The title of the article,
Why tax season is good (and bad) for Americans' health caught my eye. Expecting to read about increases in stress-related illnesses and even death in mid-April or attacks on tax return preparers, I surprised to discover that Diana Farrell focused on the use of income tax refunds to pay for health care. Citing research by the JP Morgan Chase Institute, of which she is CEO, Farrell pointed out that people who file their income tax returns early are more likely to receive larger refunds and to spend a larger portion of the refund on health care. American health care spending increases by 60 percent in the week that the refund is received. Taxpayers getting refunds in February increase health care spending over the next two and half months by 38 percent, whereas the percentage increases are lower for those receiving refunds after February. More than half of the health care spending was for services that should have been sought sooner. The conclusion, that cash flow problems cause Americans to delay their health care, makes sense. That, of course, is not a good outcome.
Farrell notes that if tax refunds are going to be used to finance health care, the timing needs to be adjusted. Farrell explains that taxpayers cannot control when they receive refunds, aside from filing early, where possible. Even filing early doesn’t guarantee that a refund will be received a week sooner than it would have been received had the filing been delayed by a week. Farrell suggests, and I agree, that it is problematic to schedule health care based on when tax refunds arrive.
Farrell proposes a solution. She thinks that “policymakers and employers should consider making changes that would allow consumers to access funds throughout the year. Policymakers might consider offering periodic tax refund payments -- perhaps quarterly payments so that families wouldn't have to defer care until tax season.” She also proposes permitting taxpayers to receive advance refunds on an emergency basis. Another proposal she offers is to permit filing earlier and receiving a refund based on “year-to-date” income.
Though well-intentioned, the first proposed solution presents too many disadvantages. Implementing it would require more forms, more filing, more IRS employees, and more aggravation. Because the amount of the refund is not known until the beginning of the following year, advance refund payments would need to reflect estimation, speculation, and guesses. Worse, if too much is paid during the year, April could bring the shock of owing money. The second proposal poses similar challenges. The third proposal is unworkable. Imagine trying to obtain “year-to-date” Forms 1099, or computing partial-year deductions. Worse, it would mean filing another return for the entire year, thus at least doubling the number of returns being filed and the time invested in filling out those returns. Talk about increasing health risks by doubling the amount of stress to which a person is subjected.
The solution is much easier. Tax refunds exist because more tax is paid or withheld during the year than is owed. Too many taxpayers use tax withholding and estimated tax payments as a way to force themselves to save money, even though they earn no interest on the money. Does it not make sense to reduce the withholding and estimated tax payments, and to simultaneously put the reduction into an account dedicated to health care? Taxpayers subject to withholding could achieve the same, or a better, outcome by asking employers to reduce tax withholding to a more appropriate level and to put the difference into an account, whether or not it is a tax-favored account. This helps those without budgetary discipline experience forced savings without using the IRS as a bank that prohibits withdrawals until tax refund season.
Granted, that solution would be unnecessary if the American health care system were fixed so that premiums were paid evenly throughout the year and care could be obtained when necessary. How can that be done? A variety of solutions have been proposed, but rather than getting into an extensive analysis of the health care system, I will simply point out that what Farrell’s Institute has discovered is yet another instance where a non-tax problem ends up burdening the tax system.
Waiting for Congress to fix things is like waiting on the side of a desert road for an ice cream truck to appear. Better for Americans to turn to self-help, fix their withholding and estimated taxes, put money into accounts – an idea Farrell also suggests – and obtain timely health care that promises long-term health improvements and long-term reductions in health care costs.