It's difficult to find a prominent politician who will issue a full-throated defense of the "Cadillac tax," a provision of the Patient Protection and Affordable Care Act that imposes a 40 percent excise tax on the most generous health care plans.
But there's a reason it was part of the landmark legislation, and many economists say the country can't afford to lose it.
Over 100 health care economists signed a letter to the House Ways and Means Committee urging Congress to maintain what the group believes is an important step towards dismantling what it calls "an economically inefficient and regressive" tax system that encourages employers to compensate workers through benefits, rather than wages.
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The current model has been in effect since 1954, when Congress voted to exempt health benefits from income and payroll taxes.
In an op-ed for the New York Times, Ezekiel Emanuel and Bob Kocher, both of whom worked with the Obama administration on designing PPACA, said the federal government loses out on $250 billion a year in revenue because of the tax breaks for health plans.
But the tax will not only be a boon to government coffers, argue economists.
It will help slow the rapid growth of health care costs that is partly due to overuse of medical services by beneficiaries with generous health care plans.
By subjecting a certain value of benefits to tax, employers are predicted to react by keeping the cost of their plans below the threshold.
Unfortunately, there is a big political cost to raising taxes on health care plans.
Business groups have announced their opposition, saying that companies will be forced to reduce benefits for workers, while unions, a key constituency that helped push PPACA, are also dismayed by a policy they believe will undo some of the benefits they worked hard to negotiate for their members.
"Workers will be angry when they see their benefits cut," Larry Levitt, senior vice president of the Kaiser Foundation, told NBC. "This is not a tax that anyone wants to pay."
But while noting the political appeal of repeal, Levitt noted that scrapping the tax entirely would bring future costs that many on both sides of the aisle will find hard to follow.
A report by the Congressional Joint Committee on Taxation has estimated that repeal would cost the federal government $91 billion over the next ten years.
And so far, few have suggested how to make up that lost revenue.
That doesn't just pose problems for deficit hawks, but for those who want to maintain or expand PPACA, since the revenue generated from the tax is intended to fund other costs of the law, including the Medicaid expansion and the federal subsidies to help people buy plans on the insurance exchanges.
"There is no clear consensus about what to replace it with," Levitt said. "I really do believe [the Cadillac tax] will be one of the biggest issues facing the next president."
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