who pays social security and medicare?
Centers for Medicare and Medicaid Services
entailment
 Reforms to the Medicare payment system are meant to promote greater efficiency in the healthcare delivery system by restructuring Medicare reimbursements from fee @-@ for @-@ service to bundled payments . Under the new payment system , a single payment is paid to a hospital and a physician group for a defined episode of care ( such as a hip replacement ) rather than individual payments to individual service providers . In addition , the Medicare Part D coverage gap ( commonly called the " donut hole " ) will shrink incrementally , closing completely by January 1 , 2020 . 

neutral
 = = = Pensions and relief programs = = = 

contradiction
 The plan allows low to moderate income households where the members have no access to employer provided healthcare to apply for coverage . The fee for coverage is calculated using a formula that results in a charge between 2 % – 5 % of a person 's income . A $ 1 @,@ 100 annual deductible is standard on all policies and allows applicants to qualify for a health savings account . The plan pays a maximum of $ 300 @,@ 000 in annual benefits . 

neutral
 On June 25 , 2015 , the U.S. Supreme Court ruled 6 – 3 that federal subsidies for health insurance premiums could be used in the 34 states that did not set up their own insurance exchanges . 

entailment
 The costs of these provisions are offset by taxes , fees , and cost @-@ saving measures , such as new Medicare taxes for those in high @-@ income brackets , taxes on indoor tanning , cuts to the Medicare Advantage program in favor of traditional Medicare , and fees on medical devices and pharmaceutical companies ; there is also a tax penalty for those who do not obtain health insurance , unless they are exempt due to low income or other reasons . In March 2010 , the Congressional Budget Office estimated that the net effect of both laws will be a reduction in the federal deficit by $ 143 billion over the first decade . 
