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Repeal & Replace Watch

GOP Overhaul Would Keep Obamacare’s ‘Cadillac Tax,’ But Delay It Until 2025

Might Republicans make job-based health insurance taxable? And how can you fight an insurance denial for lung-cancer screening? Also, can pharmacists prescribe drugs? Here are answers to some recent questions from readers.

Q: I’ve heard that Republicans plan to change the system so that I’d have to pay income taxes on my health insurance benefits. Is it true?

It’s way too soon to predict what may happen as Republicans move to overhaul the health law and several early Republican plans have included this option. But legislation unveiled Monday night by the key House Ways and Means Committee would instead keep the health law’s “Cadillac tax” on insurers and employers that provide generous coverage rather than tax the workers who receive it.

Starting in 2020, Obamacare imposes a 40 percent excise tax on employers’ plans that cost more than $10,200 for individuals and $27,500 for families. The Ways and Means Committee’s proposal would impose the tax but delay it until 2025.

The Republican proposal wouldn’t alter current federal tax provisions that exclude the amounts that workers pay for health insurance from federal income and payroll taxes. For decades, lawmakers have flirted with the idea of capping or eliminating that tax break.

A number of the recent Republican health plan proposals have taken aim at it, too. For example, the health plan that Health and Human Services Secretary Tom Price introduced when he was in Congress would have capped the amounts that could be excluded from taxes at $8,000 for single coverage and $20,000 for family coverage. The idea is also in House Speaker Paul Ryan’s Better Way plan.

Eliminating the tax exclusion and imposing the Cadillac tax are similar in some ways. “The difference is that one is paid by the employer/insurer and the [other] is paid by the employee,” said Tracy Watts, a senior partner at human resources consultant Mercer.

The tax exclusion for workers is the single-largest federal tax break, accounting for more than $250 billion annually, according to the Congressional Budget Office. Some economists and policy experts say it discourages people from paying attention to health care costs. But they’ve faced strong resistance from employers and labor unions, who argue that employers would stop providing health insurance if the tax break were trimmed or scrapped.

It’s early days yet, and what’s on the table today may be off it tomorrow. If you’re wondering how generous your own benefits are, check out Box 12 on your annual W-2 wage and tax statement. The health law required that employers include the value of workers’ health insurance coverage on the form. But remember: That figure is for your information only, you don’t owe tax on any part of it. Not yet, anyway.

Q: I want to be screened for lung cancer. I’m 60 years old and, with my smoking history, I think I meet the guidelines for screening. But my employer plan refused to cover it. Is there anything I can do?

You can appeal the denial to your health plan and, if necessary, an independent panel of experts.

Under the health law, health plans must cover preventive care that’s recommended by the U.S. Preventive Services Task Force without charging consumers for it. The only exception is for plans that are grandfathered under the law because they were in existence in 2010 and haven’t reduced benefits or increased costs to consumers significantly since then.

The task force recommends an annual low-dose CT scan for current smokers and those who quit within the past 15 years if they are ages 55-80 and smoked for at least 30 “pack years” — a pack a day for 30 years, two packs a day for 15 years or a similar calculation.

You’re clearly within the age range for the test. If you meet the smoking guidelines as well, follow the instructions on your health plan’s website for filing an appeal and enlist your doctor to write a letter explaining that the screening is medically appropriate, recommended Erika Sward, assistant vice president for national advocacy at the American Lung Association.

If your health plan still says no to the screening, under the health law you’re entitled to have the denial reconsidered by an outside, independent reviewer. Sward suggests contacting your state insurance commissioner as well if your internal appeal is denied.

“People don’t realize that the insurance commissioner has a health policy staff that should be able to help people work through an appeal,” she said.

All of this assumes that you don’t have any symptoms of lung cancer — you’re not coughing up blood or have a persistent cough, for example. If you have symptoms, the CT scan should still be covered by your plan. But because it would be considered a diagnostic rather than a preventive procedure, you could be on the hook for a copayment or other cost sharing.

Q: Do any states allow pharmacists to prescribe prescription drugs to patients?

Yes, although what they’re allowed to do varies widely. Depending on state law, pharmacists may be permitted to prescribe drugs independently, prescribe drugs as part of a collaborative practice agreement with a physician or prescribe under a “standing order” or other state protocol that allows them to prescribe such drugs as emergency contraception, for example, or naloxone, which counteracts opioid overdoses.

Pharmacists support state laws that expand what they’re allowed to do beyond dispensing drugs. “We’re clinically trained medication experts who are often underutilized,” said John Norton, a spokesman for the National Community Pharmacists Association, which represents independent pharmacies.

Physician groups aren’t so sure. They say that pharmacists are an important part of the team that cares for a patient but generally oppose pharmacists prescribing drugs because it could lead to fragmentation of care.

“We want to make sure care is coordinated and integrated for the patient,” said Dr. Michael Munger, president-elect of the American Academy of Family Physicians.

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