearing aids, but will include products like defibrillators, pacemakers, artificial joints, stents, and those involved in cancer treatments, angioplasty and vascular surgery. More than 800 companies from the powerful medical device industry have protested the tax, which will raise $1.8 billion next year, and $20 billion over the next seven years.One of the reasons that BIG MED DEVICES ("the powerful medical device industry") is protesting this tax is because the Affordable Care Act does not allow them to pass the cost of the taxes onto their customers, and a 2.3% tax will eliminate most of the profit margin that keeps smaller to medium-sized companies afloat (not to mention the people they employ), which also means that we can expect to see increasing shortages of these devices and dramatic cutbacks in R&D for improvements.
Then there is the rise in medical deductibles for all Americans (not just the most affluent):
Under current law, Americans get a tax deduction if all their medical expenses exceed 7.5% of what they make (minus exceptions and deductions). That number will rise to 10% for almost everyone in 2013. Those that are 65 and older get a pass for 3 years. This tax raises $400 million next year, $15.2 billion over seven years.I have long held the position that if the government were actually serious about helping Americans avoid medical bankruptcy, it could have--AT ANY TIME--have taken the step of lowering or eliminating this threshold. At 7.5% after deductions and exemptions it is currently almost impossible to meet. The year that my wife had major back surgery and my son had a particularly devastating year with chronic illness, we piled up thousands upon thousands of dollars of medical bills, but because (a) I itemized my deductions [which you have to do to qualify for this deduction]; and because I took a second full-time job to attempt to pay our bills, we missed qualifying for this deduction by nearly $1,000. Most people do not realize that if you have regular exemptions and deductions with, say a $75,000 income, it won't take $7,500 in qualifying medical expenses to meet the threshold, but closer to $10,000.
Who will this hurt? Middle-income families, who will be paying the lion's share of the additional $15.2 billion over the next seven years.
And then, there's this:
33 million workers choose to participate in a Flexible Spending Accounts (FSA), which count certain healthcare expenses not covered by insurance as tax deductible. Employers set the limit at how much employees can take out of their salaries, and most companies set the FSA limit around $5,000. So if you knew your child was going to need $5,000 worth of braces next year, you could put that much money in a FSA, saving on federal income, Social Security, Medicare, and in some states, state income taxes, while the employer saves on Social Security and Medicare taxes. Under the Affordable Care Act, the government will set a first-ever FSA limit at $2,500. The average employee contribution today is $1,496, so most people that do use FSAs won’t be affected. This tax is expected to raise $1.5 billion next year, $13 billion over the next seven years.This one is great: we will make it less easy for people to cover their non-deductible expenses and raise $13 billion in the next seven years--again, almost entirely on the back of the middle class (poor people generally do not have access to FSAs and the affluent don't need them).
That math-illiterate statement that because the "average" employee contribution is $1,496 most people won't be affected, is crap. For $1,496 to be the average (or mean), then it means that millions of people put in far more than that (because many people only put in trivial amounts).
In addition, Obamacare changed the rules on what now qualifies for spending: over-the-counter medications used to qualify; now you have to have a prescription, among other changes.
So the reality of the Affordable Care Act is this: while we were promised that most people would see their healthcare expenditures go down--especially those with middle incomes--the reality is that over the next seven years these last two taxes will collect $28.2 billion in new taxes primarily from middle class families.
But Howard Dean likes it, because no matter what the government promised, we should all pay more taxes.