Category Archives: Health Disease

Gruber: Pay More if You Are Fat

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There are those that are fat, there are those that smoke and those that need behavior modification. So it is any wonder when we read the highlights of the Obamacare law, we begin to understand what is in the law and why? It is any wonder why Mayor Bloomberg of New York City tried the concept of controlling soda in take, salt on the food and then there is Michelle Obama and her food program. It all begins to come into full view. Read here for the full 2 page essay courtesy of Jonathan Gruber.

Gruber became the healthcare expert on behavior modification that was core in the construction of the Obamacare law. Gruber wrote a book and a detailed essay which is found here.                                          

Every day young people engage in risky behaviors that affect not only their immediate well-being but their long-term health and safety. These well-honed essays apply diverse economic analyses to a wide range of unsafe activities, including teen drinking and driving, smoking, drug use, unprotected sex, and criminal activity. Economic principles are further applied to mental health and performance issues such as teenage depression, suicide, nutritional disorders, and high school dropout rates. Together, the essays yield notable findings: price and regulatory incentives are critical determinants of high-risk behavior, suggesting that youths do apply some sort of cost/benefit calculation when making decisions; the macroeconomic environment in which those decisions are made matters greatly; and youths who pursue high-risk behaviors are significantly more likely to engage in similar behaviors as adults.

                                                            

Taxing Sin to Modify Behavior and Raise Revenue

Jonathan Gruber, PhD, Professor of Economics, Massachusetts Institute of Technology 

U.S. policymakers have long used taxes on tobacco products and alcoholic beverages – so called “sin taxes” – both to moderate consumption of these products and to generate revenue. There is a pronounced inverse correlation between cigarette tax rates and cigarette consumption (Figure 1), and numerous studies have credited tobacco taxes as being the single most effective strategy in achieving our country’s dramatic reductions in smoking. 1 More recently, similar taxes on products linked to obesity have been receiving increased attention, with the Institute of Medicine recommending this strategy as a weapon against childhood obesity, 2 several states and localitites  flirting with significant new taxes on sugary sodas, and an early proposal to use a soda tax as a financing source for national health reform. A just-released longitudinal study showing that a 10 percent rise in the price of sweetened soft drinks was associated with a 7 percent decline in daily caloric intake from sodas, lower overall calorie consumption, lower weight, and improved insulin resistance lends new support to a sin tax on sugary soda.3 States now facing severe budget shortfalls may also find these taxes hard to resist. Estimates produced by the Yale University Rudd Center suggest, for example, that California could raise over $560 million in 2010 alone by taxing sugary beverages at a rate of 3 cents per 12 ounces. 4 Despite this allure, the case for sin taxes is not clear cut. In this essay I review the arguments for and against sin taxes and describe how these considerations play out for cigarettes and alcoholic beverages. I then offer some thoughts on using sin taxes to combat rising obesity rates.

 

 

Americans Have Backseat to Alien’s Healthcare

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Factual post by contributor: S.S.

The intention in sharing this story is not to diminish the unfavorable situation of those who were born outside the borders of this great country. I do still think, despite the attempts of this administration of fundamental transformation, America to be the greatest country. It undoubtedly offers the most freedom for its citizens. It is however the plight of its citizens that troubles me deeply.

I am a nurse, and have recently been working at a University hospital in a rural area. What I have noticed are the many patients we treat who do not speak English. Spanish, Farsi, Dari, Bengali, Bhutanese, Russian, French, Swahili, Mandarin, Vietnamese, Laotian, Arabic, and Slavic are some of the languages spoken by my patients. The procedural unit in which I work requires the patient to have a driver. More times than not their driver speaks very little English which necessitates the need to use dual phones for translation. There are onsite hospital translators for several languages but, as you can imagine it takes time to coordinate. In a unit that is driven to see as many patients in as safe a manner possible, this adds extra time and stress to those prepping the patient for the procedure as well as in recovery, not to mention the problem of communication in the procedural area where there are no translators.

For now I will put the language barrier problem to the side because I want to share a story. I was prepping a patient one day who happened to be an in-patient, not one who simply walks in for a procedure at the hospital but one who has been admitted to a room. The patient, a woman around 50 years old, could not speak a word of English and needed a procedure. Her daughter of around 20 years old accompanied her. The daughter spoke broken English and was nicely dressed. As I waited for the translator phones I simply asked for some background information as to where they were from, and what brought them here.

As it turns out, they were from a landlocked country in South Asia. The daughter had been in this small town for 3 years, attended the local community college, and took care of her baby. She could not tell me what she was studying. When I asked her she just replied with, “nothing”, and then giggled. Her mother and father had been in the US for about 6 months. When asked if either was working, she said no. I asked her who was responsible for bringing them all here, her reply, “IOM”. After getting home from work that night I looked up IOM, it stands for International Organization for Migration, and is linked with the United Nations (UN), The Department of International Cooperation and Partnerships (ICP), and the United States Association for International Migration (USAIM).

I left the room that day struggling with this scenario. For starters, what must it be like to be from a country that has little to no opportunity and you are placed in camps like herded cattle and flown off to some foreign country where you don’t know the language, but more than that I thought, “Who is paying for all this woman’s healthcare? “ Why do I feel compelled to work to provide healthcare for myself and family, but this lady can be flown into my country, not work, and have her whole family taken care of; food, shelter, college, and healthcare.

I considered this story as I stopped to visit a friend of mine the other night. She is a fellow nurse who is battling cancer. She and her husband have worked hard their whole life in order to buy their home, raise two children, and put them through college. They are now having to stress over bills they must pay for her treatment. She shared with me that applying for assistance is getting them nowhere because they make over 30K a year. So they will be penalized for working and being responsible.

There is something wrong with this picture…desperately wrong.

Meanwhile, January 22nd 2015, at the World Economic Forum, Davos, Switzerland, IOM Director General William Lacy Swing took part in a live debate, “Escaping from Poverty”. An interesting quote from the Ambassador, “Migrants today are not invaders, or interlopers. Being youthful, often just starting their work lives, migrants serve as vital partners of the native born. They fill gaps in industries where labour is in short supply; they renew decaying neighborhoods and they shore up public payments to the elderly and unemployed by putting into government coffers much more wealth than they withdraw.”1

Really? On what planet is this man living?

At what point do we as a country need to take care of our own team? I have read evidence and talked to experts who agree that we have fifty border-states, and they are indeed porous. We also have a spigot turned wide open in the “legal migration” department. In addition to IOM, we have the Refugee Resettlement Program run by the Department of Health and Human Services.

In November 2014, President Obama created a White House Task Force on New Americans by a Presidential Memorandum – Creating Welcoming Communities and Fully Integrating Immigrants and Refugees.

New Americans? I didn’t realize you became an American until you went through the Naturalization process and passed the tests? Just because you physically are here doesn’t mean you are an American, and shouldn’t entitle one to all the blessings of our national bank account.

A blog post by White House Domestic Policy Council and Director of US Citizenship and Immigration Services asks for “your input to ensure that federal programs and policies continue to reflect our ongoing commitment to welcoming and integrating newcomers into the fabric of our country.”2

In my line of work, if you have a patient with Cirrhosis of the liver, you don’t tell him/her to go home and down some alcohol. Our great country is sick, and if we don’t start demanding some change for the health of America, we will lose her. Maybe you could let your voice be heard, while you still have that freedom to do so, by contacting your local representatives to find out about how many immigrants and migrators are headed to your area, or give an earful to the integration strategy at the White House. Link provided: mailto:[email protected]

Shattuck, contributor to this website contributed this article.

 

DACA Gets an Expansion by Executive Order

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Well here it comes again, in just a few weeks the Deferred Action mission by Barack Obama beings again in February. Rather than being critical of those in Congress, how about we support two steadfast Senators that are working on immigration? The are asking for attention when it comes to immigration and below will be two primary examples.

USCIS to Begin Accepting Requests for Expanded DACA on Feb. 18

U.S. Citizenship and Immigration Services (USCIS) will expand Deferred Action for Childhood Arrivals on Feb. 18, 2015. That will be the first day to request DACA under the revised guidelines established as part of President Obama’s recent anouncements on immigration.

USCIS advises the public to be extra careful to avoid immigration scams. To learn how to identify and report scams, and how to find authorized legal assistance at little or no cost, go to uscis.gov/avoidscams or uscis.gov/es/eviteestafas.

Go to uscis.gov/immigrationaction or uscis.gov/accionmigratoria and enter your email address to get updates whenever USCIS posts new content about the executive actions.

If you have questions, in English or Spanish, you can call the USCIS National Customer Service Center at 1-800-375-5283 (TDD for the hearing-impaired: 1-800-767-1833). *** There are a few Senators that are sounding the alarms on failed immigration law enforcement. Senator Sessions and Senator Grassley need our help.

*** Senator Grassley has been a champion along with this staff getting detailed reports from the National Crime Information Center. There are 38 pages of crimes committed by illegal aliens.

Notes:
Convictions are taken directly from the rap sheet located in the Federal Bureau of Investigation’s National Crime Information Center (NCIC). As a result, some convictions may contain entries such as “No Arrest Received” or “See Comment For Charge.” Additional detail about the related crime(s) for these cases may be found either in local systems or courthouses. 

Jan 30, 2015
WASHINGTON – ‎A document provided to Senate Judiciary Committee Chairman Chuck Grassley of Iowa revealed that of the 36,007 criminal aliens released from Immigration and Customs Enforcement custody in Fiscal Year 2013, one thousand have since been convicted of new crimes.

According to the 38-page document provided by the Department of Homeland Security, the new convictions include:

assault with a deadly weapon;
terroristic threats;
failure to register as a sex offender;
lewd acts with a child under 14;
aggravated assault;
robbery;
hit-and-run;
criminal street gang;
rape spouse by force; and
child cruelty: possible injury/death.
“The Obama Administration claims that it is using ‘prosecutorial discretion’ to prioritize the removal of criminal aliens from this country. But this report shows the disturbing truth: 1,000 undocumented aliens previously convicted of crimes who the Administration released in 2013 have gone on to commit further crimes in our communities. I will continue my work to ensure our immigration officials are doing what it takes to take criminal aliens off our streets and out of our country,” Grassley said.

Earlier this month, Grassley asked Immigration and Customs Enforcement to provide details on how it has prioritized the removal of these 1,000 criminal aliens. *** Enter Senator Sessions: He entered at 25 page Immigration Reform Memo where a section refers to Executive Amnesty:

EXECUTIVE AMNESTY
The 114th Congress opens under the shadow of President Obama’s recent immigration orders. President Obama has declared null and void the sovereign immigration laws of the United States in order to implement immigration measures the Congress has repeatedly and explicitly rejected. His order grants five million illegal immigrants work permits, Social Security, Medicare, and free tax credits—taking jobs and benefits directly from struggling American workers.
U.S. citizens have been stripped of their protections they are entitled to under law.10
President Obama himself once admitted that only an Emperor could issue such edicts.11 Yet here we stand today in 2015, living under imperial decrees that defy the will of the people, the laws their government has passed, and the Constitution we took an oath to uphold.

 

Due to Haiti, No White House Run for Hillary

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There are countless reasons to keep the Clintons out of the White House in 2017. Many of them are obvious including sex scandals, Benghazi, Travelgate and Hillary’s most recent declaration that we must come to understand the reasons that militant Islamists have for killing, in short be sensitive to their condition. Yeah sure. But let’s take a look at a matter ignored for many years and that is Haiti.

Hillary’s Half-Baked Haiti Project

Caracol Industrial Park is failing to deliver on the promises made to foreign investors and Haitians.

On the fifth anniversary of the 7.0 magnitude earthquake in Port-au-Prince, Haiti remains a poster child for waste, fraud and corruption in the handling of aid. Nowhere is the bureaucratic ineptitude and greed harder to accept than at the 607-acre Caracol Industrial Park, a project launched by former Secretary of State Hillary Clinton with U.S. taxpayer money, under the supervision of her husband Bill and his Clinton Foundation.

Between the State Department and the Inter-American Development Bank (IDB), which hands out grants to very poor countries thanks to U.S. generosity, hundreds of millions of dollars have been spent on this park in an attempt to attract apparel manufacturers. But the park is falling far short of the promises made to provide investors with necessary infrastructure. If things continue this way, frustrated investors will look for greener pastures.

Successful industrial parks are built by people who know the business and who demand accountability. This park was put in the hands of State, the IDB and Bill Clinton. The results have been predictable.

I had been warned about Caracol going to the dogs by sources on the ground in Haiti. So last month I traveled east by truck from Cap Haitien, across the poor rural north of the country to see if the alarm was justified. I found a project in trouble. It can be saved, but only if it is handed over to professionals with skin in the game.

On paper Caracol makes sense. Thanks to special trade legislation passed by the U.S. Congress in Dec. 2006, Haitian-sewn apparel enters the U.S. duty free and the manufacturers can use fabric purchased from anywhere in the world. This gives Haiti a big advantage over apparel exporters to the U.S. who have to source the fabric in the U.S. even if they sew overseas. With lower wages than in many Asian markets and proximity to North America, Haitian-based producers have comparative advantages that might offset the country’s low productivity.

The State Department initially promised that the park would be able to support 65,000 direct jobs by 2020. The Clinton Foundation has made similar statements. That means constructing 40 10,000 square-meter buildings for garment assembly. It won’t happen at the current pace.

The total job-creating capacity since the foundation stone was laid in November 2011 is three assembly buildings and a 10-megawatt power plant. A fourth workshop is under construction but is unlikely to be completed before late spring.

This must be tough to take for the anchor tenant, the Korean manufacturer Sae-A Trading Ltd. It has committed to a $78 million investment at Caracol and currently employs some 4,500 Haitians. It says it wants to hire 20,000. To do so it needs another dozen buildings.

A Dec. 12 IDB press release says the Haitian government is approved for a new $70 million grant to construct, among other things, three new production buildings by 2018 with a goal of providing space for 6,800 workers. Bank officials have to know that putting Haitian government officials in charge of such a project is likely to doom it. But let’s suppose I’m wrong and the buildings go up. The Caracol workforce will then be 11,300—a far cry from the State Department’s estimate of 65,000 direct jobs or even the IBD’s forecast of 40,000.

It’s understandable for the IDB to want to lower expectations. But the target should be higher and it shouldn’t take three years to boost capacity. Craig Miller, president of the Boston-based Waterfield Design Group and a consultant for the Haitian apparel sector, told me that “once the materials are on site, a 10,000 square-meter production workshop can be built in six to eight months.”

Apparel manufacturers in Haiti are hungry for production space but my sources say investors were not given an option to build their own workshops in Caracol. The Clinton planners—Hillary at State and Bill at the Clinton Foundation—wanted to retain that responsibility for reasons that can only be guessed. So now the producers have to wait.

This is tragic for the thousands of Haitians eager to get the sewing jobs. Factory workers earn three times the average income in Haiti’s north. Sae-A produces for a wide number of American labels, such as Target and Wal-Mart, WMT +0.48% Wal-Mart Stores Inc. U.S.: NYSE $89.78 +0.43+0.48% Jan 12, 2015 11:44 am Volume (Delayed 15m) : 1.72M P/E Ratio 18.32 Market Cap $287.99 Billion Dividend Yield 2.14% Rev. per Employee $219,905 01/09/15 Toys “R” Us Holiday Period Sam… 01/08/15 Tesco to Cut Prices, Close Unp… 01/08/15 Stocks to Watch: Family Dollar… More quote details and news » WMT in Your Value Your Change Short position and the American companies regularly dispatch auditors to inspect work conditions. Even without the U.S. Labor Department breathing down its back, Sae-A has incentives to care for workers to retain them and boost productivity. Getting a spot on the assembly line opens the door to economic mobility, and that’s unusual in Haiti.

Haiti has a rare opportunity. Investors want to invest, workers want to work, and consumers want to buy. This seems like a good time for government to get out of the way.

But how did all this begin? 

Bill Clinton’s Shameful Haiti Legacy

He may be playing the hero now, but the ex-president’s trip to Haiti is a reminder of the mess his administration left behind. Bob Shacochis on how Clinton wasted a good invasion.
Like many Haitians and not a few Americans who know the island and its history, I had mixed feelings watching the video of former President Clinton step off a plane on to the tarmac at Toussaint Loverture International Airport in Port-au-Prince on Monday afternoon. Bill Clinton, the Second Coming of Hope. The First Coming, the U.S.-led invasion in 1994 adorned with 20,000 American troops, did not turn out so well. By 1996, when the American military decamped, you’d be hard pressed to find a Haitian on the streets of Port-au-Prince who wasn’t suffering miserably from hope. By 1996, Haitians were scratching their heads in bewilderment, asking themselves Why has America come to save us? Who will save us now? Ten years later, by almost every measure, Haiti was worse off than it was before Clinton had “rescued” it from the illegitimate regime of General Raoul Cedras and his gang of terrorist enforcers, known by the acronym FRAPH.

I had heard the Haitians saying of the U.S. after the American troops went home: “Lave men ou, siye li a te. It looks like you wash your hands and dry them in dirt.”

It’s the proper time, of course, to ask what is the legacy of American foreign policy in Haiti, a beleaguered neighbor that we have invaded and occupied twice in the 20th century, the first time to preempt German influence there during and after World War I, the second time during the early years of the Clinton administration, an 18-month long intervention which I reported on for Harper’s magazine.  

Looking at the images pouring out of Haiti these days, what comes immediately into focus is the near-sighted, irrational nature of what is out of focus in American foreign policy since the Marshall Plan worked its miracles on a shattered planet. I think that we can all agree that Haiti has finally found its bottom, but the descent, lubricated by man-made folly, was not inevitable.

To be sure, Haiti brings out the cynic in me. Perhaps I should express that sentiment with more precision: The United States’ two-faced relationship with Haiti stirs a cynicism within me that I’d rather not claim.

The U.S. Army came ashore in September 1994 locked and loaded to do battle with a military dictatorship composed of a tiny dysfunctional army and roving bands of FRAPH’s homicidal thugs, who threatened to send America’s sons and daughters back home in coffins. Essentially an absurd boast but from a genuine enemy. Colin Powell’s brinkmanship defused the potential for bloodshed on the eve of the invasion, yet the fact remained—our soldiers would be liberating villages, towns, and cities controlled by a terrorist organization that had brutalized the population.

Early on, there were shootouts between U.S. soldiers and FRAPH. Special Forces hunted down FRAPH leadership in the countryside, captured them and shipped the detainees to headquarters in Port-au-Prince, where, to general dismay, they were invariably released. One night, hunkered down with a detachment of Green Berets in the mountains south of Cap Haitien, I listened in alarm to a radio transmission from Col. Mark Boyatt, the overall commander of Special Forces in Haiti, telling his commandos to begin regarding FRAPH as Haiti’s “loyal opposition,” as if the terrorists, overnight, had become Haiti’s equivalent to the Republican Party, rehabilitated patriots eager to remake Haiti into a modern democratic nation.

Months later, when I challenged Colonel Boyatt on this highly counterproductive order to his troops, he clammed up on me. For the next two years, I tried to track down who in the chain of command had told Boyatt to whitewash the terrorist organization FRAPH. The trail finally led to the American Embassy in Port-au-Prince, and then it jumped to the mainland, Sandy Berger, and the White House.

Legacy No. 1: We left the poison in the system. The result: A Haiti rendered ungovernable by our heedless self-interest. The only Devil in Haiti is to be found in the deals we cut with the worst elements in that society. Sound familiar?

On March 31, 1996, the United States handed over Operation Restore Democracy to the United Nations and a peacekeeping force that has been there ever since. Early in the Clinton administration’s intervention in Haiti, the word came down to the boots on the ground from the White House: You have not been deployed to conduct nation-building. The mission turned out to be foolishly attenuated: Restore Haiti’s first democratically elected president, Jean Bertrand Aristide, to the National Palace. Hold elections that will remove the troublesome Aristide from the National Palace. Go home.

Ultimately, the mission ended up profoundly disillusioning not only the Haitians but the American troops as well. Back at Fort Bragg, I asked a Special Forces Master Sergeant if he was glad he went to Haiti. “Tough question,” he said. “No carpenter likes to build a house and see it crooked and leaning and ready to fall down the day he leaves. But if he builds a nice house, he’s happy about it, it’s something he’ll be proud of the rest of his life.”

“You don’t think you have anything to be proud of?” I asked.

“No.”

“That’s sad,” I said.

“It is,” said the Master Sergeant. “It is.”

I told him what I had heard the Haitians saying about the United States after the American troops went home. Lave men ou, siye li a te. It looks like you wash your hands and dry them in dirt.

Legacy No. 2: In Haiti, America wasted a perfectly good occupation. Call our post-earthquake presence there anything you want, but let’s hope it works out better this time around. Good luck, Bill. And remember, merry are the builders.

Bob Shacochis, a professor at Florida State University, is the author of The Immaculate Invasion, a chronicle of the 1994 U.S. intervention in Haiti.

 

 

 

2015, a Banner Year for Tax Hikes

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It is Obamacare stupid. A full report is here.

 

Full List of Obamacare Tax Hikes: Listed by Size of Tax Hike

Complied by Americans for Tax Reform

WASHINGTON, DC — Obamacare contains 20 new or higher taxes on American families and small businesses. Arranged by their respective sizes according to CBO scores, below is the total list of all $500 billion-plus in tax hikes (over the next ten years) in Obamacare, their effective dates, and where to find them in the bill.

$123 Billion: Surtax on Investment Income (Takes effect Jan. 2013): A new, 3.8 percent surtax on investment income earned in households making at least $250,000 ($200,000 single). This would result in the following top tax rates on investment income:

Capital Gains Dividends Other*
2012 15% 15% 35%
2013+ 23.8% 43.4% 43.4%

*Other unearned income includes (for surtax purposes) gross income from interest, annuities, royalties, net rents, and passive income in partnerships and Subchapter-S corporations.  It does not include municipal bond interest or life insurance proceeds, since those do not add to gross income.  It does not include active trade or business income, fair market value sales of ownership in pass-through entities, or distributions from retirement plans.  The 3.8% surtax does not apply to non-resident aliens. (Bill: Reconciliation Act; Page: 87-93)

$86 Billion: Hike in Medicare Payroll Tax (Takes effect Jan. 2013): Current law and changes:

First $200,000
($250,000 Married)
Employer/Employee		 All Remaining Wages
Employer/Employee
Current Law 1.45%/1.45%
2.9% self-employed		 1.45%/1.45%
2.9% self-employed
Obamacare Tax Hike 1.45%/1.45%
2.9% self-employed		 1.45%/2.35%
3.8% self-employed
Bill: PPACA, Reconciliation Act; Page: 2000-2003; 87-93

$65 Billion: Individual Mandate Excise Tax and Employer Mandate Tax (Both taxes take effect Jan. 2014):

Individual: Anyone not buying “qualifying” health insurance as defined by Obama-appointed HHS bureaucrats must pay an income surtax according to the higher of the following

1 Adult 2 Adults 3+ Adults
2014 1% AGI/$95 1% AGI/$190 1% AGI/$285
2015 2% AGI/$325 2% AGI/$650 2% AGI/$975
2016 + 2.5% AGI/$695 2.5% AGI/$1390 2.5% AGI/$2085
Exemptions for religious objectors, undocumented immigrants, prisoners, those earning less than the poverty line, members of Indian tribes, and hardship cases (determined by HHS). Bill: PPACA; Page: 317-337

Employer: If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $2000 for all full-time employees.  Applies to all employers with 50 or more employees. If any employee actually receives coverage through the exchange, the penalty on the employer for that employee rises to $3000. If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer). Bill: PPACA; Page: 345-346

(Combined score of individual and employer mandate tax penalty: $65 billion)

$60.1 Billion: Tax on Health Insurers (Takes effect Jan. 2014): Annual tax on the industry imposed relative to health insurance premiums collected that year.  Phases in gradually until 2018.  Fully-imposed on firms with $50 million in profits. Bill: PPACA; Page: 1,986-1,993

$32 Billion: Excise Tax on Comprehensive Health Insurance Plans (Takes effect Jan. 2018): Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family).  Higher threshold ($11,500 single/$29,450 family) for early retirees and high-risk professions.  CPI +1 percentage point indexed. Bill: PPACA; Page: 1,941-1,956

$23.6 Billion: “Black liquor” tax hike (Took effect in 2010) This is a tax increase on a type of bio-fuel. Bill: Reconciliation Act; Page: 105

$22.2 Billion: Tax on Innovator Drug Companies (Took effect in 2010): $2.3 billion annual tax on the industry imposed relative to share of sales made that year. Bill: PPACA; Page: 1,971-1,980

$20 Billion: Tax on Medical Device Manufacturers (Takes effect Jan. 2013): Medical device manufacturers employ 360,000 people in 6000 plants across the country. This law imposes a new 2.3% excise tax.  Exempts items retailing for <$100. Bill: PPACA; Page: 1,980-1,986

$15.2 Billion: High Medical Bills Tax (Takes effect Jan 1. 2013): Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI).  The new provision imposes a threshold of 10 percent of AGI. Waived for 65+ taxpayers in 2013-2016 only. Bill: PPACA; Page: 1,994-1,995

$13.2 Billion: Flexible Spending Account Cap – aka “Special Needs Kids Tax” (Takes effect Jan. 2013): Imposes cap on FSAs of $2500 (now unlimited).  Indexed to inflation after 2013. There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children.  There are thousands of families with special needs children in the United States, and many of them use FSAs to pay for special needs education.  Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center (link is external)) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education. Bill: PPACA; Page: 2,388-2,389

$5 Billion: Medicine Cabinet Tax (Took effect Jan. 2011): Americans no longer able to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin). Bill: PPACA; Page: 1,957-1,959

$4.5 Billion: Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D (Takes effect Jan. 2013) Bill: PPACA; Page: 1,994

$4.5 Billion: Codification of the “economic substance doctrine” (Took effect in 2010): This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed. Bill: Reconciliation Act; Page: 108-113

$2.7 Billion: Tax on Indoor Tanning Services (Took effect July 1, 2010): New 10 percent excise tax on Americans using indoor tanning salons. Bill: PPACA; Page: 2,397-2,399

$1.4 Billion: HSA Withdrawal Tax Hike (Took effect Jan. 2011): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent. Bill: PPACA; Page: 1,959

$0.6 Billion: $500,000 Annual Executive Compensation Limit for Health Insurance Executives (Takes effect Jan. 2013): Bill: PPACA; Page: 1,995-2,000

$0.4 Billion: Blue Cross/Blue Shield Tax Hike (Took effect in 2010): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services. Bill: PPACA; Page: 2,004

$ Negligible: Excise Tax on Charitable Hospitals (Took effect in 2010): $50,000 per hospital if they fail to meet new “community health assessment needs,” “financial assistance,” and “billing and collection” rules set by HHS. Bill: PPACA; Page: 1,961-1,971

$ Negligible: Employer Reporting of Insurance on W-2 (Took effect in Jan. 2012): Preamble to taxing health benefits on individual tax returns. Bill: PPACA; Page: 1,957