<p>密苏里州共和党参议员乔什·霍利（Josh Hawley）是一个充满有趣想法的人。他最新的提议是将医疗保健纳入特朗普政府的税收口号 “对小费不征税” 和 “对加班费不征税”。霍利报告称，特朗普对这一提议很感兴趣，作为如果民主党和共和党无法就拜登政府的临时《平价医疗法案》补贴达成一致时的后备方案。</p>
<p>霍利的 “对医疗保健不征税” 提议是将高达 25,000 美元的医疗费用（包括你的保险费！）加入标准扣除额，这样你就不会对这些费用支付任何所得税。</p>
<p>听起来不错。对我来说尤其吸引人，因为我厌倦了每年猜测我的自付医疗费用，以便使用我雇主的标准医疗费用账户，而这个账户必须在新年之前用完。霍利的计划将涵盖所有这些费用，而不是我们现在的税制，后者只允许你在医疗费用超过你调整后总收入的 7.5% 时进行扣除。</p>
<p>但有一些注意事项。首先，收入较低的群体大多数在考虑儿童税收抵免和劳动所得税抵免后，实际上已经不需要支付所得税。那么，霍利所宣传的 “工人阶级” 受益于这一减税政策的又是谁呢？通常，这将惠及那些收入高于平均水平的人。</p>
<p>这对我来说没问题，但这并不是霍利所说的。</p>
<p>无论如何，这并不是这个想法的最大问题。最大的问题是如何界定什么是医疗保健。乍一看，这似乎很简单，但随后我阅读了那本只有会计师才能喜欢的 15,000 字的 IRS 医疗费用扣除规则手册，或者说是一个有创意的逃税者。</p>
<p>首先，共和党人将很难接受 IRS 认为堕胎是医疗保健这一事实。如果乔·拜登建议对堕胎提供税收减免，共和党的尖叫声将传到木星。但看起来这正是乔什·霍利所提议的。再告诉我一遍，这些 MAGA 派是如何真正保守的。</p>
<p>无论如何，就在几周前，霍利还在抨击医疗堕胎和食品药品监督管理局的规则。等他读到国税局的规则时，顺便提一下，这些规则涵盖了变性手术、青春期阻滞剂和激素——甚至是未成年人，这也是霍利不喜欢的。霍利的办公室在我通过电子邮件提出这些问题时没有回应，但我与一些处理这些规则的会计师交谈，他们表示，这些事情在手术和医学的一般类别下是被涵盖的，因为它们被医学管理机构如美国儿科学会批准为标准护理。</p>
<h2>牙科植入物、宠物医疗、Ozempic</h2>
<p>一些 IRS 规则很容易理解——乳房植入物在用于乳腺癌或其他医疗条件后的重建时是医疗护理，但在用于改善外观时则不是。但我被告知，无论其主要原因是出于美容还是其他原因，牙科植入物都是被覆盖的。</p>
<p>关于动物医疗费用何时被覆盖、房屋改进何时符合标准、旅行费用及其哪些费用被覆盖，以及婴儿奶粉配件（乳房泵是可以的，储存瓶则不可以）都有规则。甚至还有针对死者的医疗护理的规则。</p>
<p>哦，还有 Ozempic 条款。事实证明，医生为你减肥所做的大多数事情都是包括在内的，除了加入健身房。这意味着我们当地的密苏里州参议员刚刚提议让 Ozempic 对所有美国人都可以抵税。我想我们可能应该对此进行辩论。</p>
<p>但等税务欺诈者掌握这一点时就有好戏看了。IRS 会检查你在扣除家庭机票或加油收据时，实际上是去看医生还是飞往医疗会议吗？谁将成为 IRS 的守护者，划分合法的导盲犬和拥有虚假情感支持动物证书的普通宠物之间的界限？在你扣除乳房植入物之前，你是否需要证明你曾患有癌症？</p>
<p>那么，普通人只是想做正确的事情呢？为普通人增加另外一套 15,000 字的规则，面对最简单的税务问题，对我来说听起来并不是一种改善。我们已经平均花费 13 个小时在这些麻烦的事情上，如果霍利的提议通过，这个时间只会更长。</p>
<p>我不知道霍利参议员，也许我们应该重新考虑一下。让我去查查这些规则，看看是否可以扣除。</p>
<p><em>大卫·马斯蒂奥（David Mastio）是《堪萨斯城星报》和麦克拉奇（McClatchy）的全国专栏作家。</em></p>

<p>参议员乔什·霍利提议对医疗费用进行减税，允许将高达 25,000 美元的医疗费用计入标准扣除。这包括一些有争议的领域，如堕胎和性别确认手术。该提案旨在惠及工薪阶层，但可能主要有利于高收入人群。这引发了关于医疗保健定义复杂性和潜在税收漏洞的担忧</p>

<p>Missouri Republican Sen. Josh Hawley is a font of interesting ideas. His latest is to add health care to the Trump administration’s tax mantra of “no tax on tips” and “no tax on overtime.” Hawley reports that Trump is intrigued by the idea proposed as a fallback position if Democrats and Republicans are unable to come to agreement on making the Biden administration’s temporary Obamacare subsidies more permanent.</p>
<div class="lb-trans"><p>密苏里州共和党参议员乔什·霍利（Josh Hawley）是一个充满有趣想法的人。他最新的提议是将医疗保健纳入特朗普政府的税收口号 “对小费不征税” 和 “对加班费不征税”。霍利报告称，特朗普对这一提议很感兴趣，作为如果民主党和共和党无法就拜登政府的临时《平价医疗法案》补贴达成一致时的后备方案。</p>
</div><p>Hawley’s “no tax on health care” proposal is to add up to $25,000 of medical expenses (including your premiums!) to the standard deduction so that you wouldn’t pay any income taxes on those expenses.</p>
<div class="lb-trans"><p>霍利的 “对医疗保健不征税” 提议是将高达 25,000 美元的医疗费用（包括你的保险费！）加入标准扣除额，这样你就不会对这些费用支付任何所得税。</p>
</div><p>Sounds great. It is especially attractive to me in that I am sick of guessing how much my out-of-pocket medical expenses are every year in order to use my employer’s standard medical expense account that must be used up by the new year. Hawley’s plan would cover them all, unlike the tax system we have now that lets you deduct medical expenses only if they are over 7.5% of your adjusted gross income.</p>
<div class="lb-trans"><p>听起来不错。对我来说尤其吸引人，因为我厌倦了每年猜测我的自付医疗费用，以便使用我雇主的标准医疗费用账户，而这个账户必须在新年之前用完。霍利的计划将涵盖所有这些费用，而不是我们现在的税制，后者只允许你在医疗费用超过你调整后总收入的 7.5% 时进行扣除。</p>
</div><p>But there are a few caveats. For one thing, most of the people on the lower half of the income scale already pay zero income tax after things like the child tax credit and the earned income tax credit are figured in. So who benefits from this break that Hawley pitches as for the “working class”? Generally, it will go to people who make more than average income.</p>
<div class="lb-trans"><p>但有一些注意事项。首先，收入较低的群体大多数在考虑儿童税收抵免和劳动所得税抵免后，实际上已经不需要支付所得税。那么，霍利所宣传的 “工人阶级” 受益于这一减税政策的又是谁呢？通常，这将惠及那些收入高于平均水平的人。</p>
</div><p>That’s fine with me, but it is not what Hawley is saying.</p>
<div class="lb-trans"><p>这对我来说没问题，但这并不是霍利所说的。</p>
</div><p>In any case, that’s not the big problem with the idea though. The big problem is deciding what is health care. At first glance, it would seem easy, but then I read the 15,000 word IRS rulebook for deducting health care expenses that only an accountant could love, or maybe a creative tax cheat.</p>
<div class="lb-trans"><p>无论如何，这并不是这个想法的最大问题。最大的问题是如何界定什么是医疗保健。乍一看，这似乎很简单，但随后我阅读了那本只有会计师才能喜欢的 15,000 字的 IRS 医疗费用扣除规则手册，或者说是一个有创意的逃税者。</p>
</div><p>To begin with, Republicans are going to have a hard time swallowing the fact that the IRS says abortion is health care. If Joe Biden had suggested a tax break for abortion, the Republican screams would have been heard past Jupiter. But it looks like that is what Josh Hawley proposed. Tell me again how these MAGA-types are the real conservatives.</p>
<div class="lb-trans"><p>首先，共和党人将很难接受 IRS 认为堕胎是医疗保健这一事实。如果乔·拜登建议对堕胎提供税收减免，共和党的尖叫声将传到木星。但看起来这正是乔什·霍利所提议的。再告诉我一遍，这些 MAGA 派是如何真正保守的。</p>
</div><p>Anyway, it was just weeks ago that Hawley was railing against medical abortions and Food and Drug Administration rules. Wait til he reads the Internal Revenue Service rules, which incidentally cover transgender surgeries, puberty blockers and hormones — even for minors, something else Hawley doesn’t like. Hawley’s office did not respond when I raised these issues in an email, but accountants I talked to who work with these rules say such things are covered under the general categories of surgery and medicine, since they are approved as standard care by medical governing bodies such as the American Academy of Pediatrics.</p>
<div class="lb-trans"><p>无论如何，就在几周前，霍利还在抨击医疗堕胎和食品药品监督管理局的规则。等他读到国税局的规则时，顺便提一下，这些规则涵盖了变性手术、青春期阻滞剂和激素——甚至是未成年人，这也是霍利不喜欢的。霍利的办公室在我通过电子邮件提出这些问题时没有回应，但我与一些处理这些规则的会计师交谈，他们表示，这些事情在手术和医学的一般类别下是被涵盖的，因为它们被医学管理机构如美国儿科学会批准为标准护理。</p>
</div><h2>Dental implants, pet medical care, Ozempic</h2>
<div class="lb-trans"><h2>牙科植入物、宠物医疗、Ozempic</h2>
</div><p>Some of the IRS rules are easy to understand — breast implants are medical care when they are used for reconstruction after breast cancer or other medical conditions, but not when they are used for, well, improving the scenery. But dental implants are covered, I am told, whether their primary reason is cosmetic or not.</p>
<div class="lb-trans"><p>一些 IRS 规则很容易理解——乳房植入物在用于乳腺癌或其他医疗条件后的重建时是医疗护理，但在用于改善外观时则不是。但我被告知，无论其主要原因是出于美容还是其他原因，牙科植入物都是被覆盖的。</p>
</div><p>There are rules for when an animal’s medical expenses are covered, when improvements to your house make the grade, when your trips and what expenses on your trips are covered, as well as baby milk accoutrements (breast pump yes, storage bottles no). There are even rules covering medical care for dead people.</p>
<div class="lb-trans"><p>关于动物医疗费用何时被覆盖、房屋改进何时符合标准、旅行费用及其哪些费用被覆盖，以及婴儿奶粉配件（乳房泵是可以的，储存瓶则不可以）都有规则。甚至还有针对死者的医疗护理的规则。</p>
</div><p>Oh, then there is the Ozempic clause. It turns out that most things your doctor does to help you lose weight are included, except joining a gym. That means that our local Missouri senator has just proposed to make Ozempic tax-deductible for all Americans. I think maybe we should have a debate about that.</p>
<div class="lb-trans"><p>哦，还有 Ozempic 条款。事实证明，医生为你减肥所做的大多数事情都是包括在内的，除了加入健身房。这意味着我们当地的密苏里州参议员刚刚提议让 Ozempic 对所有美国人都可以抵税。我想我们可能应该对此进行辩论。</p>
</div><p>But just wait until the tax cheats get a hold of this thing. Is the IRS going to check whether you were actually driving to the doctor or flying to a medical conference when you deduct your family plane tickets or fill-up receipts? Who is going to be the IRS guardian of the line between legitimate seeing eye dogs and standard-issue pets with bogus emotional support animal credentials? Are you going to have to prove you had cancer before you deduct breast implants?</p>
<div class="lb-trans"><p>但等税务欺诈者掌握这一点时就有好戏看了。IRS 会检查你在扣除家庭机票或加油收据时，实际上是去看医生还是飞往医疗会议吗？谁将成为 IRS 的守护者，划分合法的导盲犬和拥有虚假情感支持动物证书的普通宠物之间的界限？在你扣除乳房植入物之前，你是否需要证明你曾患有癌症？</p>
</div><p>And what about plain old people just trying to do the right thing? Adding another 15,000-word set of rules for regular people with the simplest taxes doesn’t sound like an improvement to me. We already spend an average of 13 hours on these darned things, and if Hawley’s proposal goes through it will only get longer.</p>
<div class="lb-trans"><p>那么，普通人只是想做正确的事情呢？为普通人增加另外一套 15,000 字的规则，面对最简单的税务问题，对我来说听起来并不是一种改善。我们已经平均花费 13 个小时在这些麻烦的事情上，如果霍利的提议通过，这个时间只会更长。</p>
</div><p>I don’t know Sen. Hawley, maybe we should reconsider. Let me go check the rules and see if that is deductible.</p>
<div class="lb-trans"><p>我不知道霍利参议员，也许我们应该重新考虑一下。让我去查查这些规则，看看是否可以扣除。</p>
</div><p><em>David Mastio is a national columnist for The Kansas City Star and McClatchy.</em></p>
<div class="lb-trans"><p><em>大卫·马斯蒂奥（David Mastio）是《堪萨斯城星报》和麦克拉奇（McClatchy）的全国专栏作家。</em></p>
</div>

乔什·霍利希望削减医疗保健的税收。等你听到具体内容时再说 | 评论