Paul Ryan's Healthcare Plan Uses These Two Words — Here's What They Mean

March 4th 2017

Mike Rothschild

One sticking point for Republicans in the effort to repeal and replace the Affordable Care Act is how to ensure those who need help paying for coverage will get it. This is difficult because Republicans have vowed to eliminate a revenue generating aspect of the Affordable Care Act called the "individual mandate," which required everyone to purchase a healthcare plan, or else pay a fine.

So, how will Republicans help low income people afford health insurance without raising money from the individual mandate?

Speaker of the House Paul Ryan has consistently called for the use of tax credits as a way to make coverage more affordable, touting them in a Charlie Rose interview as "a smarter way to get people the ability to go buy insurance that they like, that they can afford. [...] A refundable tax credit means you get assistance regardless of your income tax liability to buy care."

Putting aside the fact that the Affordable Care Act already offers refundable tax credits to help low income families purchase insurance on state exchanges, it's important to understand what a tax credit is, what makes them refundable, and how they're different from tax deductions.

The non-partisan Tax Policy Center gives the difference between credits and deductions as this:

"Deductions reduce taxable income and their value thus depends on the taxpayer’s marginal tax rate, which rises with income. Credits reduce taxes directly and do not depend on tax rates."

A tax deduction is an amount of money that isn't included in a filer's federal adjusted gross income (AGI). This means they don't pay taxes on the amount of money being deducted.

Commonly used deductions include certain medical expenses, charitable gifts to eligible organizations, student loan interest, mortgage interest, and state and local taxes.

So if your household had an AGI of $80,000, but paid $2,000 in student loan interest, $6,000 in mortgage interest, donated $500 to various charities, and contributed $1,500 to a retirement account, your taxable income would be reduced to $70,000. Depending on your income, this could move you into a lower tax bracket, and save you even more money in federal taxes.

Every taxpayer is eligible for either itemized deductions or the standard deduction, whichever is more advantageous. For 2016, the standard tax deduction is $6,300 for a single filer, or $12,700 for a married couple.

Tax exemptions function much the same way as tax deductions, but are claimed for people, not expenses. Taxpayers can take a $4,050 exemption for each child they have under 19, with certain exceptions, and married couples can take themselves as exemptions, as well.

It's important to note that the standard deduction explains why over 45 percent of families pay no federal income taxes. Low income families do not "pay no taxes," as they still pay state, local, and sales tax. It's just that their income is reduced to zero after the standard deduction and exemptions for children are tallied. This is why tax deductions aren't particularly helpful to working families.

Tax credits, such as the kind being proposed for the Republican's Affordable Care Act replacement, are much more helpful.

A tax credit is an amount of money reduced from a filer's tax bill. For example, a family that owes $5,000 in income taxes, but receives $3,000 in tax credits, they would then owe $2,000 at tax time.

There are an array of tax credits available to working low-income families, including credits for education expenses, child care, and the Earned Income Tax Credit.

There are also credits for adoption, installing energy efficient equipment, having children, and property ownership. To help encourage home ownership during the recession of 2008, the Stimulus Package included a First Time Homebuyer's Credit of $8,000.

In the case of health insurance subsidies, what's being discussed are "refundable tax credits." This means that if the amount of the tax credit is greater than the amount of taxes a filer owes, they receive a refund of the difference. So someone with a federal tax bill of $1,000 who receives refundable tax credit of $1,500 would receive a refund of $500.

Tax credits are seen as an important tool for helping lower income families afford health insurance. However, the Republican proposal currently being floated would see significant restrictions to healthcare subsidies the Affordable Care Act already provides. For example, under the Republican plan, older patients would have to wait much longer to receive the most generous health care tax credits.

The Republican plan would, with some exceptions, give everyone the same tax credit. This means some people get more help than they need, and others would get much less.

For example, disabled filers on a fixed income would get the same amount of money back as a wealthy professional, even if they have a wide difference in income. It would also mean less money available for elderly recipients, those whose health care naturally costs more.

A certified tax preparer can help you take advantage of all the credits and deductions you might be eligible for. Fortunately, some people even qualify for a tax deduction for tax preparer fees.