Congress Is Split on Effort to Tax Costly Health Plans

A proposed tax on high-cost, or “Cadillac,” health insurance plans has touched off a fierce clash between the Senate and the House as they wrestle over how to pay for legislation that would provide health benefits to millions of uninsured Americans.

Supporters, including many senators, say that the tax is essential to tamping down medical spending and that over 10 years it would generate more than $200 billion, nearly a fourth of what is needed to pay for the legislation.

Critics, including House members and labor unions, say the tax would quickly spiral out of control and hit middle-class workers, people more closely associated with minivans than Cadillacs.

The tax, a provision of the bill to be voted on Tuesday by the Senate Finance Committee, is one of the few remaining proposals under consideration by Congress that budget experts say could lead directly to a reduction in health care spending over the long term, by prompting employers and employees to buy cheaper insurance. Whether it remains in the bill is emerging as a test of the commitment by President Obama and his party to slowing the steep rise of medical expenses.

It is also a prime example of the major differences still to be bridged by Democrats as health care legislation advances to floor debate in both houses.

Under the Finance Committee bill, the tax would be imposed beginning in 2013 on employer- sponsored health plans with total premiums exceeding $8,000 for individuals and $21,000 for families, regardless of whether the coverage was paid for by the employer, the individual or both. The tax would be paid by insurers, who would be expected to pass along the cost to customers.

Critics say that would mean an increase in premiums or in out-of-pocket expenses for employees, raising medical costs for individuals and families.

Supporters say the more likely prospect is that employers would bargain-hunt or take other steps to avoid the tax, putting pressure on insurers to offer cheaper coverage and slowing the rise in medical costs for everyone.

In a preliminary estimate, the Congressional Joint Committee on Taxation calculated that absent any such employer efforts, 14 percent of family health policies and 19 percent of individual policies would be hit by the tax in 2013. By 2019, according to the estimate, 37 percent of family policies and 41 percent of individual policies would be affected. Those numbers rise over time in these calculations because although the initial tax threshold would increase with the economy’s overall inflation, premiums would be expected to rise even faster.

Many Democratic senators, led by the Finance Committee chairman, Max Baucus of Montana, like the idea of the tax, and Mr. Obama embraced it in his speech to Congress on Sept. 9.

“This reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money,” the president said then. “This modest change could help hold down the cost of health care for all of us in the long run.”

Congress has also heard from many economists, Republicans and Democrats alike, who support the tax.

But House Democrats, led by Speaker Nancy Pelosi and Representative Charles B. Rangel of New York, the chamber’s chief tax-writer, oppose the idea, as do labor unions and businesses. Ms. Pelosi last week floated the idea of taxing insurers’ “windfall profits” as a possible alternative, to supplement the House’s main revenue raiser, an income tax surcharge on the nation’s highest earners.