ACA Test Case

[The Madcap]

Given that it is Jan 1, 2026, I figured I would do an ACA experiment. Here's the trial case:

1. Resident in a red state, middle of the country.
2. Married couple, both 62 years old.
3. No other dependents.
4. Income of $0. (I figured I'd assume the worst possible).

Result:

No subsidies or credits.
Cheapest possible Bronze Plan - $2510.54 / month, $16,900 deductible, $20,300 max out-of-pocket.

If this holds, it's the end of the ACA and many, many poor families and near-retirees.

[MichMan]

1. Aren't the original subsidies still in place?

I thought it was only the temporary enhanced ones for Covid that reached their expiration dates.

[The Madcap]

2. That's what I thought as well.

But running the numbers, it basically told me "no subsidies."

There's going to be a huge amount of self-harm in this country if this holds, as no one except the wealthy can afford this.

[The Madcap]

3. Also, given that the enrollment ends on the 15 of January,

There is next to no hope for this to get fixed in time to help anyone for 2026 without an extension in the enrollments.

Get ready for packed emergency rooms and lots of people refusing treatment.

[Ms. Toad]

5. Correct. n/t

[Ms. Toad]

4. It depends on which red state in the middle of the country.

In states which expanded medicaid, the couple would be eligible for Medicaid.

So in Nebraska health care costs would be zero (Nebraska expanded Medicaid). In Kansas, your numbers might apply, since Kansas did not expand Medicaid (although each state - and each geographical region within each state) will have different premium costs.

In the "middle of the country" only Kansas and Wyoming did not expand Medicaid. Most of the 10 states which did not expand Medicaid are in the south.

[The Madcap]

7. Not that they didn't try to expand

But there are certain politicians in those states that are real roadblocks to expansion. They should be remembered at election time, but they never are.

[Ms. Toad]

10. My point is just that your selection of a red state in the middle of the country aren't those hardest hit.

Most of them expanded Medicaid - so people in your worst case scenario are still eligible for Medicaid.

[The Madcap]

8. Medicaid isn't really the answer, though

As it means loss of assets in most cases, not just income.

[Ms. Toad]

9. Not for expanded Medicaid - it is based on income alone.

In states that have expanded Medicaid coverage: You can qualify based on your income alone. If your household income is below 133% of the federal poverty level (FPL), you qualify. (Because of the way this is calculated, it turns out to be 138% of the federal poverty level. A few states use a different income limit.)

https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you/

[The Madcap]

6. Also tried a single young female case just for grins.

Again, $0 income.

Age 26. No dependents.

Cheapest bronze plan: $447.41/month, $8,450 deductible, $10,150 max OOP.

It said "Based on the income and household information you provided, members of your household don't appear to qualify for a premium tax credit or other savings on health insurance. You can continue to view plans, but they'll be listed at full price.

It didn't matter if I set the salary to $90,000. I ended up with the same results.

[Rstrstx]

11. Try an income of 1$ above the Federal Poverty Line

There was a “doughnut hole” created in the ACA when SCOTUS upheld that the ACA subsidies were legal but it could not force states to accept the enhanced Medicaid requirements. At 0$ you should qualify for Medicaid, though some states have work requirements, but ACA subsidies won’t kick in unless you earn above the FPL.