# The Affordable Care Act and Working Poor (Facts Only, PLEASE!) **URL:** \ **Category:** Factual Questions\ **Created:** [September 7, 2013, 11:49am UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243 "2013-09-07T11:49:27Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [September 10, 2013, 9:54pm UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/21 "2013-09-10T21:54:59Z")
Oh, I see. Yes, that’s true. ---
**Author:** ![Bridget\_Burke](https://avatars.discourse-cdn.com/v4/letter/b/7cd45c/32.png) [@Bridget\_Burke](https://boards.straightdope.com/u/Bridget_Burke)\ **Post date:** [September 11, 2013, 9:10am UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/22 "2013-09-11T09:10:58Z")
Enroll America seems to be aimed at health care providers–but also has a section with [information for individuals](http://www.enrollamerica.org/get-enrolled/how-to-enroll). ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [September 11, 2013, 10:45am UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/23 "2013-09-11T10:45:57Z")
> [@yorick73](#): > > I think one of us is confused. My point is that there is currently a lawsuit challenging the legality of giving individuals a subsidy in states that did not implement a state-run exchange. So, in a federal exchange, according to the suit, subsidies would not be allowed. The court case is [Pruitt v Sebelius](http://www.healthcarelawsuits.org/detail.php?c=2390604&t=Pruitt-v.-Sebelius-(Oklahoma-Case)) I’m not confused. The state of Indiana and the Feds worked out a compromise strictly for Indiana. Eligible Indiana residents will have access to the Federal exchanges. It’s a done deal and not connected to the Oklahoma court case. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [September 11, 2013, 1:13pm UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/24 "2013-09-11T13:13:38Z")
That’s not a compromise. Every state which refuses to set up its own exchange gets access to the federal exchange. The issue **yorick** is talking about is whether citizens of those states will also get the federal subsidies. ---
**Author:** ![yorick73](https://avatars.discourse-cdn.com/v4/letter/y/b5a626/32.png) [@yorick73](https://boards.straightdope.com/u/yorick73)\ **Post date:** [September 11, 2013, 2:44pm UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/25 "2013-09-11T14:44:38Z")
> [@Broomstick](#): > > I’m not confused. The state of Indiana and the Feds worked out a compromise strictly for Indiana. Eligible Indiana residents will have access to the Federal exchanges. It’s a done deal and not connected to the Oklahoma court case. What\*\* RNATB \*\*said. You seem to be confused about what I’m saying. There is a possibility, however slim, that people on the federal exchange will not be elegible for any subsidy because of the way the ACA was written. But I have no idea about this compromise. AFAIK everyone in the country will have access to the federal exchange if their state does not set up a state-run exchange. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [September 11, 2013, 10:48pm UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/26 "2013-09-11T22:48:30Z")
> [@Really\_Not\_All\_That\_Bright](#): > > That’s not a compromise. Every state which refuses to set up its own exchange gets access to the federal exchange. The issue **yorick** is talking about is whether citizens of those states will also get the federal subsidies. I have been assured by multiple sources that Hoosiers will have access to the Federal subsidies as well as the Federal exchanges. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [September 11, 2013, 11:20pm UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/27 "2013-09-11T23:20:55Z")
That is the IRS’ current plan - not for Hoosiers but for everyone. Depending on how the courts rule in the cases under discussion, you may not have access to the subsidies. ---
**Author:** ![yorick73](https://avatars.discourse-cdn.com/v4/letter/y/b5a626/32.png) [@yorick73](https://boards.straightdope.com/u/yorick73)\ **Post date:** [September 11, 2013, 11:50pm UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/28 "2013-09-11T23:50:19Z")
> [@Broomstick](#): > > I have been assured by multiple sources that Hoosiers will have access to the Federal subsidies as well as the Federal exchanges. Are your sources clairvoyant? If not, I give up trying to explain this. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [September 12, 2013, 12:53am UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/29 "2013-09-12T00:53:49Z")
As noted, unless a court case upsets the status quo that _is_ what will happen - everyone with access to the Federal Exchanges will also have access to the Federal subsidies. What’s so mysterious about that? Or are you just here to scare people rather than sticking to the facts? ---
**Author:** ![2ManyTacos](https://avatars.discourse-cdn.com/v4/letter/2/3da27b/32.png) [@2ManyTacos](https://boards.straightdope.com/u/2ManyTacos)\ **Post date:** [September 12, 2013, 2:10am UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/30 "2013-09-12T02:10:50Z")
I’m not digging up the cite so don’t ask me to go searching for it, but… FWIW, I remember reading not too long ago from a legal scholar (I _believe_ he was from the Uni. of Virginia but I could be wrong) that the reconciliation bill that passed alongside the ACA specifically addressed the issue of IRS subsidies in federal marketplaces and dictated in _no uncertain terms_ that, yes, the IRS has the authority to offer insurance subsidies in the government exchanges. The cite is out there somewhere if somebody wants to dig for it. So, basically, the only way the Oklahoma lawsuit is going anywhere is if some judges somewhere decide to be really activist and create a whole slew of new precedents. I can’t imagine that the SCOTUS is going to want to touch the ACA again anytime soon (read: if ever), and even if it did the entire law wouldn’t be able to be struck down. ---
**Author:** ![usedtobe](https://avatars.discourse-cdn.com/v4/letter/u/ec9cab/32.png) [@usedtobe](https://boards.straightdope.com/u/usedtobe)\ **Post date:** [September 12, 2013, 3:16am UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/31 "2013-09-12T03:16:20Z")
OK, IN residents aside for the moment, if I may, I have 2 questions about the “Benefits Summary”. It’s pop-up, and I have no idea how to link to a pop-up, so: Metal Tiers: Platinum, Gold, Enhanced Silver 73, and Bronze\* \ Key benefits by Metal Bronze 60 Silver 73 Gold 80 Platinum 90 \ Out-of-Pocket Maximum Deductible Preventative Care Copay1 Primary Care Visit Copay Specialty Care Visit Copay \ What are prescriptions? Do they fall into “General Medication Copay”, “Brand Meds”, or “Preferred brand”? I understand formularies, and in-patent and generic. I currently use 2 different (nasty benzo’s) drugs to get the effect available from one. That one is the one my insurance won’t cover, even with a doc’s letter stating that It would be much better for my quality of life to use the patented. And on “Lab Testing Copay” - is that per sample, or per visit? If I go to the lab and they run 5 blood tests and a urine test, do I get hit for 1, 2, or 6 co-pays? Maximum Out-of-Pocket For One/Family What happens when I hit that max? are all co-pays waived? Are hospitals, surgeons, etc. now reimbursed 100%? - - this comes up on the CA site - haven’t tried the Federal. For an example of coverage (again, CA): I receive the max monthly SS Disability stipend. At that income level, the bronze plan is free to an individual, and the Silver is around $130-150, depending which company writes it. In my district, I get an option of HMO, HSA, or PPO. My current insurance is a PPO. The Silver PPO is 27% of my current policy. ---
**Author:** ![yorick73](https://avatars.discourse-cdn.com/v4/letter/y/b5a626/32.png) [@yorick73](https://boards.straightdope.com/u/yorick73)\ **Post date:** [September 12, 2013, 4:06pm UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/32 "2013-09-12T16:06:30Z")
> [@Broomstick](#): > > As noted, unless a court case upsets the status quo that _is_ what will happen - everyone with access to the Federal Exchanges will also have access to the Federal subsidies. What’s so mysterious about that? Or are you just here to scare people rather than sticking to the facts? I think you finally understand what I’m talking about so that’s a start. You specifically asked how the ACA would affect you. You live in a state that is not setting up a state-run exchange. The court cases addressing this may have an effect on you. That’s why I mentioned it…facts only. I have no interest in scaring people in GQ…I am just giving you the facts. The cases may or may not have merit and that is GD territory. I thought you should be aware of this but, since it appears that facts frighten you, I won’t waste any more energy on you. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [September 12, 2013, 11:06pm UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/33 "2013-09-12T23:06:05Z")
Oh, please - the Republicans have been trying to overturn ACA for a couple years now to no avail, either in Congress or the courts. Unless you have some _evidence_ that the Oklahoma case has an actual chance at an outcome you mention it’s nothing more than scaremongering. On top of which, the agreement between Indiana and the Feds is _separate_ from those of other states without state-run exchanges due to the involvement of the Health Indiana Plan. I am not “scared”, I think you are injecting rumor and innuendo into what I had hoped would be a thread about _what people should DO_, not what they should be afraid of. ---
**Author:** ![MandaJo](https://avatars.discourse-cdn.com/v4/letter/m/ac91a4/32.png) [@MandaJo](https://boards.straightdope.com/u/MandaJo)\ **Post date:** [September 13, 2013, 1:44am UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/34 "2013-09-13T01:44:03Z")
> [@dracoi](#): > > You’re basically right, but not entirely. > > The employer requirement is that insurance (single-only) not be more than 9.5% of W-2 wages for the employee. So in that sense, I suppose there an incentive to “stick it to employees” but keep in mind that the family coverage rates are set by the insurer. It’s not like the employer can come up with arbitrary rates. > > Now, the household/employee perspective is a little different, and this is what an exchange looks at. The exchange says that you do not have affordable healthcare if the premiums (all of them) are more than 8% of household income (not just any one employee). Therefore, it is possible that an unemployed spouse and kids might take a policy through the exchange, while the employee has their policy through work. But it’s also possible that the family rate through the employer still meets this “8% of household” definition of affordable and so will need to use the employer policy. Can I piggy-back on this? Because I thought I understood, but now I am confused. The premiums for my personal healthcare are well below the limit, but the premiums to cover my husband and so are another $9K a year, and amount to close to 10% of my take-home. Are they eligible for the exchanges? Last I heard they were not. ---
**Author:** ![usedtobe](https://avatars.discourse-cdn.com/v4/letter/u/ec9cab/32.png) [@usedtobe](https://boards.straightdope.com/u/usedtobe)\ **Post date:** [September 13, 2013, 5:24am UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/35 "2013-09-13T05:24:51Z")
> [@MandaJo](#): > > Can I piggy-back on this? Because I thought I understood, but now I am confused. > > The premiums for my personal healthcare are well below the limit, but the premiums to cover my husband and so are another $9K a year, and amount to close to 10% of my take-home. Are they eligible for the exchanges? Last I heard they were not. I’m guessing that it would come down to the definition of “Household”. How do you file taxes? Single? Head of Household? Anyone listed as a Dependent? That’s all I can add - I’m looking for individual coverage, and have not looked into Family coverage. ---
**Author:** ![MandaJo](https://avatars.discourse-cdn.com/v4/letter/m/ac91a4/32.png) [@MandaJo](https://boards.straightdope.com/u/MandaJo)\ **Post date:** [September 13, 2013, 10:00am UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/36 "2013-09-13T10:00:51Z")
> [@usedtobe](#): > > I’m guessing that it would come down to the definition of “Household”. How do you file taxes? Single? Head of Household? Anyone listed as a Dependent? > > That’s all I can add - I’m looking for individual coverage, and have not looked into Family coverage. Married, and one dependent. It’s about as traditional a household as you can have. ---
**Author:** ![lazybratsche](https://avatars.discourse-cdn.com/v4/letter/l/ba8739/32.png) [@lazybratsche](https://boards.straightdope.com/u/lazybratsche)\ **Post date:** [September 13, 2013, 12:45pm UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/37 "2013-09-13T12:45:43Z")
> [@MandaJo](#): > > Can I piggy-back on this? Because I thought I understood, but now I am confused. > > The premiums for my personal healthcare are well below the limit, but the premiums to cover my husband and so are another $9K a year, and amount to close to 10% of my take-home. Are they eligible for the exchanges? Last I heard they were not. Sounds like your income is high enough that you wouldn’t qualify for subsidies anyways. I believe anyone can just go out and buy insurance on the exchange, and the “affordable” definition mess just determines whether you can get a subsidy. So perhaps you can find a cheaper plan for your family? It probably won’t be dramatically cheaper, but you should have some reasonable choices on the exchange. ---
**Author:** ![dracoi](https://avatars.discourse-cdn.com/v4/letter/d/90db22/32.png) [@dracoi](https://boards.straightdope.com/u/dracoi)\ **Post date:** [September 13, 2013, 3:27pm UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/38 "2013-09-13T15:27:00Z")
> [@MandaJo](#): > > Can I piggy-back on this? Because I thought I understood, but now I am confused. > > The premiums for my personal healthcare are well below the limit, but the premiums to cover my husband and so are another $9K a year, and amount to close to 10% of my take-home. Are they eligible for the exchanges? Last I heard they were not. If your husband doesn’t work, then the information you’ve provided makes it sound like he can shop at an exchange, because family coverage would be more than 8% of household income. If he does work, then we have to see whether insurance is offered through his employer and whether that insurance (for him, single-only) is more than 9.5% of his gross wages. If it’s less than 9.5% then he has “affordable” coverage already available and then neither of your is eligible for shop through an exchange. Also, if he does work, we need to factor his wages into household income when calculating the 8% eligibility for the exchange. And if your child works… rinse, lather, repeat. ---
**Author:** ![MandaJo](https://avatars.discourse-cdn.com/v4/letter/m/ac91a4/32.png) [@MandaJo](https://boards.straightdope.com/u/MandaJo)\ **Post date:** [September 13, 2013, 5:02pm UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/39 "2013-09-13T17:02:55Z")
> [@lazybratsche](#): > > Sounds like your income is high enough that you wouldn’t qualify for subsidies anyways. I believe anyone can just go out and buy insurance on the exchange, and the “affordable” definition mess just determines whether you can get a subsidy. So perhaps you can find a cheaper plan for your family? It probably won’t be dramatically cheaper, but you should have some reasonable choices on the exchange. I meant 20% of my household income. I make $50k-ish > [@dracoi](#): > > If your husband doesn’t work, then the information you’ve provided makes it sound like he can shop at an exchange, because family coverage would be more than 8% of household income. > > If he does work, then we have to see whether insurance is offered through his employer and whether that insurance (for him, single-only) is more than 9.5% of his gross wages. If it’s less than 9.5% then he has “affordable” coverage already available and then neither of your is eligible for shop through an exchange. Also, if he does work, we need to factor his wages into household income when calculating the 8% eligibility for the exchange. > > And if your child works… rinse, lather, repeat. He doesn’t work. Interesting. That could make a huge difference in our lives. Last I had heard, we were not eligible. Off to research . . . ---
**Author:** ![usedtobe](https://avatars.discourse-cdn.com/v4/letter/u/ec9cab/32.png) [@usedtobe](https://boards.straightdope.com/u/usedtobe)\ **Post date:** [September 13, 2013, 11:17pm UTC](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243/40 "2013-09-13T23:17:54Z")
Again - so far, the GOP has not won much in the way of killing it. As the original plan, anybody - whether their State operates an Exchange o r not, is free to buy a policy - individual or family on the Exchange. If your income is too high, you will not qualify for a subsidy, but you will NOT be disallowed to apply. **Manda** - does your State have an Exchange? If so, I know of no serious threat to the numbers you are seeing vis-a-vis rates and subsidies. [Previous page](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243.md?page=1) [Next page](https://boards.straightdope.com/t/the-affordable-care-act-and-working-poor-facts-only-please/668243.md?page=3)