Here's the background.
My 28 year old son is a waiter. He works six days a week and is considered full time. He (and we) live in Northern VA, so we're stuck with healthcare.gov as Governor Ultrasound declined to have VA set up its own exchange. His income is $22,280 annually (via his 2012 W2). His employer DOES offer health insurance to its waiters, but my son has never taken it because it's utterly unaffordable. A catastrophic equivalent plan is $279/month (15% of son's pre-tax income), and a silver equivalent (sort of) plan is $379/month (20% of son's pre-tax income). CLEARLY not affordable, so he didn't opt for it. He is uninsured.
October was a bust as far as getting through the ACA signup process was concerned. With the advice of others both here and in the real world, I waited and then created a new account for him.
I provided all of his information. If you've gone through the healthcare.gov signup and enrollment process, you know the steps are (roughly) thus:
1. Sign up for an account.
2. Wait for the email (which arrived within minutes) and verify the account.
3. After verification, go through steps to prove you are who you say you are.
4. Provide income, insurance and other information (in VA, you have to answer whether or not you are a tobacco user).
5. From there, you're onto enrollment.
So - without really knowing it, the "glitch" I hit occurred in step 4. I input son's income information from his W2, as well as his Social Security number. During the insurance status section, I was asked (paraphrased) first to indicate whether he has insurance from his employer now. That was an easy answer - "no". The next question kicked off the glitch. They asked (again, paraphrased) if he could get employer provided insurance in 2014. Strictly speaking, if it wasn't wildly expensive and ridiculously crappy insurance, the answer would be "yes". He COULD get employer provided insurance in 2014.
Turns out that answering that "yes" to the second insurance question caused the problem. Without asking an affordability question or providing me the option to give additional information about the insurance offered through his employer, healthcare.gov decided that my son was NOT eligible for premium subsidies.
It was only through yesterday's diary and the patient advice of many scarily informed kossacks that I figured that out. You see, before I was assisted in identifying what the issue was, I was getting what I considered wildly wonky prices in the enrollment phase.
Because of that little "yes" answer, his premium for the lowest cost bronze level plan was coming back at $178/month (9.6% of his pre tax income) and the lowest cost silver plan was coming back at $220/month (11.8% of his pre tax income). I knew intellectually that this wasn't right. I'd been on a variety of sites and knew that, given his annual income, he shouldn't be paying more than 6.02% of his income on health insurance premiums.
Did. Not. Compute.
And even worse - I had gotten ALL THE WAY THROUGH the enrollment process because I kept thinking the subsidy would be applied sometime after selecting a plan, and there was no way to back out of that.
SO. I created another NEW account for him and started the whole shindig over again. This time, I answered "no" to the question of whether or not he "could" get health insurance through his employer. THAT made the difference. Instead of taking me straight to "select a plan" in the enrollment portion, I had a NEW option to set how the subsidy was applied (that didn't exist before when I answered "yes" to the aforementioned question). I selected to apply all of the premium subsidy to his premium, and voila! He got a great silver PPO with a lowish deductible and decent out of pocket maximum for $101/month. (5.4% of his pre tax income).
My final commentary is overall positive, but with an exception.
Once I was assisted in identifying why his results were so out of whack, creating a new account and getting him through the process (minus enrolling fully - more on that in a moment) was really pretty easy. It moved quickly, I didn't get error messages, and I found it clear and easy-to-follow.
But the exception IS concerning. I imagine that there are countless low wage workers out there - hospitality, retail, etc. - who DO have health insurance available through their employer. They would naturally indicate, in that second insurance question, that they "could" get health insurance through their employer in 2014. The application doesn't ask you how much that insurance costs, however. So "could" becomes a very subjective word, and I don't think a casual user would ponder the results to the extent that I did. Nor do I think that a casual user - particularly one in the target demographic (which my son is) - would know well enough to know that there was something wrong with the premium they were getting. They would just know that the resultant premium, without the premium subsidy, is unaffordable for them, and they'd check out.
The Kaiser Family Foundation Subsidy Calculator clearly states that - for the purposes of THEIR tool - you should select "NO" to the question of whether employer provided insurance is available if the plans they offer exceed 9.5% of monthly income OR if the plans they offer aren't ACA compliant. A simple extra question, when answering "yes" to whether or not he COULD get employer provided insurance in 2014 would have fixed the problem. That question would have been to input how much the lowest cost plan was on a monthly basis. The application could have easily seen that my son's options were far in excess off the guidelines for his income level. In the case that the lowest cost employer provided premium was below or at the monthly maximum % of income for any given user, the application needs to ask if the plan is ACA compliant. If the answer is "no", subsidy applies. If the answer is "I don't know", the application can prompt the potential enrollee to call in or initiate a chat to determine plan compliance. If the answer was "yes", the application could proceed without application of the premium subsidy.
Success of the ACA really does depend on the target demographic - the "invicibles" - using the website at the lowest possible level of acumen and experiencing success. To that end, I think that the fixes I cite above are crucial - or else the resultant (incorrect) premium is going to scare that person away from the ACA and have them simply accept the penalty.
And in wrapping up, no, he is NOT enrolled just yet. I didn't take the second attempt to that level. For one, he is "enrolled" in a non-subsidized plan through my first incorrect attempt. So I need to rectify that. And for another, I'm really not comfortable answering "no" to that second insurance question - about whether or not he could get employer provided insurance in 2014. I am going to take him and myself to a navigator and sort it out. Cancel the enrollment in the wrong program, and provide the documentation showing that he qualifies for the premium subsidy on the basis of income and the affordability (or lack thereof) of insurance that his employer provides.
So that's my story! What's yours?