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Question & Answer Session

            DR. GINSBURG: Okay. This is probably a good time for us to go to the audience to ask for questions or comments on what we’ve covered so far. And please hold off on asking questions about what we’re going to get to after the break. So why don’t you come to one of the microphones and identify yourself, please.
            FLOOR QUESTION: Good morning. I’m Katherine Kunkel (ph) with the National Business Coalition on Health, and I’ve really appreciated the discussion because I’ve always been a firm believer that HIPCs was a very viable alternative. But I was very disappointed from the viewpoint of our organization that it wasn’t more successful.
            With regard to the tax credit issue, though, I just have one burning underlying question, and that is that--it’s a very practical question. For people who are low-income, the tax credit implies, at least this is my understanding, that they have to wait to get that money returned to them. Is that not correct? Am I misunderstanding? That you pay up front and then you get the refund.
            DR. GINSBURG: Well, actually, it is starting out like that, but a number of the people on this panel--Stuart in particular has been dreaming up ways to avoid that problem.
            DR. BUTLER: It’s not dreaming up, exactly.
            DR. GINSBURG: Well, in the sense that--
            DR. BUTLER: Well, I mean, we don’t have to wait until the end of the year to get the mortgage deduction, for example. It’s factored into people’s withholdings, typically. I mean, I suppose you could wait until the end of the year, but you don’t have to do that. There are other ideas, including one in the Jeffords bill, which would permit lower-income people to assign a credit to an employer--to an insurer, rather. In other words, the premium is discounted in line with the total value, and I think that’s another--that’s an easier mechanism if you have a fixed credit, certainly, but I don’t think it’s precluded by other types of credits.
            So I think there are ways of doing it. I think this notion that any kind of tax measure is somehow fundamentally deficient because everybody, you know, gets no benefit from a tax break until April 15 or thereafter, I mean, it’s just--that’s not how tax breaks work. Everybody goes in, you know, to their employer and they make an adjustment.
            Now, even if it’s a refundable tax credit, in principle there’s no reason why that can’t be a net payment in a sense to the employer and, hence, to the employee and is just an adjustment in the total net amount that the employer remits to the treasury.
            I think there are all kinds of ways of dealing with these kinds of things. So I don’t think that’s a fundamental problem at all.
            DR. GINSBURG: Okay. Other questions?
            [No response.]
            DR. GINSBURG: Well, let’s take a break now. We’ll return at 10:40.

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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.