Erik Paulsen tries again to dump medical device tax

WASHINGTON — Rep. Erik Paulsen’s campaign to forestall an Affordable Care Act tax increase on medical device companies came up short last session.
It won 270 votes in the House and Paulsen was, for a week, the Republicans’ spokesman for dismantling what the GOP sees as the most egregious parts of “Obamacare.” Minnesota’s whole House delegation backed the bill, and both senators supported it in principle. But the bill’s payment mechanism was controversial, the Senate never took it up, the White House opposed it and, by extension, device companies started paying the tax last month.
Paulsen will reintroduce legislation repealing the tax on Wednesday, looking to leverage the tax’s impact on business to try steering the bill through a friendly House, a potentially hostile Senate, and a White House thus far completely opposed to the effort.
“It is definitely an uphill climb, but we are feeling much more optimistic and hopeful that we’ll be able to get something to the president’s desk this year,” said Shaye Mandel, the Vice President and COO of the industry group LifeScience Alley.
Obama opposed the effort
Paulsen's bill would repeal the ACA’s 2.3 percent excise tax on medical device company sales, ending a $29 billion health care reform funding stream. The goal is to protect jobs — Paulsen said companies have shed about 10,000 so far.
The bill is identical to one the House passed last June by a rather healthy margin. Democrats who opposed the bill did so on two grounds — they took offense to the bill’s spending offset (a leadership-written provision that limited health insurance subsidies for low-income individuals) and warned that industry concerns over massive job losses were unfounded.
The White House initially threatened to veto the legislation, blaming the payment mechanism (which is not included in Paulsen’s new bill). But Obama’s opposition went deeper than that. Asked about Paulsen’s new measure Tuesday, the White House pointed to Obama’s December interview with WCCO, in which he came out flatly against repealing the tax.
His basic premise, shared by many congressional Democrats, is that the Affordable Care Act will provide a new customer base for medical device companies, thus increasing revenue and blunting the affects of the tax.
“The health care bill is going to provide those health care companies, 30 million new customers,” Obama said. “It’s going to be great for business and they’re doing really well right now and they’re going to get 30 million more customers as a consequence, so this additional tax essentially comes back to them as new customers.”
Trying to find support
The industry, of course, disputes that, noting that most device consumers are older and already covered by Medicare or other insurance. They hope that sentiment takes hold in states with big med tech industries, no matter the politics of their representatives.
That means trying to find support in the Democratically-controlled Senate. Minnesota Sens. Amy Klobuchar and Al Franken and 16 other Democrats tried include a device tax delay in end-of-the-year fiscal cliff negotiations in December, but they fell short and the law took affect. Paulsen said Klobuchar is helping write the Senate version of the bill, though there’s no word on when it’ll be introduced.
The question, of course, is whether other Democrats, from Obama on down, will follow that lead.
“With bipartisan support in Congress, the administration is going to be much more receptive to entertaining passage,” Paulsen said.
Paulsen held up the one major ACA change Congress has managed to enact. In 2011, lawmakers overturned the law’s 1099 tax reporting requirement mandating business owners file documentation when they buy more than $600 worth of goods or services from a vendor. The rule was seen as burdensome and would have hit cash-strapped small businesses.
There are a couple key differences between that and the device tax, however:
- First, repealing the 1099 requirement had broad bipartisan support. The Senate passed it with 87 votes, and even Obama called it an “unnecessary burden for small businesses.” That’s not the case with the device tax: It’s a mechanism built into the law to raise revenue to help implement it, and there’s been little indication most Democrats or the president consider it the kind of mistake the 1099 provision was.
- Secondly, the tax has taken effect, and the government has started receiving revenue from it. It’s a “tough hill to climb because, number one, it’s started. Revenue is coming in. It’s always tougher to stop a tax once its started,” Paulsen said.
Two-pronged lobbying effort
Mandel said the device industry’s lobbying effort will be geared around a two-part message, the first being the lost revenue and job cuts companies have pinned to the tax.
Take, for example, St. Jude and Medtronic. The former told the Star Tribune last month that it plans to pay up to $60 million under the tax plan. When it laid off 800 employees last year, the tax was partly to blame. Medtronic plans to spend between $125 million and $175 million annually.
But the message is broader than that.
"It's really about the future of the medical device industry and where it’s going to be,” Mandel said. “We see a future where the device industry is largely located in other places and where leadership no longer is in the US. We’re trying to keep that from happening.”
Paulsen’s office said he’ll have 157 co-sponsors on the bill when it drops on Wednesday. Majority Leader Eric Cantor voiced his support for the measure in a Tuesday speech, and Paulsen said the bill could move forward either on its own, or tied into a larger tax reform bill.
Its passage in the House is certain if GOP leaders want it to advance. Pushing it through the Senate and White House is where the real heavy lifting lies.
“It’ll be a challenge, but we’ll move forward,” Paulsen said.
Devin Henry can be reached at dhenry@minnpost.com. Follow him on Twitter: @dhenry
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Comments (6)
Tax consequence
If we want to encourage something, lower the taxes on that something. If we want to restrict something, raise the taxes on that something.
Couple Questions
Maybe some folks can answer..
I agree with the statement that most medical devices covered under this tax go to folks who are elderly. One study said 80-90% of the users of most of these devices are 55+ years old. And I also agree that most of these people already have insurance and/or Medicare. This is the rhetoric used to say there won't be ANY windfall from a device unit shipment perspective. My questions...
1) How much does the 2.3% excise tax affect profit levels, on average (ie what would the tax need to be if it were based on profits - and I understand some to many small med device companies are not profitable for many years so it skews the number)? I think I have heard numbers around 12-14% net hit on profits, but those are numbers from the industries lobbying to repeal - I'd like an unbiased, 3rd party response.
2) Ok, so MOST people using these devices are elderly.. what % of people already receiving these devices are not covered under Medicare or their own insurance?
3) How many devices sales are possible given the answer to point 2 for the 30M people who are uninsured today and elect not to receive treatment?
4) Can we have an honest discussion about what is causing layoffs at the medium to big device firms? No BS answers. These companies have been laying off hundreds to thousands of people every year for the previous 4-5 years, seen slumping sales and profits, had multiple quality issues, etc etc. Can we stop letting the industry frame the discussion around job loss to simply the MDTax?
All good questions,
to which I'll add this:
If this is an excise tax (a type typically passed on to end-users) and if the tax applies to both domestic and imported medical devices, then how can it affect competition?
obviously
If that pacemaker or ICD goes up 2.3%, I'm going to skip getting it, and instead carry around a car battery and jumper cables.
Missing the point
Wouldn't you think that the MD companies are competing against other industries for investment dollars? They want their profits high as to attract investors instead of those investors shifting their funds to other more profitable industries. To make it a level playing field, Obamacare should have imposed the 2.3% tax on sales to every industry.
To which
Everyone else would have cried foul.
I am in agreement with critics of the tax that being an excise is a bad route. It unfairly targets young firms and upstarts that aren't profitable and makes it harder to keep investing in small R&D and facilities. That's one reason I find it funny that the big firms are the loudest and most vocal in opposition - they stand to do better than smaller firms that would otherwise reach profitability quicker, allowing them to stave off disruption.
I would say that focusing ONLY on medical devices was also a very narrow view considering the entire healthcare industry stands to benefit. Drug companies, hospitals, makers or medical supplies (not devices), etc. They should have been included and the rate should have been lowered, affecting each firm less. Just my opinion.
To answer your question, yes, these companies do fight for investment dollars. Both from venture capital and public investment. I'd like my questions earlier answered to truly understand the impact on their bottom line. I'm sure there is an impact, just not as much as the companies claim (they stand to gain by painting the picture as bad as possible). Even after that, what I see is a bunch of companies and people who are unwilling to accept the idea of lower profits, (possibly) slower innovation to help a large number of people gain access to healthcare. It's always a discussion of what's going to happen bad to ME.