The new healthcare bill will affectthe daily lives and wallets of millions of Americans. While we don't know yet precisely what that impact will be or even the full breadth of what's in the bill, it isn't too early to consider some of the possibilities and start thinking about ways to deal with them. Here are a few of the expected consequences of the healthcare bill, along with some possible financial planning strategies for managing them.

HIGHER TAXES

Starting in 2013, the bill increases the Medicare payroll tax from 1.45% to 2.35% for high-earning taxpayers (single taxpayers earning over $200,000 and couples earning over $250,000). In addition, these same taxpayers will see a new 3.8% Medicare tax that is levied on investment income, including dividends, capital gains and rents. This is not like the differences in income tax rates, where only the amount over a designated minimum is taxed at the higher rate. All unearned income is subject to Medicare tax if the total amount is even one dollar over the limit.

Dividends and capital gains are now taxed at 15%. In 2011, high-earning taxpayers will see dividends taxed at ordinary income rates, which will increase to 39.6%. Capital gains taxes will increase to 20% or more. With the new Medicare tax included, these rates could rise to a maximum of 43.4% for dividends and 23.8% or more for capital gains.

Planning strategy: High-income taxpayers will want to accelerate as much income into 2010 as possible. Taxpayers with high accumulated earnings in C corporations should seriously consider taking them out in dividends in 2010, paying the 15% tax before it ultimately jumps to 39.6% in 2011 and 43.4% in 2013.

Taxpayers with S corporations, who have salaries near the Social Security wage base of $106,800, and who take enough dividends to trigger the 3.8% Medicare tax should consider taking more in salary and less in dividends to take advantage of the lower Medicare tax on salary. If their salary is substantially below the wage base, any increase is subject to additional FICA taxes of 12.4%, so it is important to compare tax costs carefully before making any decisions to boost salary.

For some investors, it may make sense to shift from investments generating high dividends or interest to those generating tax-exempt or tax-deferred income, such as municipal bonds, or to defer more income through employer-sponsored retirement plans or annuities.

Another option is to reduce investments paying high dividends or interest in favor of those that emphasize long-term capital gains. While this would still require payment of the 3.8% tax upon the sale of the investment, it could help reduce income to less than the $200,000 or $250,000 limit and defer paying the tax until a year when income is low and the taxpayer is under the income thresholds that trigger the tax.

For those with unearned income approaching the upper limit, working closely with a financial planner and CPA will be essential. An important component of tax planning will be reviewing the year's income before the end of the tax year, and considering tax strategies while there is still time to implement them. The bottom line is that careful tax planning will become more important than ever.

HIGHER PREMIUMS

The bill will prevent insurance companies from limiting coverage and thereby increase demand for medical services without doing much to contain costs. Pharmaceutical, insurance and medical device companies all negotiated deals with the White House that give them the ability to pass on $107 billion of new taxes to consumers.

Starting in 2018, the Senate bill would impose a40% tax on insurance premiums in excess of $8,500 for individuals and $23,000 for families. This may not affect most Americans today, but it will eventually, because the premium cap is not sufficiently indexed for increases in healthcare costs.

For example, I currently pay health insurance premiums of $18,000 ayear for a family policy. Just two years ago my cost was $8,400. By most estimates, healthcare costs will double within the next five to seven years-mine did in just two. By 2018, it's easy to assume I will pay more than $23,000 a year, which will trigger the 40% tax.

Planning strategy: Businesses and individuals need to plan for increases in health insurance costs for the foreseeable future. Count on future increases being equal to, or exceeding, those of the past.

One way to keep premiums under the threshold is by dumping "extra" insurances like dental and eyeglass coverage. Consider raising your deductibles and setting up a health savings account before the lower caps become mandatory. If you are a small business owner, consider adding a cafeteria plan oramedical reimbursement plan (C corporations only) that will make it permissible to write off all qualifying nondeductible expenses.