My problem with the Affordable Care Act

[MrsKirkley]

Two years ago, I was diagnosed with cancer. At the time, I was lucky to be eligible for breast/cervical cancer Medicaid. I had four cancer-related surgeries and lost my job because my FMLA ran out. (My degenerative disk disease severely limits the type of jobs I'm able to do, which are pretty much non-existent in our area. Now, I've developed bad knees and am unable to pass the physical to go back to work at the place I previously worked for.) When Medicaid claimed I was no longer eligible and gave notice of their intent to drop me, my fiance and I hurried to Vegas to get married so he could put me on his insurance to avoid a coverage gap. Nobody knew at the time if the ACA would make it through the Supreme Court and 2014 was 3 years away. The problem is, my husband is paying for coverage we can't afford to use. He works at Walmart and our deductible is $5,500 and annual maximum $10,000. I haven't seen my oncologist for over a year and I'm supposed to go every 3 months to be monitored for recurrence. I am happy that the new law is helping so many people and I don't want it to go away. But it needs to be improved and I don't see that happening until Democrats regain control of the House. I do NOT blame the Affordable Care Act for refusing to expand Medicaid. I blame the Supreme Court and the state we live in. What I do blame the law for is making family members who are offered health insurance through an employer ineligible for subsidies when their premiums aren't even counted in the 9.5% affordability calculation. The only way for me to be eligible for subsidized health insurance with a 94% actuarial value (meaning I only pay 6% of everything) is for my husband to drop from full-time to what Walmart considers part-time (33 hours or less, which may change to less than 30 hours in 2015). Walmart only offers health insurance for spouses to full-time employees. Several others have shared their experiences, both good and bad, so I thought I'd share mine.

[Turbineguy]

1. I understand there is a help provision on the deductible

but others on DU know more about this than I do.

[leftstreet]

2. They're calling it the 'family glitch'

WASHINGTON — A "family glitch" in the 2010 health care law threatens to cost some families thousands of dollars in health insurance costs and leave up to 500,000 children without coverage, insurance and health care analysts say.

That's unless Congress fixes the problem, which seems unlikely given the House's latest move Friday to strip funding from the Affordable Care Act.

Congress defined "affordable" as 9.5% or less of an employee's household income, mostly to make sure people did not leave their workplace plans for subsidized coverage through the exchanges. But the "error" was that it only applies to the employee — and not his or her family. So, if an employer offers a woman affordable insurance, but doesn't provide it for her family, they cannot get subsidized help through the state health exchanges.

http://www.usatoday.com/story/news/politics/2013/09/23/aca-family-glitch-issues/2804017/

As Robert Pear reported in The Times recently, the law considers a worker’s share of the insurance premium unaffordable when it exceeds 9.5 percent of the worker’s household income. But that calculation is based on individual coverage for the worker alone, not family coverage, which is much more expensive. That is how the wording of the law has been interpreted by the Internal Revenue Service and the Congressional Joint Committee on Taxation.

Analysts at the Kaiser Family Foundation, a nonpartisan research organization, estimated that in 2008, 3.9 million nonworking dependents were in families in which the worker could afford individual coverage (costing less than 9.5 percent of household income) but not the family plan, which cost, on average, 14 percent of household income.

In the most recent Kaiser survey, in 2011, the worker’s share of the premium for individual coverage averaged $920 a year, meaning that any family making $9,700 or more would be deemed to have affordable insurance. But the share for a family policy cost workers an average of $4,130 a year, far more than what most low-income families can pay.

http://www.nytimes.com/2012/08/26/opinion/sunday/a-glitch-in-health-care-reform.html?_r=0

I think that's what you mean.
It sucks

[napi21]

3. Check out the ACA, enter your info and see what the results are.

I know if your annual income is low, you get a supplement to help pay for the premiums. I can't guess at how much you mighty have to pay each month, but from everyone I've talked to, it appears the premiums (including the gov't supplement) will be affordable.

[Dragonfli]

4. Read the actual post, not an option for this person, stuck with WallMart insurance

and therefore ineligible to buy insurance through the ACA which is the only way to receive a subsidy.

Not to be rude, but this is a well known problem and the barrier to the ACA was well explained in the OP. You are the second person that only skimmed it without reading the details, it makes us all appear tone deaf to the author that already knows about the ACA and knows that the only way to access it would be for her spouse to drastically reduce hours and income (that they likely need to live on) to not be barred from enjoying the benefits of the exchange and the subsidies that go with it.

Company supplied insurance bars one from "checking out" the ACA as you are not allowed to refuse the company plan in order to sign up and people insured by their employer are ALSO not eligible for any subsidies to assist in paying for work supplied insurance plans.

I am sure you meant well, but providing an answer the person knows does not apply to them is actually less helpful than just listening to their problem and only replying with answers that show you were actually listening to them.

I have no answer and would not presume to suggest her husband sabotage his job in order to be eligible to apply, so I just listened and hoped someone who had an answer I could not think of replied to her.

[Sgent]

5. She is eligible

to buy through an exchange -- but isn't eligible for a subsidy.

It still make sense to buy through an exchange depending on walmarts insurance.

[TheKentuckian]

7. You think someone that works part time at Wallyworld can afford an unsubsidized policy?

Are you being serious? Are they going to eat their policy or is that going to act as their roof and they eat dirt?

[progressoid]

6. I know the feeling.

We too are stuck with that "family glitch" and high deductibles.

I wish there was something more I could do but give you this electronic hug...

[Barack_America]

8. Fellow "family glitchers" here...ADVICE.

Given your deductible is so high, check to see if your husband is eligible to sign up for an HSA. If so, at least your health expenses (including premiums) are pre-tax deductible, so long as you pay them from your HSA.

[Jim Lane]

9. A question about the mechanics of the family glitch...

You obviously know more than I do about the situation. Your account of a dash to Vegas and quick marriage, for insurance purposes, made me wonder about the reverse. Suppose you and your husband entered into a sham divorce (as a lawyer, I'm not advocating that you perpetrate a fraud on the court, I'm just curious). If you and he were divorced, but continued in all other respects to live together as if you were married, would you then be eligible to go on the exchange and get insurance, with a subsidy that might cover all or almost all your premium?

As I said, I'm not advocating it, but I'm wondering if one effect of the family glitch will be to prompt sham divorces. If so, maybe a bill to fix it could get past the House, if enough Republicans were worried about being called out for hypocrisy on their "family values" rhetoric.

[IronLionZion]

10. The law needs to be amended to deal with this serious coverage gap

and other similar but totally fixable policy details. But these assholes in the tea party won't ever let anything even come up for a vote. Its a shame that its like this, and it sucks that so many people are affected. I'm sorry this happened to you.

I don't know what else to say.