Discussion I'm having on FB. Can someone with knowlege about the ACA help me out?

[yourmovemonkey]

A good friend of mine's wife just posted this on FB. They recently moved from NY to PA. She opened up a little craft and art shop last month. Lot's of people dissing the ACA in her discussion. I could use some ammunition.

Her post:

"Well, folks....(my shop) will most likely be shutting it's doors soon (after just opening in November). I don't qualify for health coverage through the "Affordable" Care Act - one must earn $11,460 to qualify and I don't, and won't for a while yet. (my husband)'s new job (and all the ones he looked at) are only providing affordable heath insurance for the individual employee. If you want two person or family coverage it's $1300 per month. Yes, you heard me correctly, $1300 per month. I also have to say that my experience with the government website, the customer service reps, and the information provided to me has been a nightmare. From information not being able to be accessed, to reps who don't seem to know what they are doing, to calls not returned, I have been more than frustrated. Only to be told this in the end...If you don't qualify for Medicaid (I don't, I won't), and you don't qualify for the "Marketplace" (I don't make enough), then please visit your local clinic for your healthcare needs. So, for all the imagined people this "act" was supposed to help, there are real people like me who are without health insurance for the first time in their lives. So, I will now search for work that will make the government happy if I want to qualify for something we can afford. The customer service rep told me my dream shop just "sounded like a hobby anyway". I bet he has health insurance."

I asked her a few questions, and this was her response to me:

"we would have purchased healthcare for me through husband's new job.( I've always had it through my own employment, or his.) That was until we found out that all the employers he was looking at made huge changes to how they cover their employee's dependents. They will cover individual employees, but they pass along the much higher rates for family coverage. That's when I started looking at the ACA. If I have to purchase it privately, not through the Marketplace, it will cost $800 to $1,000 per month just for me, unless I choose a plan with a very high deductible, like a $6000 deductible. Then it would be around $500 per month. So, the very least it will cost for us both to be covered is around $800 per month, and the most would be $1300 per month. I don't know about you, but I think that's a lot of money! I've been working for most of my life, and health insurance was always doable through employers - until now. The only thing that I know of that has changed is The "Affordable" Care act. You think maybe they should have read what was in it, and thought about how it would affect the working class who work for private employers?"

Anything I can tell her? Any advice? I've always had my health insurance through my work, so I don't have any idea what it would be like to get it on my own.

[JaneyVee]

1. If she doesn't earn $11000 wouldn't she qualify for Medicaid?

She can always just pay the fine instead. Sounds like another terrible business owner whose own failures they're blaming on the Govt.

[kelly1mm]

36. Medicaid eligibility is based on the joint income if married. She is. Also, the business

opened in November, you know, last month. Maybe you can give her a break. But of course, if someone in anyway questions or points out even the smallest problem with the ACA, they OBVIOUSLY are a RW troll and thus deserve any snark directed their way.

[JaneyVee]

43. Nope. No break for "personal responsibility" crowd who never take

Personal responsibility for anything. If she really wanted health insurance she would be blaming it on the rightful oppressor; her Republican governor.

[Puzzledtraveller]

46. Medicaid eligibility varies state to state

up until now in Kentucky you must have dependent children in the home, be pregnant or be 65 or older, blind or disabled in the case of adult Medicaid. In addition to that there are numerous other criteria that must be met including deprivation of children in the home and relationship of family members. Expanded Medicaid as in the case here in Kentucky removed many of the old criteria but still has very strict income limits. The criteria for Medicaid programs is complex and each state has it's own eligibility criteria. I'm a Medicaid caseworker in Louisville. I'm not sure about the criteria in the state effecting the example in the OP. To be honest we have only just had our training on the HBE and Kynect interface and application system this week and we still have a lot of questions, particularly what will become of our existing Medicaid programs after Jan.1.

[Ruby the Liberal]

2. Yeah - tell her that Karen Ignagni of AHIP wrote the damn bill

to ensure profits keep rolling in for the insurance industry and that she should vote for politicians that support Medicare Part E (as in everyone) like sane countries like Australia and Japan do.

Oh, and welcome to DU.

[arcane1]

3. I call bullshit. Your friend's wife is lying, or doesn't exist.

Perfect example: she says "I've been working for most of my life, and health insurance was always doable through employers - until now. The only thing that I know of that has changed is The "Affordable" Care act."

Ummm, didn't she say that they started their own business a month ago? That's not a change? Is PA participating in the exchanges?

This sounds like yet another made-up "horror story", especially with that editorializing in it.

[yourmovemonkey]

8. That was one of the questions I asked her

I don't think PA is participating in the exchanges. Would that make a difference in the rates people are shown through the Fed website?

It's a small arts and crafts shop. Clearly it's not making a huge amount. She might even be running it out of their home.

I can give you a screen grab, if that will make you believe me.

[Ms. Toad]

33. PA is not participating in expanded Medicaid -

I have a friend there who is not eligible for subsidies because he doesn't make enough, and isn't eligible for un-expanded Medicaid.

She is eligible to purchase insurance through the exchange (healthcare.gov - PA did not set up its own site) - she just won't be eligible for subsidies.

[yourmovemonkey]

38. And these people will just blame the President

At least we can try to get some real info through to our friends.

[Ms. Toad]

39. Yes - but some of the information in this thread is not real.

So I'm not sure it was helpful to pass it on without fact checking.

Filing status- joint v. single - in isolation, for example doesn't dictate whether you can purchase an individual or joint health insurance policy - what you are eligible for will depend on whether you are legally related, not how you file your returns. Although if you are married, there are often penalties for filing separate returns; since the penalties are often intended to prevent people from playing games with taxes and eligibility for various tax breaks I would be very surprised if you could make yourself eligible for better health insurance subsidies by filing separately.

And there is nothing odd at all about an employer choosing not to subsidize health insurance for the entire family; so picking up the entire bill for the employee but requiring the family to pay full price for the non-employee portion of the insurance premium shouldn't raise the kind of flags it seems to have raised for you.

[Hassin Bin Sober]

4. So it's Obama's fault her husband's new employer charges extra for families?

Thanks, Obama!!!!

[yourmovemonkey]

9. Well, that's pretty much what she's been saying n/t

[elleng]

5. Something wrong with this assertion???

'I don't qualify for health coverage through the "Affordable" Care Act - one must earn $11,460 to qualify and I don't.'

[yourmovemonkey]

11. I didn't understand that either

Does it have something to do with PA not having its own exchange?

[BlueStreak]

28. Medicaid is different from the exchanges

She can buy any policy on the exchange, but she cannot get a subsidy because she is below 133% of poverty level, I believe. That would put her into Medicaid, but PA is jacking around trying to get the Obama administration to give them all the Medicaid expansion money while not actually expanding Medicaid to cover everybody at no cost up to 133% of poverty level.

So er beef is with the dumbass governor of her state that is jacking around with her and her fellow low-income Pennsylvanians.

[yourmovemonkey]

30. OK, I get it now

Thanks. It's difficult to understand with all of these states each trying to play their own game. Also why single payer would have been so much simpler.

[BlueStreak]

32. It is economic insanity for any Governor to NOT expand Medicaid

The first year costs the state nothing, but even down the road the Federal government pays 90% of the cost of providing health care to all these millions of low income people. Think about that.

That means that for every $1000 of money spent for that health care, only $100 will be paid by the state. And what happens to that $1000? It goes into the salaries of the state's TAXPAYERS. Nurses, Doctors, Receptionists. Administrators. Orderlies. Custodians. Food prep workers.

And what do they do? They pay tax on this income. And the money turns over multiple times to other people and companies that in turn pay taxes. That $1000 will generate MORE than $100 in additional sales and income taxes or the state. In other words, the state ends up AHEAD.

Even if the Republican Governors don't give a shit about whether their people have health care (and obviously they don't), as a pure economic development program, this is a no-brainer.

Having said all that, if it is a married couple, then I don't think the wife can individually qualify for Medicaid if the family income is over the Medicaid level.

[yourmovemonkey]

35. Your post

is the reason I've been reading this site for so many years. I only signed up just a few months ago, but I've always gotten the best information here. Maybe you don't realize it, but that is so succinct and so inarguable... I'm going to use it in my own discussion. Thanks.

[BlueStreak]

37. Thanks. Dems ought to be going straight at those governors with economics

"Governor, We get that you don't give a shit about the health care of your citizens, especially the lowest income citizens. You have made that perfectly clear. What we don't get is why you are passing up a no-brainer economic development program that is absolutely GUARANTEED to improve your state's private sector economy and RETURN MILLIONS to your state's coffers. Can you please explain that, Governor?"

[pnwmom]

42. Welcome to DU yourmovemonkey!

When you're talking to your friends about how PA rejected the funds for Medicaid expansion, make sure you mention that the Federal government will be collecting the money to pay for it from PA residents anyway (those who make more than $200 K in investment income alone.)

So wealthier PA residents will be sending tax money to the Federal Gov. that won't be coming back to fund Medicaid in PA-- it will go to helping other states instead.

Pretty dumb way to score political points.

[BlueStreak]

44. And also mention

that the ACA calls for reduced payments to hospitals to cover indigent care because the law assumed every state would implement this no-brainer program. Lots of hospitals in these red states will be shutting down because of this. As pnwmom says, this is a really dumb way to make a political point.

I can't even remember what the point was.

"As your governor, I have decided to not expand Medicaid, even though it would actually improve the state's budget every year and be a powerful driver for our state's economy. As a result, hundreds of thousands of you will continue to go without health care coverage, and those with insurance will pay more than people in the other states because you are picking up the tab. And the practical result is that all of our hospitals lose some funding, so much that several hospitals will have to close altogether. I realize this may sound insane to you, but let me explain why I took this action that appears stupid from every angle you look at it. I determined this was the only right thing to do because ... well, I can't exactly really remember why. But God Bless America, and good evening." (Exit stage left without taking any questions.)

[Rstrstx]

41. Actually it's just 100% of FPL

But if she makes less than that, yeah, she's pretty much SOL. If I were someone who was a few hundred or thousand or so below qualifying I'd see if I could "earn" some extra income from a friend or relative to put me over the top, whatever it took. 2014 may be the first year ever the IRS sees a number of people actually overestimating their income, just to get health insurance.

I've been racking my little head over this for a couple of months trying to figure out how to help some people legally get coverage if they don't make 100% of the FPL but too much for Medicaid. Anyone have some creative ideas?

[Warren Stupidity]

6. Self employed insurance cost me over 1200 month 8 years ago.

Your rightwing friend is blaming ACA for not going far enough with healthcare reform. I agree, we should expand Medicare to cover everyone. Meanwhile, our crappy system is ridiculously expensive. Too bad she must be living in one of those fucked up republican states that refused to accept Medicaid expansion funds, from her description of her income level she might have qualified for Medicaid.

[elleng]

10. Pennsylvania

[arcane1]

13. I expect to see more of this, from non-participating states.

Pundits will blame the crappy healthcare of the non-participating states on the very program they refuse to participate in.

We get little hints of it now and then on DU, but in 2014 I expect this to be a major campaign strategy.

[yourmovemonkey]

15. So, is that what you think it is then?

I really couldn't figure this out.

[yourmovemonkey]

14. In one of my responses to her

I mentioned that it could be because PA didn't set up it's own exchange. I'm pretty sure they declined to expand Medicare as well. It really doesn't make sense to me.

[tiredtoo]

7. Yes sounds like bs to me also. EOM

[yourmovemonkey]

12. Not BS... probably just a Pennsylvania thing n/t

[jazzimov]

16. She needs to get on her husband's insurance.

"They will cover individual employees, but they pass along the much higher rates for family coverage"

Well, yeah, that's always been true!

But if she want's individual insurance, she needs to make sure she files taxes individually and not married. It sound to me like she's complaining because she's not being treated "special". She needs a Waaaahmbulance.

[yourmovemonkey]

17. That's the part that really doesn't make sense

It's like she's saying that the employer will cover her husband's entire insurance cost, but to add a spouse is another $800-$1300 per month. It doesn't seem right.

[Ms. Toad]

34. It depends on how the insurance is set up.

There are employers who make access to health insurance available for family members, but don't subsidize it (even if they cover the entire cost for employees). Since (until now) many people can't get insurance because of pre-existing conditions, just having guaranteed access to insurance (even if it is very costly) is critical.

But from the employer's perspective - why should the employer be required to pay 2-3 times as much for health insurance for its employers who have a family than for those who are single? I'm actually surprised more employers don't use this structure.

[LuvLoogie]

18. She should move back to New York.

The GOP controlled PA legislature is not expanding Medicaid, so she is SOL. And put it to her that way. The ACA will cover her in Pennsylvania. All the GOP has to do is accept the funding.

[yourmovemonkey]

19. I really wish they would

In spite of her being pretty right-wing, they're both very sweet and kind people. Her husband is a heck of a guitar player too! I think they just moved there so she could be closer to her kids and grandchildren.

[LuvLoogie]

23. Oh the irony of being a working class right winger...

"So, I will now search for work that will make the government happy if I want to qualify for something we can afford. The customer service rep told me my dream shop just "sounded like a hobby anyway". I bet he has health insurance..."

Because the GOP legislatures think that working people who can't afford insurance are just another form of dead-beat and need to get a second job. "So we won't LET you benefit from the ACA, even though you could."

"...The only thing that I know of that has changed is The "Affordable" Care act. You think maybe they should have read what was in it, and thought about how it would affect the working class who work for private employers?"

The ACA DOES COVER people like her. The GOP state legislatures won't let it. Tell her. Get her to look in the mirror.

[BlueStreak]

45. I never understood Log Cabin Republicans either

It is like Stockholm Syndrome.

[yourmovemonkey]

20. Thanks for your help everyone

I totally forgot about having to go through all of my brother's bills this past year. So I added something about that in my final response to her. There's no responses since I wrote this. How did I do?

"I did a little bit more research. Health insurance for the self-employed has always been expensive. I know this because I've had to look through my brother's bills over the past year. He was paying about $13,000/year. That is a stripped down policy with a huge deductible before the ACA ever took effect. On top of that, he had another few thousand dollars in miscellaneous health expenses. Those insurance companies sure were treating us good before the ACA, huh? I guess he showed them. They won't be getting another dime outta him at least.

The income cap you mentioned is definitely the fault of the state of PA. They refused the federal funds that were available to expand Medicare for people in your income bracket. If you were in NY, it would be quite different and you would get assistance. This depends on whether you file your taxes jointly or separately with (your husband).

When you mention the cost of joining (husband)'s policy, I'm not sure if you are saying that would be the total cost for both of you (a pretty good rate), or the additional cost to add you (a little hard to believe). This could also depend on your filing status. Your filing status should match the way you purchase insurance. For example: you shouldn't try to get an individual policy while still filing jointly.

Yes, the guy you spoke to is a jerk."

[elleng]

22. Good work, monkey.

Welcome.

[yourmovemonkey]

25. Thanks

Couldn't have done it without the help. Amazing that I had forgotten about going through my brother's bills until someone else here mentioned the cost of insurance before ACA for self employed people. I should have looked at my dining room table.

[elleng]

31. That's the way things happen!

I've been through lots of docs and info, since my husband (separated) passed, and couldn't tell you everything I've learned!

[LuvLoogie]

24. That is a much nicer way of putting what I just said.

You are a good friend.

[yourmovemonkey]

26. Thank you

They're good people. I'm hoping they'll eventually come around.

[Skittles]

27. wait, wait

what's a move monkey?

[yourmovemonkey]

29. It's actually a line I use with my cousin's son

It's a good answer to "What are we gonna do now!?"

[Jesus Malverde]

40. cute, welcome to DU..nt