advice for low income workers left out of Affordable Care Act

[MrsKirkley]

I'm glad this law was passed and I think it's going to help a lot of people, however:

Why should eligibility for subsidies have anything to do with access to employer based health insurance? Why aren't subsidies based on income alone? Too many low income workers (think Walmart wages) and their families can't afford health care because their health insurance deductibles are $4000+. They're basically paying for something they can't use! Instead of letting them get subsidized insurance on the exchange so they can afford medical care, the law says they're ineligible for subsidies. So they continue paying for policies they can't use and continue being unable to afford medical care. The 9.5% rule does nothing to help these families because only the subsidized premiums of the worker count, not premiums of their spouse and children. If these families could get subsidized coverage on the exchange, they might qualify for a policy with a 94% actuarial value (meaning they only have to pay for 6% of everything). But the offer of useless employer based coverage makes them ineligible. I understand that the law intended for families with incomes of 138% of the federal poverty level to be eligible for Medicaid and the Supreme Court messed that up. But even if they hadn't, how are families at 139% or 140% of the federal poverty level supposed to afford $4,000+ deductibles? It's common now for hospitals to require the entire deductible up front before surgeries.


I'm sure there are many low income families who desperately need subsidies, but don't qualify. Some may even have chronic conditions like diabetes or cancer. What advice would you give them?


This is what I've come up with so far:

1. Ask their employers to either pay more of the deductible or stop offering insurance and pay the fine.

2. Start working at 2 part-time jobs instead of full-time so the family will become eligible for subsidies.

3. If eligible for Medicaid and their state isn't expanding it, try to find a way to move to a state that is.

[House of Roberts]

1. If a family's income is close to the threshold,

declare slightly more income than you actually have, as long as the taxes are cheaper than not being eligible for the subsidy. Anybody can say they mowed yards during the summer for cash.

[duffyduff]

2. Also try and convince single people without dependents

that Obamacare is superior to company-paid health insurance. It isn't when you have to pay through the nose for premiums for Obamacare and often a token amount for company-paid insurance.

Many, many people have perfectly good employer-paid health insurance that will likely not exist in five or ten years knowing how beholden Washington politicians are to business lobbyists.

I apologize that I am extremely skeptical of the effects of ACA. I just don't believe unlike most here that it is a step towards single-payer.

We have the private pension system as a model of what is likely to happen, and it is not pretty. Neoliberals do NOT believe employers should pay for ANYTHING on behalf of their employees whether it is pensions, health insurance, Social Security taxes, or unemployment insurance.

[leftstreet]

4. +1 People will start losing good coverage by 2018

9: What is a “Cadillac Health Plan”?

The PPACA imposes a 40 percent excise tax on “Cadillac” health insurance plans. This new tax will apply to health plans valued in excess of $10,200 for individuals and $27,500 for families. Those thresholds will grow annually by inflation plus 1 percent. The tax takes effect in 2018.
http://www.cpehr.com/affordable-care-act-obamacare-for-business

Obamacare attempts to change this dynamic. Under the law, health plans that cost over $10,200 for an individual or $27,500 for a family will have to pay an excise tax of 40 percent on every dollar that they exceed that cutoff beginning in 2018. As Jonathan Gruber, an MIT economics professor who helped design the law, explained to the New York Times, the tax is meant to reorient the way that employers approach their workers’ health problems and their associated costs. “It’s focusing employers on cost control, not slashing,” said Gruber.
http://thinkprogress.org/health/2013/05/28/2064441/employers-obamacare-cut-wasteful-spending/

How Obamacare Is Encouraging Employers To Cut Wasteful Spending And Promote Workers’ Health

By Sy Mukherjee on May 28, 2013 at 4:05 pm

In an effort to cut wasteful U.S. medical spending, certain employers will be scaling back expensive health plans available to their employees and encouraging workers to pursue more preventative and ongoing primary care. The move is being prompted by Obamacare provisions that encourage a more cost-sensitive and efficient approach to Americans’ health care than the status quo.

Recently-released government data shows that Americans’ medical bills are completely random, with some hospitals charging as much as $100,000 more for the same services performed at other facilities. In turn, that drives up the costs of many private health plans, and increases companies’ spending on employer-sponsored insurance.

Obamacare attempts to change this dynamic. Under the law, health plans that cost over $10,200 for an individual or $27,500 for a family will have to pay an excise tax of 40 percent on every dollar that they exceed that cutoff beginning in 2018. As Jonathan Gruber, an MIT economics professor who helped design the law, explained to the New York Times, the tax is meant to reorient the way that employers approach their workers’ health problems and their associated costs. “It’s focusing employers on cost control, not slashing,” said Gruber.

Companies aren’t waiting until 2018 to shift their health care models. Some are increasing their use of high-deductible health plans (HDHPs) — which charge workers low monthly premiums but high annual deductibles — in an effort to raise employees’ awareness of how much their health care consumption costs.

http://thinkprogress.org/health/2013/05/28/2064441/employers-obamacare-cut-wasteful-spending/

[L0oniX]

5. I also am extremely skeptical. I do not expect ACA to work well for lower end employees.

I can't afford a $4000 deductible no more than I can have an extra $100 a month for ACA. If they start handing out fines to poor people there will be hell to pay!

[jwirr]

3. That is what the expansion of Medicaid is about but unfortunately many states are refusing to use it