Self Employed Premiums Unaffordable


My husband and I have not been helped but hurt and our details are below. But before I get into our details want to say that middle income people who do not qualify for subsidies, especially those who do not have health coverage via an employer (e.g. self employed or those who work for employers that don’t offer coverage) are getting hit hard overall. Wasn’t the law supposed to help the middle class struggling to stay out of poverty? While the ACA provides subsides to many living just above the poverty line, the cost of health coverage has not gone down. Proponents brag that it is going up at a slower rate but when rates are still rising from what was already untenable, how is that affordable? It’s not.

And, no, there are no provisions in the ACA to prevent some people from paying 25% to over 100% (depending on the situation and will give example below) for healthcare coverage. The provision that no more than 9.5% (NOTE: corrected from 8.5%) of ones income can go to premiums applies only to employee coverage and only to the employee portion – meaning the total cost of the premium can be much more than 9.5% of the employee’s income – and most employers who pay the difference find ways to cut employees pay so the employee ends up paying indirectly. In addition, this 9.5% only applies to the employee’s coverage, not for spouses or family coverage. There is no limit to the percentage of income that go to pay for that. (NOTE: the limit for an exemption is 8% for self-only or dependent-only, or an average of 8% for two or more people.)

It is as if those who worked on the bill, never thought to apply some of their ideas to real life situations.

For example, those with fluctuating incomes can’t predict year to year how much they will make. These are the people who, ironically, most likely are in need of coverage. For instance, a self employed writer, contractor, business person may make a lot of money on a big project one year and the following year make very little. Those who have lost a job and are actively seeking another job are also unable to predict how much money they will earn. If they sign up for a plan based on their current situation of little to no income and then get a job, they have a tax problem and fines to pay. OR, if they don’t sign up because they banked on getting a job that didn’t come thorough, they have forfeited a much needed subsidy. How is that helpful or even efficient? Wouldn’t it be better to base subsidies on the previous year so there are no surprises? Of course, this could mean someone in a lean year might have trouble paying based on making more the previous year but would be far easier to manage/track. Of course, none of this would be an issue if we had expanded “Medicare to All” .

OUR DETAILS:
We are a middle aged couple who earn combined income of around $65,000 a year. We are barely hanging in the middle class on this income but do not qualify for subsidies so must pay the full price. I am 56 and my husband is 62 and we live in Los Angeles. The bronze plans can be much more costly for anyone who may actually need to see a doctor so the silver plans are the cheapest plans over all. We have had Kaiser and wish to stay with Kaiser and the monthly cost is: $1233.00/mo ($14,796 a year, which is almost 24% of our total income JUST FOR HEALTH PREMIUMS) with a MOP of $12,500 a year in addition to the premiums and each of us has an individual $2000 deductible. With copays and costs for lab and tests subject to deductibles, we pay out approximately $1500 in a year when both of us are free of illness and only getting a yearly physical. With the cost of prescriptions added, it brings up the total cost for medical to 25% of our yearly income when we are employed. That is affordable? But it gets worse. My husband was laid off his job the year before ACA went into effect, but then he finally got another job so we didn’t sign up for subsidies and continued to pay full price. But after only 3 months on his new job, he was out of work again and unable to find another job before the year ended. Our total income for last year was less than $28,000, which means nearly 53% of our income went just to pay premiums but there is no retroactive subsidies for us! And because I had a medical emergency and spent the day at the ER and my husband had issues with his heart this past year, our care all added up to maximum out of pocket bringing us to nearly 100% of our total income going just to medical costs. And, because we have no dental or vision coverage, when my husband broke a bridge that needed to be replaced and I needed a new crown, we had to borrow money to pay for that and because what was left of our savings went to pay for all of our other bills and basic needs, e.g. food, utilities, etc. we are one step away from going bankrupt due to healthcare costs. So the promise of helping the middle income was false. We won’t get help until we are driven into poverty. Thanks! And if I sound angry and bitter, it is because I am. I am angry that Obama and the Democrats didn’t fight the Republicans to get, at least, a public option or buy into Medicare. I am angry that this market reform helps only the insurance industry and sick of hearing the right wing refer to this market based reform as socialized medicine. Liars. I wish we had socialized medicine or insurance. I wish.

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The posts were the story here not the FinA-H moderator who spread false information. As i said this new millennium generation ???? I cant wait till they are 50 in 25 short years so they csn pay 75 percent in taxes and health costs.

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Not 100% clear on your point, but you are taxed on income, not wealth, and healthcare costs rise substantially as you age. The average person would benefit from paying more taxes and getting their healthcare costs covered (when you are young, because many don’t earn that much, when you are older, because your healthcare costs are higher). Think about the tax funded public social program Medicare, think about how many seniors depend on this program.

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Regarding the site mediator on Self Employed Premiums Unaffordable, this MF [edited] is as stupid as the day is long. He a product of todaysSelf Employed Premiums Unaffordable school thinks a write off on excess of the 9.5 percent is the same as a credit. Clue this dumb F [edited] tgat the write off is at the tax bracket not a credit. Jesus FC you millennials are soooo F’n {edited] dumb it blows my mind. Obamacare facts my tushy [edit]. Self employed people like me havd a 100 percdnt tax. JFC you people are stupid.

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I have been self employed for over a decade, and I’m older than you imply. I would not tax either of us at 100% if I had a magic wand… and this is a story written by a reader, not me.

As for the difference between a deduction and a credit, yeah they are different.

All that said, you are very yell-y and you are implying I don’t understand what I’m talking about, when I would wager that I do. I didn’t just stumble and fall and end up with 1,000+ page on the ins-and-outs of the ACA. As for what others write on the site as their personal stories, I don’t edit them, and I can’t affect if they are right or wrong.

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Same situation here. For 2018, for two of us, the premium will be $2,144/mo. I may have to quit work to get a subsidy. Ridiculous. My husband was laid off from his job of 35 years and now finds himself doing real estate which is very unpredictable as far as income. If we take out of our 401 to help us out, guess what, TAX

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My wife and I are in the same boat…so we don’t have health care. Can’t afford it! Funny I don’t hear anyone raising hell about those of us that don’t have healthcare NOW like the democrats were when the “poor” didn’t have health care before obamacare. I cannot believe that the republicans did not have an agreed upon good plan to replace obamacare after 7 years of complaining about it. I say, put all state and federal employees on obamacare and see if it gets fixed! Sick of politicians AND media.

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I am in a similar situation. I am a contractor and the sole breadwinner with a wife and two kids. My premiums are rivaling my mortgage…I make a decent salary, but at the rate my premiums are increasing…I may only be able to afford insurance for maybe one to two more years. This plan was a disaster from the beginning and there is no solution from the Democrats or the Reublicans!

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Unmarried no kids self employed real estate investor here. Ive been self employed for 15 years. Premiums in my state have shot up so fast, that I simply cannot afford it. In 2016, my insurer cancelled all individual plans. My income is violently unpredictable so if I can make premiums one month, I might not make it the following month. I know I am not alone on this: its better to just wait for a better system to come along after the ACA finally fails and is cancelled. I much rather have a tax penalty assessed than forego food, shelter, and transportation have to have insurance.

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We are facing very similar problems. Our plan for a small business in our middle age is dying due to the unexpected cost of healthcare. Who can put aside $20000 per year per person to pay for premiums and deductibles??? 25-30% of income is insane. The stress, anxiety and despair this causes me is going to lead to health problems.

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Same thing happening to us! Self employed in flordia and pregnant! The deductible is 7150 and out of pocket 7150 with monthly premium of $585 for health insurance that is the same as welfare Medicaid!

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At the end of the year you should get a refund based on your income/expenses, etc. We had this happen to us when my wife got cancer…..at least they couldnt drop us. We got money back because of it.

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My sons insurance went from 300 to 1800. He has four children and is not eligible for anything. Be ready for more people than ever to not have insurance. The press has given Obama a eight year ride. He is the worst president we have ever had.

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I agree with those who wrote that the ACA is really the UNAFFORDABLE Care Act. The ACA has failed and it has placed an unrealistic burden on those (small business owners, independent contractors, self-employed) attempting to purchase health insurance coverage. The outrageous premiums and sky-high deductibles are ludicrous when considered next to realistic income levels.
Real Life Example: My husband and I are over 55 and not yet old enough for Medicare. We are self-employed – our health insurance premiums are now 180% of what they were just 3 years ago. We make an MAGI of approx. $72,000.00 (too much for any reduction in premiums). The Bronze Plan offering medical services in our area costs $15552.00 per year… factoring in last year’s out of pocket expenses we were at over $18,500.00 in medical expenses (for “routine” medical services) …If we factor in the potential max. deductible for the Bronze Plan (should it ever be needed) … we would be at over $29,000.00 for one year ! – It is an unrealistic expectation to think that middle-america can carry this burden. If we consider a Silver Plan (similar to the affordable insurance we used to have before ACA) we would be at a premium of over $36,000.00 per year. Who can afford such a premium along with life’s other necessities ?? AND, who wants to “use” insurance that carries such a deductible? You are afraid to go to the doctor at all. Our alternative is no insurance, partial year “temporary” health/accident insurance – Or, possibly find different occupations with some sort of employer insurance… That is another unrealistic expectation: to think that all those 55+ yr old Americans who are not yet Medicare eligible can leave their self-employed situations and close their businesses and find “viable” employment to fill the gap before Medicare. The implications of this Act will surely kill the small business person and the American entrepreneurial spirit. It has also sucked away a good deal of disposable income which used to feed local businesses. Example: in order to me our monthly budget, my husband and I reduced to one car and we no longer frequent any of the local business we used to: local hair salon, local restaurants, local merchants, … all a thing of the past. We cancelled memberships to museums, we substantially reduced our charitable contributions… and Christmas shopping is now a thing of the past, too. Our health care costs are now our single highest expense over food, housing, transportation, or income tax. (ACA is a disproportional tax!)
The ACA’s idea of a viable insurance “pool” has failed. An alternative must be found.

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Son is in lower middle class. He’s also paying out most of his check because he’s a contractor for a major company that just laid off 80% of their workers. His premiums are at $180.00 a month at present and just recieved a letter stating their raising his premiums to $360.00 a month. He can’t even get in to see a dr. without paying a high deductable if he needed to. When taxes come as well a large portion of his savings go into taxes. He’s barely making ends meet between the two odds against his financial favor. He’s looked around for cheaper premiums and it’s pretty much all the same. Best to all going through this as well.

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My husband and I are self employed. We just looked at the 2017 plans available for coverage of our family. The best that we can hope for is to pay $20,000–$20,000!!!!–out of pocket, and that’s hoping that only one of us maxes out our deductible. There are two very bad local plans with almost no doctors or facilities in their miniscule networks, and with poor BBB ratings, that could possibly reduce that by $3,000 or $4,000 dollars. But more than likely, at some point we would be forced to go out of network (my son has to see a pediatric gastroenterologist, and there are none in-network) and none of that care would covered, so costs could very likely be even higher if we chose that path. We don’t know what to do. Every decent plan that we could just barely afford in the last two years has disappeared, and now we’re lost. I feel certain we will end the year with thousands in medical debts that we can’t pay. Thanks “Affordable Care” Act. Thanks for absolutely nothing.

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I am self-employed and healthy. I used to pay $115/month for BCBS health insurance before Obamacare. The very same plan is now $504/month. And it is the only plan in my region. How could our government have not thought of the middle-class self-employed? For the first time in my life, I’m considering just going without insurance… Moving out of the country is another option… What a disaster.

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We are in the same situation. We are paying sky-high premiums (almost 900 / monthly) and still have to pay a huge deductibles. I had a concussion and Blue Cross denied almost all claims, we ended up paying almost $5,000 out of pocket (on top of the monthly premiums). This is ridiculous. I freelance and my husband owns a small business. We work hard and still can’t get ahead. This is NOT affordable!!! Can we start a class-action lawsuit against Blue Cross in NC? Nationwide? They are raising our premium rates 25% in January 2017. They did that last year too – that’s a 50% increase. We can’t afford the ‘Affordable’ Health Care!

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Unfortunately the ACA allows health insurance providers to cherry-pick lowest risk groups and charge them less. Self-employed fall into the higher risk group of individual coverage policies, thus get hammered with high premiums. There is no use in trying to change this system, the health insurance companies are making good money, thus supporting politicians accordingly. Here in Washington State I have tried to implement logical changes, however Insurance Commissioner is absolutely useless. Should anyone find a useful dodge for self-employed accessing healthcare insurance at cost similar to large company program, please identify and post here. Thanks.

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Thank you for article. Both my husband and I are self-employed. We no longer qualify for group rates because are married group of 2 (why?). We’ve been in business for 20+ years, and mostly saw double digit % premium increases each year since started businesses. Since ObamaCare, we continue to see this but % increases on already high premiums are unsustainable. Now in our late 50’s, we will together pay about $1400/mo for a 2017 HSA Bronze plan in state of WA, that has huge deductibles with more limited provider network, thus benefit coverage worse every year. I believe ObamaCare had good intentions and some of the benefits were an important step, such as 26yo under parents, no limits on lifetime benefits, and removed pre-existing conditions. The 2017 individual market without subsidies is limited to only 2 lousy choices offering HSA plans. I also deal with health Ins companies on daily basis in my job, and it is unbelievable how inefficient the system is. Ins competition across state lines has not worked. I work as healthcare provider and I see many employer plans with out of state Ins and helps very little. I want to see more patients than deal with tons of paperwork. I get hit on both sides with pay-cuts from payors and more non-billable time. I do feel angry that we pay so much more than most anyone I know because we are self-employed. I am grateful many low income people are getting healthcare and I see a few in my practice, although a few cheat on their income reporting. I do not believe that hard-working self-employed middle to upper-middle Americans should have to pay for everyone else. That is unfair. We paid off our mortgage, but now have another mortgage paying for healthcare. We may be able to pay, but very tempted to not be insured for the first time in our lives. We are healthy, take care of ourselves, and rarely use healthcare; but something bad could happen. I don’t go to the doctor because of costs, and fortunately I know when to go or not; but others may not. Something needs to change for self-employed or we should be able to form a group like large employers; or need to have a simple national option that providers would accept. I see many less fortunate self-employed getting hit harder because income lower but too much for subsidies. Single-payer system seems like a necessity to remove unethical profit-based system, improve efficiencies for providers, and hopefully improve costs while still giving providers a fair salary. Ins companies have huge lobbyists and employ a tremendous amount of people, so transitioning will be painful. Nothing ideal. Single Payer would still have bureaucracy but at least it would be one system to comply with, not multiple different layers that providers have to navigate through by hiring more staff that increases costs for everyone.

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we live in north carolina, 61 & 60. we have a business and income of 61,000. our current monthly is 1675 and will increase to 2105 in 2017. our bcbs value plan premium gets us nothing. our rates are better if we elect uninsured. shall we say that the 14% needs to organize and vote out every rxisting member of congress … starting with nancy pelosi … may she rotin hell.

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Fifty or sixty years ago there was not such a gap between what medical care and medication was affordably available to the average American citizen. The doctor would often come to your house. The insurance was not bloated, the medical charges were affordable. What happened? Why have expenses spiraled up so drastically across the board and made every doctor or hospital visit so expensive that the insurance payment part is absolutely crucial? We used to pay doctors directly for their services without using insurance at all. The has been a drastic shift in the dynamic of the doctor patient relatio0nship and in the delivery and payment for medical services. THAT is what we need to focus on. I know you can’t put the broken egg back together again, but surely it’s obvious that things were simpler and better before. Is it that now doctors simply expect to make so much more money? Is it that the insurance companies have captured the whole process.. to make more money? I wouldn’t doubt either of those. The whole paradigm is flawed and skewed against the end consumer… the patient and the healthcare system in general.

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I totally agree! My husband and I are in the same boat. Paying right at $1500 a month in premiums! And we do not have any major use. I have been to the doctor twice in the past year.
We are self employed. He is some proprietor of the business. And even though I work in the business I am not allowed to be on payroll and receive $0 social security credit.
We definitely need one payer. The insurance companies are getting rich while the working people are suffering. Last I head, we are the ones that make this country go!
And Obamacare didn’t make this happen. Our insurance premiums were going way up every year BEFORE and after Obamacare.

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Hello,

This is so difficult for many of us Self employed middle age hard working people who are undergoing minor to major health issues. I lost my job due to an injury. My livelihood unfortunately has been taken away from me. I am not only in pain, devastated but feeling like we are going down. My husband is self employed and we had to purchase health insurance that has costed us $1800 a month as well as high hospital, lab, doctor, dentist bills. There has got to be some reprieve for us.

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My wife and I are in our late fifties and self employed with a modest income. Before the ACA our premiums were around 600.00 per month with 1000.00 deductibles. Now they are almost 2000.00 with 2500.00 deductibles and quickly rising. Last years increase was 33% and expect that and more for 2017 at which point will become unaffordable. We are considering selling our home that took 20 years of hard work too pay off just so we can offset the high premium costs.
The only positive part of ACA is my wife and I are both covered if we become pregnant. Woo Hoo

I certainly wish that those who pass the laws should also have to live by the laws.

Disgusted

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Your scenario makes no sense, if you made 65,000 per year you should get a subsidy of aprox $350 month if you picked the second lowest silver plan in your area. If your husband was laid off or not working you qualified for a special enrollment period and should have cancelled your policy and re-enrolled using a special eligibility provision of the law and gotten a larger health care subsidy and lower out of pocket and deductible.

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This is so true, I am self employed and live in Los Angeles, where the cost of living is astronomical and the cost of a bronze plan is well over a silver if you have any prescriptions or go to the doctor. The costs of these plans are NOT AFFORDABLE. I had better coverage when there was no Obamacare. The narrow networks are harrowing, HORRIBLE DOCTORS and when I had my previous policy I was covered wherever I went and now it is a 30 mile zone. The cost is too much, I can’t make rent and pay for insurance, which really sucks because nothing makes you feel more worthless than not being able to take care of yourself when you need to. It screws anyone making 35-80,000, which by the way is NOT what you take home, and the costs of cities like LA should be taken into consideration for the poverty level. Rent in one city is not the same in another. Being freelance, I have no idea what will be a good year or a bad year. We all hope for good years but now I am terrified if I make 40-70, because I can’t afford to pay 400 a month for a crappy insurance policy I can’t even afford to see the doctor on because the copays are still 60-90 per visit and make my monthly bills. So then I get penalized for not being able to afford the rates and have to pay a fat fine, and pray I die in ER if anything happens because I will go bankrupt. This needs to be changed, it should be called the UN-AFFORDABLE CARE ACT TO BANKRUPT MIDDLE INCOMES.

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I understand your and your husband’s plight because my son, 34 year old, self employed with two young children and wife is in similar predicament. He works hard to make ends meet and is in the situation that is required to pay monthly over $800.00 to have health coverage for his family. His income fluctuates slightly yet , after he would pay his required health premiums his net income would be on the borderline of federally designated poor family status. He is forced into situation that he cannot afford these premiums and thus his family will not be insured and still endure the penalty. Outrageous but true.

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there is no way he would pay $800 a month if he were anywhere close to the Family Poverty level of $24, 250 for a family of 4. In fact he could make all the way up to 60,625 in 2016 and still get a partial subsidy. More likely than not Mom, your son is telling fibs again and crying to mommy about how hard he work’s, boo hoo hoo. Tell him to grow up already and pay his way.

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Whoever is writing the replies marked as “Fact” has no idea of the actual facts.

For self-employed people, like the author of this article and me, the “Affordable Care Act” has made health insurance completely unaffordable. My somewhat affordable grandfathered policy was cancelled by my insurance company at the end of 2015. There are no more grandfathered policies sold anywhere, so the partial Obama lie about “keep your plan if you like your plan” has now become a 100% lie for anyone who is self-employed. The lowest cost, ultra-high deductible plan available on healthcare.gov would cost me twice what I was paying, with higher deductible and out-of-pocket, and what I was paying had already gone up by a factor of 2.5 since ACA was forced upon us.

Those of us who have been responsible, self-supporting insured middle class people all our lives are being harshly punished by the abomination that was insultingly named the “Affordable Care Act”. I am now without any health insurance for my family for the first time in my adult life.

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For the record i’m well aware that a portion of the countries premiums are higher under the law. So to be clear, that is a problem in the eyes of me and pretty much every democrat and republican running for office. There are 320 million Americans. Millions got affordable coverage for the first time, millions got a worse deal, hundreds of millions had a different experience. So the facts are like that, large numbers and hundreds of millions of experince. Some of those experince are life saving, some of them are a kick in the wallet. Don’t think we can just give up and stop reform at this point, we simply need to continue to address our issues in a way that doesn’t leave people dying on the street.

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Your response to me again illustrates how you are either ignorant of the facts regarding Obamacare, or intentionally choosing to sugar-coat the facts.

There is no one in any “portion” of the entire United States that has not seen higher health insurance premiums. The only people paying lower premiums are those being subsidized by US taxpayers. The actual premium policies, of all policies of any type, have skyrocketed everywhere since Obamacare was illegally passed into law by a lying President and by conniving Democrats who found a sneaky way to thwart the obvious will of the people, who clearly demonstrated with votes in 2009, 2010 and again in 2014 their fierce opposition to the idiocy of socialized medicine.

“Fact” says we “don’t just give up and stop reform at this point”. In other words, we should double-down on generational theft and socialist stupidity. The entire Obamacare system is costing billions more than it was projected to do. It is further bankrupting an already bankrupt US Treasury. It is stealing freedom and economic opportunity from future American generations. It is costing millions of people thier jobs and costing those who have jobs to get their hours and benefits cut. In short, it is a social and economic disaster for the entire country.

No one was “dying on the streets” prior to Obamacare anymore than they are with Obamacare. Obamacare is just another massive, socialist transfer of wealth scheme that rewards those who are irresponsible at the expense of those who are responsible.

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I too am angry and bitter about the cost of healthcare. However, as part of a long-standing self-employed couple, I was angry and bitter about the cost of healthcare long before Obamacare. The private insurance companies, all without Obama’s help, were doing a fine job all on their own in making us regret we ever had the audacity to go it alone as self-employed, and God forbid, get older. Yes, it has gotten even more unaffordable with the Affordable Care Act, and that makes me very stressed, and angry. But as long as for-profit insurance companies are involved, this is what we are going to get! I have to say though that the fact pre-existing conditions are covered under Obamacare is one great thing it brought. That was never going to happen without Obama pushing for it. How could it be that mild pre-existing conditions such as asthma made one “high risk” and uninsurable? I am no cheerleader for EITHER PARTY, but on this issue, the Republicans could have cared less about the sorry state of healthcare and the number of uninsured citizens. I never heard one alternative plan voiced by any of them, except to leave it as it was. There is no doubt that the individual insurance policy holders just above the subsidy threshold are currently getting the worst deal — probably because we don’t have lobbyists and we are a relatively small percentage. That shows what self-reliance and hard-work will do for you. (I should add that the people who are getting THE worst deal of all are the very poorest citizens that don’t qualify for subsidies or Medicaid in certain states because they are TOO poor! The Governors of those states refused to accept Federal funds to expand Medicaid….but they will accept Federal funds gladly for other things when it suits them politically.) Honestly, I’m glad that now with Obamacare more and more people are also miserable with their new high premium, high deductible, co-pay, co-insurance plans. I feel like saying “Welcome to our world we’ve been living for quite some time!” They don’t realize it’s been going out for many years for some of us folks. Something’s got to give now, and we need to demand it of our leaders. Pay close attention to what each presidential candidate says they will do to improve the state of healthcare. Anyone saying “Repeal Obamacare” and stating their solution is to open up insurance competition between states so people can shop around is not to be taken seriously. Already, smaller insurance companies are being bought out by the big ones, thwarting competition. Good luck getting a better deal from one state to the next!

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“The private insurance companies, all without Obama’s help, were doing a fine job all on their own in making us regret we ever had the audacity to go it alone as self-employed, and God forbid, get older.”

The private insurance companies were increasing premium prices before Obamacare, but at no where near the pace they have since Obamacare. The reason is that there is now NO COMPETITION ALLOWED by Obamacare. I have been self-employed for 16 years. Prior to Obamacare, I could change health insurance to a different company every three years and would get an “introductory” rate that would lower my premiums back down to where they were three years prior. It was a pain to keep changing, but still relatively easy to keep my premiums under control. Now, with Obamacare, this is totally impossible. It is no longer possible to get any competitive bids, all the available policies must be Obamacare-compliant, and they all cost within a few % of each other.

“But as long as for-profit insurance companies are involved, this is what we are going to get!”

This is a leftist, socialist reaction to a problem that has been created by leftist and socialist government interference with the private sector. The ever-increasing prices of health insurance were not a result of private sector companies seeking to maximize profits. It was a result of over-burdensome government regulations controlling and dictating everything that the for-profit insurance companies did. Not being able to sell the same policy across state lines is just one example. If “for-profit insurance companies” are the root cause of high insurance rates, then why are homeowners, business liability and car insurance rates so incredibly cheap?

“I have to say though that the fact pre-existing conditions are covered under Obamacare is one great thing it brought.”

The government mandate to Cover pre-existing conditions totally defeats the entire concept of insurance and is the ultimate interference in the private sector marketplace. It guarantees that insurance rates will never, ever be affordable again. It effectively turns “health insurance” into nothing but social welfare. It is comparable to the government mandating that car insurance must pay medical liability and repair cost for car accidents that happen before the insurance is purchased.

“…the Republicans could have cared less about the sorry state of healthcare and the number of uninsured citizens. I never heard one alternative plan voiced by any of them.”

Either you chose to be ignorant of the numerous reforms proposed by Republicans, or you are a Democrat plant who is just lying. I strongly suspect the latter. The Democrats controlled the legislative and executive branches of government when Obamacare was being debated and would allow no alternatives but their own to even be heard, much less to be considered for a vote. The HSA option, for example, that was a blessing to me and many other self-employed, was a Republican idea. It has now been effectively killed by Obamacare.

“…the people who are getting THE worst deal of all are the very poorest citizens that don’t qualify for subsidies or Medicaid in certain states because they are TOO poor!”

The statement above exposes either your complete ignorance or your agreement with socialist ideology or both. There is no one in the United States that does not qualify for Medicaid because they are “too poor”. The so-called “Medicaid expansion” was to allow states to cover people with even higher incomes than those already covered by Medicaid. States’ rejection of “Medicaid expansion” does not cause someone to be denied for being “TOO poor”. One can only be denied Medicaid for being NOT poor.

“Honestly, I’m glad that now with Obamacare more and more people are also miserable with their new high premium, high deductible, co-pay, co-insurance plans.”

Leftist, socialist philosophy 101 includes the desire to make all people equally miserable. The statement above identifies you as the poster girl for radical, left-wing socialism and bureaucratic tyranny. It also makes you in opposition to those of us who still believe in individual liberty.

“Anyone saying “Repeal Obamacare” and stating their solution is to open up insurance competition between states so people can shop around is not to be taken seriously.”

Anyone not saying “repeal Obamacare” should be taken as the same type of radical, left-wing, egalitarian socialist as you obviously are. Anyone proposing to eliminate government interference and to return to true free market competition should be applauded as a friend of freedom and common sense.

I think that we will see people choosing to not go to the doctor for serious illness, continue to visit the ER instead, and will choose to pay the penalty, then we can watch our costs soar even more — oh wait, that is happening right now….huh, I’m not a politician or statistician and could have told you that would happen. Right now, for a family of four with both of us self employed, we have catastrophic insurance that costs us almost $800 a month, with a $5000 individual/$10,000 family deductible. We will have to pay for everything out of pocket ($172 for a 20 minute doctor visit! Is this really considered “affordable?) until we reach our deductible, and then…if we actually reach our deductible, we are still on the hook for 30% coinsurance AFTER we meet our deductible. Really? All I’m getting for the $9600 I’m shelling out this year is “peace of mind” – but God forbid should anything major happen, will be out at least another 5K plus 30% — how in God’s name is this defined as affordable, with health care costs what they are? The premiums may be the least of my worries, and yet that’s all the ACA focuses on — forget about the actual costs! A doctor visit and lab work will cost me about $250 each time I go….I’ve already cancelled my first appointment, going to have to tough it out. The worst insurance scenario we have been in ever, and it just gets worse and worse. If you have an employee-sponsored health insurance plan, be thankful! I love this “but you get to write off 100% of the premiums.” As if that helps, at the end of the year I will STILL have to write a check to Uncle Sam. And nope, don’t come close to qualifying for assistance. The self-employed in this country are screwed from every angle. The American Dream has not just died, it has been killed.

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I agree 100% with this article – my wife and I are basically in the same situation. I too wish we had socialized medicine.

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I currently work in the healthcare industry and was informed that my health system’s premiums and deductibles are going up ($3K and $5K options) – I cannot afford this – I am a single mother, with one child and make $60K a year. I know this is a generous salary, but being a single mother with a mortgage (small home), regular debt, I do not qualify for the subsidy. I have worked hard to get to where I am and now I have to shop around for an employer with “better benefits” or continue to work a second job just to pay for healthcare? Why are the middle class not getting any benefits out of these plans? I have wondered how a middle class family could afford high deductible plans, let alone a low income family? What was the meaning behind all of this? Who is actually benefiting from this? The wealthy can write a check for these high deductible plans with no issue! Neither family can pay that high deductible – I can handle a $1K deductible if needed, but $3K-$6K deductibles are outrageous! So I end up paying in full for monthly medications, etc. – everything applies to those deductibles. Don’t understand why or how all of this has changed what the employers offer to their employees.

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High deductible plans are the result of rising rates and a Market that has to include everyone and limit the max amount in premiums a person can be charged. All the heat was shifted from exclusions and low premiums for some to medium premiums and high deductibles. HSAs and subsidies (tax breaks and credits) help to ease the burden, but not everyone can access these equally in practice. This results in lots of people with essentially unaffordable deductibles (not $40,000 hospital bill bankruptcy unaffordable, but everyday trying to make it through the year unaffordable).

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We can completely agree with this article. Although we are not self employed, we are pre-65 retirees who make $65,000 a year and we have the same issue. No subsidy available and the average premium for 2016 will be $1500 mo for us. You do the math. That is 30% of our gross income. No breaks at all. So we are seriously considering just paying the $2000 penalty and saving the premium. At least it will be $18,000 in our pockets and not the insurance companies. Sad that our age we are considering just going without. Luckily we are both very healthy. Something must change, Obamacare has been a nightmare for us.

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You won’t owe the penalty. You automatically qualify for an exemption if the lowest cost plan is more than 8% of household income for the lowest cost bronze plan you’ll be exempt. At that cost i’d advise getting cheap catastrophic coverage (if you get your exemption early you should qualify) and an exemption and like you said saving the extra money. You could also, like we’ve noted before, max out an HSA with the cheapest HSA eligible bronze plan. This will drop your household income below $63,720 and will cap your family plan at 9.5% of household income. This is probably the smartest bet, but it requires you to fund the HSA and we know budgets are tight here. Hopefully this advice helps.

See page 9 and 11 of instructions for details on the exemption:

https://www.irs.gov/pub/irs-pdf/i8965.pdf

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I don’t understand the suggestion about catastrophic coverage – none of the insurance companies in Colorado is offering catastrophic coverage.

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To get catastrophic coverage you have to qualify for an exemption due to cost or you have to be under 30. You can then get catastrophic coverage through the marketplace.

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This is unfair. Not to mention paying all this money and don’t have an illness. But, nothing rolls over. So we will sell 2 of our 3 cars just to pay for health insurance. Money where we pay for car insurance will go toward health insurance. We don’t buy fruits, steaks, or alcoholic beverages. We don’t do Christmas or Thanksgiving. Qnd we do not travel anymore.

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Very sad, make sure if you are self employed to write off those premiums and medical costs and to take advantage of cost assistance through the ACA. The law and tax code favors self employed people in many ways.

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Are you kidding me? What good is it to deduct the premiums on your income tax if you are going broke paying them in the first place? The IRS isn’t going to pay you back.The bottom line is ,my husband and I can’t afford the new 2016 premium of $1500.00 a month. Two years ago, before the ACA, it was $560 a month for basically the same plan, with the exception that the deductible on the old plan was less. Affordable? The self employed middle class is rapidly becoming poor. So much for the American dream and life as we knew it. Thanks a lot for the big fat LIE.

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It’s clear that this group has a lot of those who are hit the hardest by the premium increases. This group being those who could afford coverage under the old rules and make too much for subsidies. It’s important to realize that you aren’t alone in some respects, yet others in your same situation are better off under the law. Also those who make less are better off.

Deducting all health related expenses is something ONLY self employed can do. So this is a BIG benefit. Still no matter what carrots are being offered there is little that will console a person whose cost doubled. That is rough. Make sure to use the tax advantages and make sure to shop the Marketplace for the best plan and cost assistance. Likely $1,500 a month will net you an exemption if we are talking about the cheapest bronze plan. If not, consider switching to cheaper coverage. It’s almost always a better long term strategy unless you need a lot of medical treatment.

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Write offs are a joke!
If you pay 1300 a month in premiums that is 15600 a year not including any deductable. The times this by your tax rate say 25% fed and you have 3900 off your income taxes. Woopee.
In 2002 I gad insurance for me and my children for 300 a month! Now I pay 1300 a month for the wife and i.
The 5000.00 Cadillac tax on plans that you see with large employees and Goverment was not enacted so as to buy the union employees vote in 2012.
Democrats buy votes by spending our money.

These folks are absolutely correct. I am self employed and our family’s plan used to cost $600/month prior to ACA with high deductibles we decieed on. The sample plan with all of the ACA’s unnecessary coverages has increased every year to where we now pay $1300/month for the same thing except the deductibles and out of pocket limits are even higher. Essentially I am now funding someone else’s healthcare simply because I am self-employed. Mandating a set of minimum coverages which most Americans do not require, and preventing competition across state lines is pure genius if your intention was to RAISE the cost of health insurance – ACA is a farce. Nothing government has ever done makes anything better for those that work and are responsible for themselves.

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The rising costs are a big problem, nothing much to say. But being self employed you have a lot of write-off potential and cost assistance potential with the ACA. Also, the last quip about government is obviously not true, for example Medicare (which takes care of parents in old age), CHIP (which takes care of kids at a young age), and the military.

The Affordable Health Care Act is not affordable for self-employed individuals who may not qualify for subsidies. The reason it is not affordable is that the premiums, out of cost fees, and deductibles make this form of health insurance hover outside of the ball park for many people.

I am a self-employed professional, and I certainly believe that the mission of the Act should be applauded; however, the act mandates that every individual have an insurance policy that covers mandatory services such as maternity care, which is not tailored to individual’s needs. Men do not need maternity care, women pass the child bearing age do not need maternity services, and women who do not want anymore children do not need maternity care. This factor is just one example of an unnecessary standard that raise costs. What should have happened is that people who had a customized insurance plan that fit their needs, should have been allowed to keep their plan even if it did not meet the mandate service provision of the Act. Now, if you have an insurance plan or catastrophic plan that do not meet the mandatory requirements, you will have a tax penalty, even though you have an insurance plan that meets your needs and is affordable within your budget.
All Americans deserve coverage that they can afford. The Act takes this right from individuals. For example, I am a healthy individual, so why would I pay monthly premiums double the amount I would pay for say a catastrophic plan if the plan is going to cost me twice as much with little to no value to me. But if I don’t know, I now have the burden of staring down a tax penalty or dealing with the IRS.
Is this Act affordable to most middle class and self-employed individuals? Yes, if you have pre-existing conditions and need the expansive services, that is certainly a plus for these groups. However, remember this Act is supposed to make all of our lives better, so to the other individuals that fall through the cracks of not qualifying for subsidies or worse, not qualifying for eligibility of this care, it fails miserably.
CL

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You were on track until the end when you incredibly managed to blame Republicans for this. The Democrats passed this on their own. They didn’t even try to get bipartisan support, nor did they need it. The president basically told the Republicans to sit down and shut up. There was no need to fight the Republicans because they had no power to stop or even influence this law. This is 100% the fault of the democrats and President Obama. Unfortunately the rest of your article is correct.

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Exactly Rick. Hard to blame how ignorant and outright liars Obama fannyboys are.

They Democrats passed this OUTRIGHT. Nearly every Democrat voted for it and nearly every Republican against it. This failure is 100% on the Democrats but when you are blind partyliner you’ll never see your own corruption and failures.

It’s this blind pride, hubris, and arrogance they leads to the downfall of societies, marriages, families, and every other sacred institution.

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I think some people though just see this as the opportunity to start fixing the healthcare system and the opportunity to ensure our poorest get care while we figure out how to really solve the health care crisis. The economy and our pocketbooks are and have been in danger.

See the CBO’s longer term outlook on this report for instance: https://www.cbo.gov/publication/49892

Doesn’t matter if you relate to the left or the right, we all can read the dang CBO report and look at reality. Just like we can look at the PPACA and read line by line what it really does and we can look at charts that show rising premiums and rising uninsured and equate that back to Americans going without proper in our backyards.

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Trust me lady you don’t want socialized medicine, I have friends and family in Canada, Mexico and Europe and it’s worse than what we had. It’s basically the same argument, it’s fine until you need it. It’s why there are industries that get people needed care in the states, since the waiting period is so long. They handle finding doctors, getting planes booked and even fighting their socialized medicine bureaucrats for reimbursement. Basically we want more and better quality care, not just more care. The quality goes down if you just provide more, as in socialized settings. If you allow competition then you’ll you’ll get more and cheaper care with good quality. There are doctors that can perform operations in their own offices for fare cheaper than hospital ones, but hospitals are in bed with local politicians and have made this illegal. Our insurance companies subside the price of pharmaceuticals for socialized medicine countries, we pay more so they can pay less. We also get lots of elites from other countries coming here for care because either the waiting list or local options suck. Another thing, many problems could be handled by a nurse practitioner rather than a doctor, again a cost savings. It’s been said before and always proven true, if you want something to be better add competition, because if the business, lets be honest health is a business, is forced to do what the customer wants the customer benefits.

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PS – what happens when I can no longer afford the premiums at the level I selected but my income still does not qualify for a cost reduction? My hours have just been cut, I already have coverage in the marketplace – need to change to bronze level but the “open enrollment” period when I could switch plans is now closed.

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You can update your information even after open enrollment has closed. You’ll report changes to projected income. Often the marketplace will base your projected income on past income, but for many this won’t be accurate. You should always base cost assistance on projected income. If you can’t afford your plan, you most likely qualify for more, not less cost assistance. Try calling the Marketplace for help walking through updating your application or simply follow the steps on HealthCare.Gov or your state’s Marketplace.

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As I said, I pay the full premium and even with my reduced hours our income is still to high for assistance. We can no longer afford the level we are at and there us no option for us to change after open enrollment.

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You should check with the Marketplace, that could qualify as a hardship exemption. If it does it should trigger a special enrollment period. There are a number of qualifying life events that trigger hardship exemptions and or special enrollment periods.

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I totally agree! And the response below is so automated – further insult – so ignores the fact that some of us are NOT employees of big companies. My husband owns his own shop – no employees – and I work for a company with only 3 employees so we have market place insurance for us and our daughter – total $918 per month just for insurance!! Plus deductibles and co pays and we have some issues – I am going into debt and don’t know how long but at this rate we will also be bankrupt at some point for sure. I hate when some think we are getting a handout! I don’t know anyone with work covered insurance who pays even close to that! there is no such thing as the 8.5% max – that is only if you are already lucky enough to have employer sponsored insurance. Since we are now only a family of 3 – we make too much money – we don’t have any savings and can barely get by – I don’t know where they come up with these incomes that are supposed to make this insurance affordable – it’s just ridiculous – see you in bankruptcy court – wonder if outstanding insurance premiums are exempt from that like taxes

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If the cheapest plan available to you cost more than 8% of your household income for self-only coverage, or on average for the family, then you are exempt from the fee. That is the 8% rule, the 9.5% rule applies to those who get coverage through work. For self-employed coverage you can write off medical expenses including premiums (for the self employed the tax break is essentially the “tax credit”.) Still, coverage can be expensive, and even 8% of household income for one person is rather a lot of money.

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I’m right there with you, I was laid off and so lost my grandfathered healthcare, new employer still pays what would be fine had the aca not come in and made insurance unaffordable through new requirements. Does this 9.5% thing only apply to the cheapest bronze plan available, I’m paying over 11% after subsidies, but I’m in a silver plan. My insurance, that work paid, runs about the same as the exchange price, but plan was far, far better than the crappy aca plan I have. We’ll all be broke at this rate, but hey, better to have 2 jobs, live off of top ramen and beg for death everyday and be insured, then to be insured and pay less right.

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For individual plans the cheapest plan has to cost more than 8% of household income, for self-only coverage, for the cheapest plan (which would be the lowest cost bronze plan available to you through the Marketplace).

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Bleep-beep-boop I do not compute human, is this your attempt at a joke?

clarification needed

Why blame the Republicans? Wasn’t this a law voted in by the Democrats? From what I’ve read and observed this was largely opposed by Republicans. By the way, I do not identify with any party but choose to vote on the best individual whenever possible.

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100% Democrats voted for ACA
NO REPUBLICANS.
I am self employed and my insurance is aprox 24% of my income also.
Basically the self employeed will foot the bill for others until they crush us.
Then you will see socialized medicine. 2-? Months for treatments.
Talk to a Canadian about it. Not just one that has never had a health issue.

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Well self employed have lots of write-off benefits with healthcare and can get cost assistance, but sure it can be pretty bad in certain situations.

As for the Canada stuff, that is really bunk. We have the most insanely rationed system in the west, as it is rationed on money that people don’t have… admittedly for some, in part due to the cost of premiums in the first place. I am not a supporter of our problems, but I am willing to defend solutions.

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A little history lesson. When the Affordable Care Act was being developed, Senate Republicans pushed for 210 amendments. The Senate Democrats adopted 161 of those amendments and several key GOP planks, one of which was the elimination of the public option. In other words, only 49 Republican amendments were rejected out of 210 considered, yet the bill got zero Republican votes when it passed out of committee for full Senate vote. So, yes you can blame the Republicans as well as the Democrats for the failures of Obamacare. Obamacare IS basically the GOP version of healthcare, originally used in Massachusetts, and at the time called Romneycare, which also did not have a public option. The public option would have made the Affordable Care Act actually affordable for everyone.

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Yeah, exactly. I don’t have specifics on the numbers on hand, but the concept here is 100% correct. The biggest shame was losing the public option part of Romney Care for ObamaCare. The second biggest shame was the GOP playing Peter for the next 8 years. “I don’t know him!” “I’ve never heard of an ObamaCare or mandate system!” Oh really GOP…? Oh really?

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The problem is you have people making 65k a year as older self employed couples who have $2000 a month payments with 10k deductibles. That’s real, and crazy. The best strategy is for them to quit their jobs, go on unemployment and they’ll make about the same as they’ll now qualify for everything. Sad Part is people are doing that not cause they want to, but because they have to. I blame the government as a whole, both parties. This is a real problem that needs to be solved quickly as the poverty level will increase further accelerating premiums on the middle class. A vicious cycle with no end .

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There are millions of contractors in the US tech industry right now who can’t afford these premiums. Never mind we are the techs keeping your big data-centers running so everyone’s flights, rental cars, the food industry, energy grids, etc., are running redundantly. Unfortunately it’s been cheaper to pay the “fine” then the premiums. I’m uncovered but luckily my wife and kids are covered by their American Indian health benefits. I’m in my 40’s and have worked and paid taxes in the US since I was 16. Unfortunately; however, many in the tech industry have opted to avoid paying benefits by subscribing to ‘contract for hire payment’ despite being full time employees and in most cases working beyond that is the expectation. I’m currently saddled with a torn meniscus and a badly torn rotator cuff that has to go untreated for the time being because my wife and I simply don’t make enough to pay the premiums or the doctor/surgeon bills that will undoubtedly pile up forcing us into debt we may never recover from. When choosing between my kids lively hood, where staying in the home we love or more importantly the school they attend, and my minor health issues is really no choice at all. My only recourse while working my butt off is to suffer and somehow manage to not be hospitalized any time soon. There’s no telling how many others are suffering the same circumstances just waiting for the inevitable and unfortunate to occur. It’s hard to take when I hear someone who barely works or better yet wants to work getting better healthcare than me. Thanks for listening.

Sorry about the misunderstanding. The story is an important one.

The comment was clarifying the difference between the 9.5% employee-only income affordability limit in the workplace and the 8% affordability limit that exempts one from the fee. The 9.5% does not apply to self employed individuals.

Self employed individuals, regardless of what they make, are wise to get a marketplace plan. If during the year income changes, cost assistance can be applied at that point. So when your husband lost his job, and you knew your income would be lower, you could have qualified for cost assistance (for both premiums and out-of-pocket costs) moving forward throughout the year.

As this story illustrates, it is important for everyone to remember that ACA affordability is based on premiums, but total medical spending can be much higher. This is why Cost Sharing Reduction on the marketplace is so important.

The ACA actually does do a lot to curb costs, but it doesn’t discount that health insurance and health care are still very expensive costing many Americans more than what they would consider affordable. https://obamacarefacts.com/obamacare-control-costs/

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To be clear, losing one’s job qualifies them for special enrollment. Meaning the marketplace could be signed-up for upon losing one’s job outside of open enrollment.

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We don’t need health insurance first off. Everything does not have to be paid for. We the people allow this to go on blame ourselves. The country needs reform in a whole and fortitude and people need the heads examined

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By the way, the Framework is in place for 2017, for states or regions that choose to go that route. So the ACA could very well lead to a specific US solution for single payer that would get a test run in specific states and regions. Together as a country we can continue to address the health care crisis.

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If the framework is laid for single payer, that would be wonderful. But, my fear is all the things that are bad about the ACA will be wrongly blamed on “guvment run” healthcare because too many people do not understand healthcare financing and that the bad things about the ACA are only because it is NOT government run but controlled by the private insurance industry.

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Yep, because government run healthcare is so awesome, I guess you don’t know any vets. Look at the regulations that have made healthcare so bad, it used to be you get sick, go to a doctor and get fixed, now malpractice insurance is higher than the doctors salary, and we pay 12 dollars for aspirin at a hospital so they can pay for people who skip out on the bill. You want to see some actual changes for the better, sell insurance across state lines and tort reform. Also, I have friends and family in Canada, Mexico and Europe and socialized medicine is a complete farce. There are more bureaucrats in the nhs than actual healthcare workers, great healthcare system if you a bureaucrat and get to profit from it.

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Thank you for your story. There is nothing more frustrating than not being able to afford health coverage or care. The ACA does a lot, but it didn’t fix all of our problems. It provided the framework and solutions for many, but certainly not for everyone.

Only things to keep in mind are.

Coverage can’t cost more than 9.5% of employee only income.

If it costs more than 8% of any one person they are exempt from the fee and qualify for a hardship exemption.

If it does cost more than 9.5% you can get an exemption and shop for marketplace coverage.

At your income you can simply deny employer based coverage and get a cheaper plan. You are not required to take employer-sponsored coverage. The employer only gets in trouble if you get marketplace cost assistance.

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It is frustrating to read the response from “Fact” below, as the 9.5% claim is addressed in the story above and is about a self employed and middle income person. Whoever wrote the reply did not read the story carefully.

1st: The 9.5% ONLY applies to employee income so is of no help to people who are self employed or laid off. In addition, this 9.5% rule ONLY applies to an employee’s coverage, not family coverage. If am employee is insuring their family, there is no limit. Also, employers find ways to offset any cost on their end since the coverage costs continue to rise.

2nd: The story is not about denying employee coverage for someone with low income. It is about self employed people with middle income who do not qualify for subsidies and have to pay the full price, which is extremely expensive and costs are still rising. The ACA has done nothing to bring down the cost of coverage.

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Zoom hits the point dead on. The self employed are left out. This year, 2016, my husband and I are paying 1611.77 per month for health insurance (we do not qualify for a subsidy and believe me we are not well off). We are not protected with a cap in premium costs at all. Hypothetically, we could pay what, 2, 3, 4 thousand a month if it came down to it????

And please don’t tell me, well, you are self employed, you can deduct those premiums!!
You try coming up with that nut every month, knowing that the next year, and the year after, those premiums will still go up.

So much for entrepreneurship in America…

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That is crazy expensive costs, but I mean what can I say. Self employed means you have access to cost assistance and CAN write off the costs. I find this to be one of the more favorable positions all things considered. But for sure, there are lots of costs on small businesses. I am a big supporter of all people and businesses who are playing by the rules, so with the facts for said, I also have many frustrations over how the self-employed and small businesses in America… and with rising healthcare costs.

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I am looking to reduce my health care costs. My husband and I are self employed. I have been researching the pros and cons of healthcare.gov. it is ugly! All of these stories…accounts of your health encounters are scary. I thought I was the only one with HIGH monthly premiums, of course, I am not. And then we do t get help from the plan. My deductible is $10,000.
I feel everyone pain! And we, the self employed should get some kinda help!!

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My husband is a a self employed consultant and I am a farmer. We pay $2165.00 per month for premiums on a Cobra’d Aetna Silver Policy from my husbands ex-employer.
It was the least expensive policy we could find. Price vs. benefits.
Every month I cry when the premiums are deducted. It is more than our mortgage and all household expenses combined.
I have spent endless hours trying to find a more affordable plan. There is nothing out there for us.
I may be forced to stop doing the work I adore, to go look for work that offers insurance coverage.
So disgusted and afraid for the future.

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