Friday, June 28, 2013

The Affordable Care Act, or IRS Tax Code 101


The Affordable Care Act is not really about Health Reform. It is about restructuring health service revenue cycles and the business of health payments. It also requires significant amendment to the IRS tax codes.

There is much more about IRS involvement than the ACA individual mandated insurance coverage. The extend of the change will be outlined below, one  the most intrusive is under ‘Collecting Information” and forms a close inter-relationship between IRS and HHS.  Little has been disclosed about this connection either by the HHS, CMS, nor media outlets.

Health Reform actually takes place with mandated change specified in the ACA and a second law, (much less known)

Through a series of manipulations, robbing Peter to pay Paul a series of tax increases take place up front and additional premiums will fund some of the later ACA implementation.

Further burdens include significant increased taxes, and major modifications to the IRS Tax Code, and the immediate secondary impact of increased tax reporting, administration, legal and accounting fees.


Charitable Hospital Tax:

Codification of the “Economic Substance Doctrine”:

Black liquor” tax hike:

Tax on Innovator Drug Companies

Blue Cross/Blue Shield Tax Hike

Tax on Indoor Tanning Services:

Medicine Cabinet Tax:

HSA Withdrawal Tax Hike:

Surtax on Investment Income:

Hike in Medicare Payroll Tax:

Tax Hike in Medicare Payroll Tax

High Medical Bills Tax

Flexible Spending Account Cap

Retiree Rx Drug Coverage Tax Hike:

Compensation Limit:


Individual Mandate Tax

Employer Mandate Tax

Tax on Health Insurers

Excise Tax on Health Insurance

Distributing subsidies

Early Retiree Subsidy

Nonprofit Tax Exemption

Reinsurance Tax Exemption

State Exchange Tax Credit

Cost-Sharing Subsidy

Small Business Tax Credit:

Small Business Tax Exclusion

Indian Tribe Tax Exclusion:

Therapeutic Discovery Tax Credit:

Adoption Tax Credit:

Tax Exclusion for Dependent Coverage:

Advance Tax Credit and Cost-Sharing Reductions:

Health Care Services Loan Tax Exemption:

Collecting Information

  1. State Exchange Information Reporting:

  2. Exchange Participation Requirement:

  3. Taxpayer Information Disclosure

  4. Insurance Provider Information Reporting:

  5. Large Employer Information Reporting:

  6. Medicare Beneficiary Information Disclosure:

Enforcing compliance

Health Plan Penalty:

New Group Plan Penalty

Group Plan Compensation Discrimination Prohibition

Nonprofit Indicator System:

Small Business Exemption for Cafeteria Plans:

Corporate Tax Advance

Credit to Ryan Ellis and Americans for Tax Reform for their research on this list.

1. “Patient Protection and Affordable Care Act: IRS Should Expand Its Strategic Approach to Implementation.”  Government Accountability Office, June 2011.

The GAO report list 47 new IRS powers in Obama Care, but one has been repealed since the report was issued – the employee voucher requirement.  It would have required employers to provide free choice vouchers to certain employees who contribute over 8 percent but less than 9.8 percent of their household income to the employer’s insurance plan.  The voucher could have been used by employees to purchase health insurance though an exchange.


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