Skip to main content

View Diary: So are the ACA "Subsidies" or are they LOANS!?! (166 comments)

Comment Preferences

  •  That isn't new - that's always been part of (15+ / 0-)

    Medicaid, or the state variants thereof. In this country where access to health care is not an absolute right, and still isn't, if you have expenses beyond your financial means, medicaid will kick in, even if you are fairly well to do, but they get to put a lien on your house to pay for some or all of it if and when you die.

    I repeat, this is not new; this has been in place for a decade. Also, if you go into a nursing home and need medicaid to pay for it, and most do, the nursing home gets most of your retirement check to pay for it.

    People don't know about this until they go up against it. I understand why they don't want someone eating up tens of thousands of dollars in medical care and then leave a mansion to their kids, but this his middle class and low middle class income people hard.

    The ACA didn't create this, it inherited the situation. If it doesn't seem fair, it isn't. The government expropriates Grandmas house for the price of keeping her alive. But if we thought we lived in a fair country, we wouldn't be on the Daily Kos trying to change things, would we?

    Just another underemployed IT professional computer geek.

    by RhodeIslandAspie on Wed Nov 06, 2013 at 07:47:34 PM PST

    •  That should have been "been in place for decades." (5+ / 0-)

      Just another underemployed IT professional computer geek.

      by RhodeIslandAspie on Wed Nov 06, 2013 at 07:49:17 PM PST

      [ Parent ]

    •  What is new is that ... (11+ / 0-)

      ... people with incomes under 1.4x the poverty line are hearing that they will get health insurance under the Medicaid Expansion, at least in the 25 states that are implementing a Medicaid Expansion ...

      ... and while previously many state's had wealth as well as income tests for qualifying, now there is only going to be an income test in those 25 states, and some people may choose to go into the Medicaid Expansion instead of the HIX for the lower deductibles without realizing the downside in terms of clawback from their estate.

      Support Lesbian Creative Works with Yuri anime and manga from ALC Publishing

      by BruceMcF on Wed Nov 06, 2013 at 07:53:35 PM PST

      [ Parent ]

    •  I thought that (3+ / 0-)
      Recommended by:
      tardis10, Lujane, sewaneepat

      in your nursing home example, that an elderly person who has assets cannot get Medicaid coverage for a nursing home until those assets are exhausted. And this is not part of the ACA, it's part of Medicaid. What I didn't know was what the diary asks.

      "Every Pootie is a masterpiece." - Da Vinci

      by mdsiamese on Wed Nov 06, 2013 at 07:54:18 PM PST

      [ Parent ]

      •  That would apply to cash assets (6+ / 0-)
        Recommended by:
        Mr Robert, RBinDLH, mdsiamese, Lujane, raines, Pluto

        or assets that could be sold easily, like stocks and bonds. They don't really expect you to sell your two bedroom house that you may have been living in for most of your life, because you've got to live somewhere. But government wants it eventually, either when you sell it, or you die and pass it on to your heirs.

        Just another underemployed IT professional computer geek.

        by RhodeIslandAspie on Wed Nov 06, 2013 at 08:19:00 PM PST

        [ Parent ]

      •  mds - the point of the diary is that the ACA (4+ / 0-)
        Recommended by:
        raines, splashy, tommymet, beverlywoods

        is expanding the population of people eligible for Medicaid as well as offering significant subsidies to others. While the subsidies have no claw back after someone passes, that is a feature of Medicaid. Her question is how is it fair that the subsidy comes with no strings attached but the expanded Medicaid population has their "subsidy" (free Medicaid) with strings attached?

        "let's talk about that"

        by VClib on Wed Nov 06, 2013 at 10:32:31 PM PST

        [ Parent ]

    •  what is so unfair about having a sick person (4+ / 0-)

      pay his own bills out of his estate after he dies? What could be more fair than lending someone money that only is paid back after the person no longer exists?

      •  I agree, society should be reimbursed... (2+ / 0-)
        Recommended by:
        Kickemout, doc2

        A mind like a book, has to be open to function properly.

        by falconer520 on Wed Nov 06, 2013 at 08:02:13 PM PST

        [ Parent ]

        •  Including Businesses Who Get Tax Breaks To (4+ / 0-)

          improve the economy, but decide it ain't working out and pack up and leave town with taxpayers holding the bag.

          "I think that gay marriage is something that should be between a man and a woman.” - Arnold Schwarzenegger 2003

          by kerplunk on Wed Nov 06, 2013 at 08:25:15 PM PST

          [ Parent ]

        •  I don't agree because society is paying (2+ / 0-)
          Recommended by:
          raines, beverlywoods

          poverty wages and not providing dignified work for people.  Look, masses of middle aged are under-employed, unemployed and being paid a fraction of previous wages.  These people used to make enough money to buy a mortgage.  They are watching their offspring struggle in this impossible economy but, hope to give their children a windfall so they can support a family or just have a place to live.
          I don't agree because social reimbursement means generational wealth stripping with the wealth concentrating at the "top" financial industry.

      •  I don't get the feeling that most industrialized (12+ / 0-)

        countries expropriate the house for the cost of giving somebody lifesaving health care. I could be wrong on this, but I have a feeling I'm not.

        Just another underemployed IT professional computer geek.

        by RhodeIslandAspie on Wed Nov 06, 2013 at 08:06:25 PM PST

        [ Parent ]

        •  Of course they don't. And when (5+ / 0-)

          Other nations decide their health system needs reform, they look into the costs and the profit margin of the health services and devices and other goods.

          Rather than working on seizing a $ 50K trailer from some semi-indigent person, officials in other nations  see to it that an artificial hip, cost to manufacture under $ 400, is not sold to the hospital or clinic for $ 13,000. And then they don't have the hospital charging the individual patient, (or the government,) some   $ 22,000 for the operation. (The example and the figures I cite were the ones that Bill Maher choose a few weeks ago, when he admitted that he thought that health care costs were in need of regulation.)

          Offer your heart some Joy every day of your life, and spread it along to others.

          by Truedelphi on Wed Nov 06, 2013 at 08:48:47 PM PST

          [ Parent ]

        •  No, they tax in advance. Pay (2+ / 0-)
          Recommended by:
          RhodeIslandAspie, tommymet

          the higher taxes that most countries collect than the pittance here and care can be prepaid.

          I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

          by samddobermann on Thu Nov 07, 2013 at 05:20:50 AM PST

          [ Parent ]

      •  Or (3+ / 0-)
        Recommended by:
        Kane in CA, offgrid, Lujane

        Why should the country increase their beneficiaries' legacy money?

        The same principle is used in England for retirement home care (though not the medical element). This has to be paid for unless the person has total assets below a certain figure which includes the equity in their home. People have been forced to sell their homes to pay for their care although this is often deferred until after their deaths and a claim made on their estate (this should now be the practice rather than the exception but the regulations have not kept up).

        We will work, we will play, we will laugh, we will live. We will not waste one moment, nor sacrifice one bit of our freedom, because of fear.

        by Lib Dem FoP on Wed Nov 06, 2013 at 08:07:11 PM PST

        [ Parent ]

      •  What's Unfair Is The ONLY People Who Have To (12+ / 0-)

        pay back their medical insurance premium subsidy are those who get Obamacare via Medicaid.

        Those who got a subsidy without going on Medicaid, don't have to pay back the subsidy.

        "I think that gay marriage is something that should be between a man and a woman.” - Arnold Schwarzenegger 2003

        by kerplunk on Wed Nov 06, 2013 at 08:09:03 PM PST

        [ Parent ]

        •  But it's the way we calculate things in this (5+ / 0-)

          country. Social security retirement, or advisability is treated as earned income, even if the recipient gets more out of it than they ever put it, but SSI is not considered earned income, because SSI is for the poor. That's why someone on social security can work a part time job with little or no penalty, but someone on SSI who works a part time loses a big chunk of their check.

          When I buy into the exchanges, my subsidies are considered something I've earned, where the medicaid folks are considered being given something. Go figure. But remember this. There's a good chance we'll all end up on medicaid sometime in our life if we go through a prolonged illness, and if we've got something, they'll come after us to pay for it.

          Just another underemployed IT professional computer geek.

          by RhodeIslandAspie on Wed Nov 06, 2013 at 08:24:03 PM PST

          [ Parent ]

          •  Why (1+ / 0-)
            Recommended by:
            beverlywoods

            are you considered to have earned it if you are a working person just above the cutoff, but not if you're just below it?

            It may be the way we do things, but that doesn't mean it makes sense or is equitable.

            We're trying to get to where health care is something everyone is entitled to, like the rest of the civilized world. Now would be a good time to start changing our thinking about Medicaid.

        •  Thank you. That is one of the thoughts that (2+ / 0-)
          Recommended by:
          kerplunk, beverlywoods

          Occurred to me, and I wrote about it at greater length up thread a bit.

          Offer your heart some Joy every day of your life, and spread it along to others.

          by Truedelphi on Wed Nov 06, 2013 at 08:49:45 PM PST

          [ Parent ]

      •  However keep in mind that it applies to all assets (0+ / 0-)

        no matter how little they are worth.  So you know that handmade sweater grandma knit for you while she was in the hospital, better give that back.  Don't forget any family photo albums as well  Oh, and don't even think of scanning them into your computer either as the copyright also goes to the state government.

        You have watched Faux News, now lose 2d10 SAN.

        by Throw The Bums Out on Wed Nov 06, 2013 at 08:10:14 PM PST

        [ Parent ]

        •  I Believe They Will Let You Keep What They Term (0+ / 0-)

          "personal items" and furniture and one car and $2000 in the bank.

          I'm considering furnishing my home with antiques such as a china hutch built in 1794 worth $150,000.  Also have a Rolls Royce sitting in the garage.  

          "I think that gay marriage is something that should be between a man and a woman.” - Arnold Schwarzenegger 2003

          by kerplunk on Wed Nov 06, 2013 at 08:20:37 PM PST

          [ Parent ]

      •  Here is where the unfairness comes in - (4+ / 0-)
        Recommended by:
        RBinDLH, splashy, raines, beverlywoods

        According to what people both here and on DU are saying, the "MediCaid individual" ends up with the state coming after their assets, but the "subsidized" person who is slightly better off doesn't have that worry.

        Let's say that  a Californian is desperately poor, and they apply to the Exchange, then the Exchange directs them to MediCal (Which is exactly what happens) then that poor person will owe 100% of the cost of the insurance policy premiums yet meanwhile  my husband and I who are a bit better off and can come up with some $ 200 a month to help pay for our subsidized premiums, and we don't have to worry that the State will go after us should we die, as we have remaine d "on the Exchange" but the poorer person will, again in my example of an older person, be liable for the five hundred a month in premiums if a single person, or the one thousand bucks a month if part  of a couple?? So just having that $ 200 bucks to help pay for the one thousand a month premium means you are OLLIE OLLIE OCEAN FREE, but the poor people can get their estate wiped out?

        Offer your heart some Joy every day of your life, and spread it along to others.

        by Truedelphi on Wed Nov 06, 2013 at 08:44:12 PM PST

        [ Parent ]

        •  Do you have a link to show the cost of (0+ / 0-)

          Medicaid premiums?

          The spirit of liberty is the spirit which is not too sure that it is right. -- Judge Learned Hand, May 21, 1944

          by ybruti on Wed Nov 06, 2013 at 08:54:47 PM PST

          [ Parent ]

          •  Here is the official link for ACA premiums (0+ / 0-)

            And if you are poor enough you will be enrolled in MediCal:

            https://www.coveredca.com/

            Offer your heart some Joy every day of your life, and spread it along to others.

            by Truedelphi on Wed Nov 06, 2013 at 10:05:47 PM PST

            [ Parent ]

          •  Medicaid premiums ("capitation") (2+ / 0-)
            Recommended by:
            ybruti, beverlywoods

            These sites seem to give some indication of "capitation" rates (for at least 36 states) ----(and these figures are not current  i.e. 2001).  

            A quick peek at rates [chart]

            A more in-depth study, also not current ('97-'98) ---See just past 1/2way down page.  

            I think these give some idea of what "premium" amounts states might be "clawing back".

            ~A govt lobbied, campaigned and selected by corporation... is good for corporation. Bad for people.~ -8.88 -8.36

            by Orj ozeppi on Thu Nov 07, 2013 at 09:01:58 AM PST

            [ Parent ]

            •  All of the capitation rates from 2001 (2+ / 0-)
              Recommended by:
              Orj ozeppi, beverlywoods

              are higher than a 54-year-old single man in Central California with $16,000 income would have to pay ($37) for a subsidized Blue Shield plan in the Covered Çalifornia exchange.  With a little bit less income, he would be forced into Medicaid and all his costs after age 55 would be "clawed back" from his estate.

              The spirit of liberty is the spirit which is not too sure that it is right. -- Judge Learned Hand, May 21, 1944

              by ybruti on Thu Nov 07, 2013 at 09:57:07 AM PST

              [ Parent ]

        •  But for the others, it's a tax credit (0+ / 0-)

          The non-Medicaid subsidized person is actually getting tax credits, right? A tax credit does not have to be given back, does it? Certainly not to the state since it is a federal credit.

        •  causing hereditary generational poverty (3+ / 0-)
          Recommended by:
          splashy, raines, beverlywoods

          way to go, government!

          Keep the poorest people poor, and their children and childrens' kids without an inheritance. NO upward mobility for you but heck, if you are struggling working-middle class, we'll let you pass stuff on.

          It is an imbalance. I'm remembering that African Americans have starkly less inheritance (usually none) compared to the average for White Americans. Researchers believe that is one cause of generational poverty in the African American community.

          •  though I'm not clear what would be right (1+ / 0-)
            Recommended by:
            sewaneepat

            I'm thinking it's strange the policies are different. I'm glad subsidized folks don't have to pay it back.

            Maybe it's a stingy thing. "heck at least these folks contribute something" vs not.

            Yet, many Medicaid people pay for it. I have Medicaid and depending on my income or if I can work at all (am disabled) I pay between $9 and $67 per month for the 20% Medicaid covers (Medicare, which I pay $109 for, covers the other 80%). So as you/anyone can see the "takers" actually pay, sometimes as much as the discounted people on the exchange it seems.

            My single person coverage costs say $150 while you are saying coverage for a couple is $200.

            I bet loads of people don't know you pay for Medicare. I pay it sounds like about the same amount as someone making more who pays the subsidized amount via the ACA exchange, at least by this example. I pay >10% of my income for health insurance.

          •  Yes! That IS the point, isn't it (0+ / 0-)

            We know that was set up by the right wingers. No one else would be so crass, callous and cruel.



            Women create the entire labor force.
            ---------------------------------------------
            Sympathy is the strongest instinct in human nature. - Charles Darwin

            by splashy on Thu Nov 07, 2013 at 08:25:04 AM PST

            [ Parent ]

        •  No, that's silly, medicaid doesn't have premiums (0+ / 0-)

          The possibility will be a lien for CARE.

          I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

          by samddobermann on Thu Nov 07, 2013 at 05:26:27 AM PST

          [ Parent ]

      •  Not the point (1+ / 0-)
        Recommended by:
        denise b

        The point is that those that make enough to go on the exchanges can get subsidies that aren't expected to be paid back, while those that don't who are forced into Medicaid don't have that luxury.



        Women create the entire labor force.
        ---------------------------------------------
        Sympathy is the strongest instinct in human nature. - Charles Darwin

        by splashy on Thu Nov 07, 2013 at 08:20:56 AM PST

        [ Parent ]

      •  Read Vclib's post just a bit above yours. n/t (0+ / 0-)

        Offer your heart some Joy every day of your life, and spread it along to others.

        by Truedelphi on Thu Nov 07, 2013 at 12:03:44 PM PST

        [ Parent ]

    •  If Grandma Owns as Much As a House (8+ / 0-)

      an elder law attorney needs to be obtained yesterday because there are loopholes that, of course, can be found by those who have something to preserve. But you don't have to be in the yacht class to be able to preserve something.

      We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

      by Gooserock on Wed Nov 06, 2013 at 08:01:49 PM PST

      [ Parent ]

      •  Yes. The loopholes may not have been (3+ / 0-)
        Recommended by:
        Mr Robert, raines, tommymet

        intended for us common peasants, but that doesn't mean we might not be able to make use of them.

        Just another underemployed IT professional computer geek.

        by RhodeIslandAspie on Wed Nov 06, 2013 at 08:07:14 PM PST

        [ Parent ]

      •  Here in California (2+ / 0-)
        Recommended by:
        offgrid, tommymet

        you can preserve your home by signing it over to your heirs prior to your death. I think you have to sign over the home ten years before your death but it might be a bit longer.

        My mother was concerned that this might affect her and while this didn't come up we made certain that her home was in my name just in case.

        As far as ACA is concerned, those on Medicaid need to consult with a family law attorney if they own their own home and want to protect it.

        The only trouble with retirement is...I never get a day off!

        by Mr Robert on Wed Nov 06, 2013 at 08:36:49 PM PST

        [ Parent ]

    •  It is not just your house, it is everything you ow (0+ / 0-)

      own including any family heirlooms (regardless of worth) and even your family photo albums.

      You have watched Faux News, now lose 2d10 SAN.

      by Throw The Bums Out on Wed Nov 06, 2013 at 08:05:05 PM PST

      [ Parent ]

    •  An element of fairness (2+ / 0-)
      Recommended by:
      RhodeIslandAspie, raines

      There used to be a specialty of elder law practices that showed people how to hide their assets and get free nursing home care for the families elderly people.  The elderly could give away their assets to the relatives, then be technically poor and get nursing home care paid by the rest of us.

      The changes in the law in the time period in the diary required that people spend down their assets before they got the free Medicare services.  Say the elderly couple had lived fifty years in a modest bungalow on what is now a million dollar seaside lot.  Should they be able to give that away then get free care?  That was an example of the situation.

      To be clear, the healthcare insurance marketplace exchange subsidies do not relate to this.  The non-subsidized free Medicaid expansion might relate.

      It is common for technical correction bills to follow large new laws like the ACA.  This is an example of the need.  The Republican House won't permit the correction bill.

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site