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View Diary: Health insurance 'coverage gap' coming to a red state near you (33 comments)

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  •  Why don't they qualify for subsidies??? (2+ / 0-)
    Recommended by:
    Jon Perr, guyeda
    •  Thank the Supreme Court... (13+ / 0-)

      ...for helping Republicans blow this massive hole in the ACA.

      The short answer is that subsidies/tax credits for purchasing insurance in the exchanges are ONLY for people earning between 133 percent and 400 percent of the federal poverty level.  Below 133 percent, individuals and families qualify for Medicaid.

      Originally, the federal government could twist states' arms by holding back ALL of their Medicaid funding unless they agreed to the expansion of Medicaid.  But the Supreme Court struck that down, making expansion optional for the states.

      The Cover Oregon site explains the resulting quandary this way:

      If your income falls below the amounts shown, you may qualify for coverage under your state’s Medicaid program. But if your state is not expanding Medicaid in 2014--and you don't qualify for Medicaid under your state's rules--you can’t get lower costs on Marketplace coverage based on your income. You'd have to pay the entire cost of a Marketplace insurance plan.
      Kaiser Health News explained in this way in its analysis of the disaster in Missouri:
      In a twist that wasn’t intended by the authors of the federal Affordable Care Act, most of Missouri’s poorest, working-age residents — those under age 65 and below the poverty line of $11,490 for an individual and $15,510 for a couple — aren’t eligible for government help.

      They can’t get free or low-cost health coverage through Medicaid. Nor can they get federal tax credits to help pay for private insurance.

      They fall in a coverage gap.

      The tax subsidies that will be available through the exchange are intended to make private coverage affordable for people who make between the poverty level and four times that amount.

      Under the Affordable Care Act, those making less than 138 percent of poverty — or about $32,500 for a family of four — were supposed to be covered by an expansion of Medicaid, the public insurance program for the poor.

      But the U.S. Supreme Court ruled that the Medicaid expansion was optional for states. Missouri — and 26 other states — turned it down. As a result, a big swath of the uninsured will stay that way when new coverage options kick in Jan. 1.

      Health care advocates who will counsel the uninsured during online sign-ups this fall say they aren’t sure what they’ll say when no affordable option pops up on the computer screen.

      •  I suppose telling them their Republican (9+ / 0-)

        government would rather have them die than provide them access to affordable health care would not be an option?

        “The future depends entirely on what each of us does every day.” Gloria Steinem

        by ahumbleopinion on Fri Aug 30, 2013 at 04:53:11 PM PDT

        [ Parent ]

      •  But at less that 133%, it's still capped at 2% of (0+ / 0-)

        income. That shouldn't change.

      •  Please read this. It states otherwise. (4+ / 0-)
        Recommended by:
        Jon Perr, Losty, kareylou, guyeda
        If a state opts not to extend Medicaid eligibility to 138
        percent of FPL, then individuals 100 percent to 138 percent of FPL who otherwise would have been eligible for Medicaid will have access to premium subsidies.
        http://www.actuary.org/...
        •  Can someone please tell me (4+ / 0-)
          Recommended by:
          tikkun, Sunspots, FloridaSNMOM, guyeda

          that this is true? Much hangs in the balance for me. I am getting so much conflicting information from so many "experts", including a man who teaches a course in how to implement the ACA who tells me that I am out of luck.
          I am a self-employed (piano teacher) single woman in Virginia, no children, whose income has fallen below the poverty level the last several years due to astronomical medical expense deductions. Wouldn't it be ironic if those expenses excluded me from the largest health care reform ever passed? I have been spending my meager retirement savings trying to hang on til the ACA passed and now I'm trying hard to remain hopeful.

          To keep our faces turned toward change, and behave as free spirits in the presence of fate--that is strength undefeatable. (Helen Keller)

          by kareylou on Fri Aug 30, 2013 at 08:55:39 PM PDT

          [ Parent ]

        •  There appear to be two types of assistance: (1+ / 0-)
          Recommended by:
          kareylou

          premium credits and cost sharing subsidies.  The breakdown of eligibility can be seen in this KFF summary, which was recently updated in Apr of this year.  It seems to match what's in the link you provided, but only for the premium credits.  It appears that people in states that have not agreed to the medicaid expansion may still face a coverage gap for the cost sharing subsidies.  A more understandable Q&A type document, though older, can be found here.

          •  aargh. still confusing. (1+ / 0-)
            Recommended by:
            guyeda

            If it is based on 2014 income, I should be covered, because I won't have such high medical expenses, because of the ACA, right? Or is that circular reasoning? Or maybe I should just stop deducting so much of my medical expenses and then my AGI will be above the poverty level and I can get tax credits. My brain hurts.

            To keep our faces turned toward change, and behave as free spirits in the presence of fate--that is strength undefeatable. (Helen Keller)

            by kareylou on Sat Aug 31, 2013 at 02:42:55 PM PDT

            [ Parent ]

            •  Heh, I think I got it wrong too. (1+ / 0-)
              Recommended by:
              kareylou

              I'm learning as I go.  My current understanding is that if your income level is at or above the FPL, you will be eligible for assistance both for the insurance premium and cost sharing, with the level of assistance being dependent upon how high above the FPL your income is.  If your income level is below the FPL but above your state's eligibility for medicaid you qualify for neither medicaid nor any assistance (stupid but that appears to be the way it is.)  It also appears that the credits are independent of tax burden, i.e. even if you end up not owing tax, you still qualify for the credit.

              As far as the specifics on income, that's not simple either.  The income value is termed Modified Adjusted Gross Income (MAGI), which is the Adjusted Gross Income you would have on your federal tax form plus foreign income and tax-exempt interest.  There's other adjustments that consider number of dependents etc.  I believe most itemized deductions are done on your AGI so the medical expense deduction you would normally use would affect your tax burden but not your eligibility for subsidies. This brief covers the income basis for medicaid eligibility but it appears to be used for subsidy eligibility as well.  I am neither a lawyer nor a tax expert so I may still have substantial parts wrong.  

              •  thanks for trying!! (1+ / 0-)
                Recommended by:
                guyeda

                I will study this. I hope you are right that my medical expense deduction is not used to determine my eligiblity. The past few years I have spent 3/4 of my income on medical treatment and supplemented with my savings. It doesn't seem like I should be penalized for that.

                To keep our faces turned toward change, and behave as free spirits in the presence of fate--that is strength undefeatable. (Helen Keller)

                by kareylou on Sat Aug 31, 2013 at 08:51:45 PM PDT

                [ Parent ]

      •  It actually looks like anything below poverty (1+ / 0-)
        Recommended by:
        FloridaSNMOM

        level that's not covered. I guess I need to do more reading.

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