<p>密蘇里州共和黨參議員喬什·霍利（Josh Hawley）是一個充滿有趣想法的人。他最新的提議是將醫療保健納入特朗普政府的税收口號 “對小費不徵税” 和 “對加班費不徵税”。霍利報告稱，特朗普對這一提議很感興趣，作為如果民主黨和共和黨無法就拜登政府的臨時《平價醫療法案》補貼達成一致時的後備方案。</p>
<p>霍利的 “對醫療保健不徵税” 提議是將高達 25,000 美元的醫療費用（包括你的保險費！）加入標準扣除額，這樣你就不會對這些費用支付任何所得税。</p>
<p>聽起來不錯。對我來説尤其吸引人，因為我厭倦了每年猜測我的自付醫療費用，以便使用我僱主的標準醫療費用賬户，而這個賬户必須在新年之前用完。霍利的計劃將涵蓋所有這些費用，而不是我們現在的税制，後者只允許你在醫療費用超過你調整後總收入的 7.5% 時進行扣除。</p>
<p>但有一些注意事項。首先，收入較低的羣體大多數在考慮兒童税收抵免和勞動所得税抵免後，實際上已經不需要支付所得税。那麼，霍利所宣傳的 “工人階級” 受益於這一減税政策的又是誰呢？通常，這將惠及那些收入高於平均水平的人。</p>
<p>這對我來説沒問題，但這並不是霍利所説的。</p>
<p>無論如何，這並不是這個想法的最大問題。最大的問題是如何界定什麼是醫療保健。乍一看，這似乎很簡單，但隨後我閲讀了那本只有會計師才能喜歡的 15,000 字的 IRS 醫療費用扣除規則手冊，或者説是一個有創意的逃税者。</p>
<p>首先，共和黨人將很難接受 IRS 認為墮胎是醫療保健這一事實。如果喬·拜登建議對墮胎提供税收減免，共和黨的尖叫聲將傳到木星。但看起來這正是喬什·霍利所提議的。再告訴我一遍，這些 MAGA 派是如何真正保守的。</p>
<p>無論如何，就在幾周前，霍利還在抨擊醫療墮胎和食品藥品監督管理局的規則。等他讀到國税局的規則時，順便提一下，這些規則涵蓋了變性手術、青春期阻滯劑和激素——甚至是未成年人，這也是霍利不喜歡的。霍利的辦公室在我通過電子郵件提出這些問題時沒有回應，但我與一些處理這些規則的會計師交談，他們表示，這些事情在手術和醫學的一般類別下是被涵蓋的，因為它們被醫學管理機構如美國兒科學會批准為標準護理。</p>
<h2>牙科植入物、寵物醫療、Ozempic</h2>
<p>一些 IRS 規則很容易理解——乳房植入物在用於乳腺癌或其他醫療條件後的重建時是醫療護理，但在用於改善外觀時則不是。但我被告知，無論其主要原因是出於美容還是其他原因，牙科植入物都是被覆蓋的。</p>
<p>關於動物醫療費用何時被覆蓋、房屋改進何時符合標準、旅行費用及其哪些費用被覆蓋，以及嬰兒奶粉配件（乳房泵是可以的，儲存瓶則不可以）都有規則。甚至還有針對死者的醫療護理的規則。</p>
<p>哦，還有 Ozempic 條款。事實證明，醫生為你減肥所做的大多數事情都是包括在內的，除了加入健身房。這意味着我們當地的密蘇里州參議員剛剛提議讓 Ozempic 對所有美國人都可以抵税。我想我們可能應該對此進行辯論。</p>
<p>但等税務欺詐者掌握這一點時就有好戲看了。IRS 會檢查你在扣除家庭機票或加油收據時，實際上是去看醫生還是飛往醫療會議嗎？誰將成為 IRS 的守護者，劃分合法的導盲犬和擁有虛假情感支持動物證書的普通寵物之間的界限？在你扣除乳房植入物之前，你是否需要證明你曾患有癌症？</p>
<p>那麼，普通人只是想做正確的事情呢？為普通人增加另外一套 15,000 字的規則，面對最簡單的税務問題，對我來説聽起來並不是一種改善。我們已經平均花費 13 個小時在這些麻煩的事情上，如果霍利的提議通過，這個時間只會更長。</p>
<p>我不知道霍利參議員，也許我們應該重新考慮一下。讓我去查查這些規則，看看是否可以扣除。</p>
<p><em>大衞·馬斯蒂奧（David Mastio）是《堪薩斯城星報》和麥克拉奇（McClatchy）的全國專欄作家。</em></p>

<p>參議員喬什·霍利提議對醫療費用進行減税，允許將高達 25,000 美元的醫療費用計入標準扣除。這包括一些有爭議的領域，如墮胎和性別確認手術。該提案旨在惠及工薪階層，但可能主要有利於高收入人羣。這引發了關於醫療保健定義複雜性和潛在税收漏洞的擔憂</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>密蘇里州共和黨參議員喬什·霍利（Josh Hawley）是一個充滿有趣想法的人。他最新的提議是將醫療保健納入特朗普政府的税收口號 “對小費不徵税” 和 “對加班費不徵税”。霍利報告稱，特朗普對這一提議很感興趣，作為如果民主黨和共和黨無法就拜登政府的臨時《平價醫療法案》補貼達成一致時的後備方案。</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 “對醫療保健不徵税” 提議是將高達 25,000 美元的醫療費用（包括你的保險費！）加入標準扣除額，這樣你就不會對這些費用支付任何所得税。</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>聽起來不錯。對我來説尤其吸引人，因為我厭倦了每年猜測我的自付醫療費用，以便使用我僱主的標準醫療費用賬户，而這個賬户必須在新年之前用完。霍利的計劃將涵蓋所有這些費用，而不是我們現在的税制，後者只允許你在醫療費用超過你調整後總收入的 7.5% 時進行扣除。</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>但有一些注意事項。首先，收入較低的羣體大多數在考慮兒童税收抵免和勞動所得税抵免後，實際上已經不需要支付所得税。那麼，霍利所宣傳的 “工人階級” 受益於這一減税政策的又是誰呢？通常，這將惠及那些收入高於平均水平的人。</p>
</div><p>That’s fine with me, but it is not what Hawley is saying.</p>
<div class="lb-trans"><p>這對我來説沒問題，但這並不是霍利所説的。</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>無論如何，這並不是這個想法的最大問題。最大的問題是如何界定什麼是醫療保健。乍一看，這似乎很簡單，但隨後我閲讀了那本只有會計師才能喜歡的 15,000 字的 IRS 醫療費用扣除規則手冊，或者説是一個有創意的逃税者。</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，共和黨人將很難接受 IRS 認為墮胎是醫療保健這一事實。如果喬·拜登建議對墮胎提供税收減免，共和黨的尖叫聲將傳到木星。但看起來這正是喬什·霍利所提議的。再告訴我一遍，這些 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>無論如何，就在幾周前，霍利還在抨擊醫療墮胎和食品藥品監督管理局的規則。等他讀到國税局的規則時，順便提一下，這些規則涵蓋了變性手術、青春期阻滯劑和激素——甚至是未成年人，這也是霍利不喜歡的。霍利的辦公室在我通過電子郵件提出這些問題時沒有回應，但我與一些處理這些規則的會計師交談，他們表示，這些事情在手術和醫學的一般類別下是被涵蓋的，因為它們被醫學管理機構如美國兒科學會批准為標準護理。</p>
</div><h2>Dental implants, pet medical care, Ozempic</h2>
<div class="lb-trans"><h2>牙科植入物、寵物醫療、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 規則很容易理解——乳房植入物在用於乳腺癌或其他醫療條件後的重建時是醫療護理，但在用於改善外觀時則不是。但我被告知，無論其主要原因是出於美容還是其他原因，牙科植入物都是被覆蓋的。</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>關於動物醫療費用何時被覆蓋、房屋改進何時符合標準、旅行費用及其哪些費用被覆蓋，以及嬰兒奶粉配件（乳房泵是可以的，儲存瓶則不可以）都有規則。甚至還有針對死者的醫療護理的規則。</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，還有 Ozempic 條款。事實證明，醫生為你減肥所做的大多數事情都是包括在內的，除了加入健身房。這意味着我們當地的密蘇里州參議員剛剛提議讓 Ozempic 對所有美國人都可以抵税。我想我們可能應該對此進行辯論。</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>但等税務欺詐者掌握這一點時就有好戲看了。IRS 會檢查你在扣除家庭機票或加油收據時，實際上是去看醫生還是飛往醫療會議嗎？誰將成為 IRS 的守護者，劃分合法的導盲犬和擁有虛假情感支持動物證書的普通寵物之間的界限？在你扣除乳房植入物之前，你是否需要證明你曾患有癌症？</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>那麼，普通人只是想做正確的事情呢？為普通人增加另外一套 15,000 字的規則，面對最簡單的税務問題，對我來説聽起來並不是一種改善。我們已經平均花費 13 個小時在這些麻煩的事情上，如果霍利的提議通過，這個時間只會更長。</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>我不知道霍利參議員，也許我們應該重新考慮一下。讓我去查查這些規則，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>大衞·馬斯蒂奧（David Mastio）是《堪薩斯城星報》和麥克拉奇（McClatchy）的全國專欄作家。</em></p>
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喬什·霍利希望削減醫療保健的税收。等你聽到具體內容時再説 | 評論