Unaffordable Coverage Option Story With Solutions

Obamacare is about to ruin my life. I now work 40 hours per week for an employer who has more than 50 full time employees, although many employees were cut back to 30 hours due to the ACA. I escaped that misery. But the law is still set to have a horrible impact on my life.

My employer offers insurance through BC/BS, and the individual payment would be 65 dollars per week. I make, gross, 370 dollars per week. I am left with much less after the mandated deductions.

In any case, there is no way on earth that I can afford the 65 dollars per week.

The ACA law agrees that this is unaffordable to me, as it is over 17 per cent of my income. Gross income.

But, I cannot be expected to apply for insurance via an Obamacare exchange.

Read this:

“Employers are subject to fines (“assessable payments”) if they do not offer affordable coverage to full time employees. But under the statute the payment is triggered only if at least one employee receives a subsidy.”


Wouldn’t it be lovely for both myself and my employer if I were the “at least one” employee to receive a subsidy (which I would, if I applied via an exchange….since the cheapest plan available to me in Michigan would cost about half my income).

I am not going to make that happen to either of us. Obviously.

My employer offers what the company can afford. His family’s corporation is not Wally World.

I must conclude that the purpose of the law is to ruin the lives of the working poor, such as myself…I need all 40 hours to make expenses.

In addition, it must aim to ruin relatively small, successful employers who can afford to hire more than 50 full-time workers, but who cannot afford to subsidize the the exhorbitant cost of insurance.

The fool in the White House said that people could afford insurance if they quit buying t.v. and internet service. Not so.

As it is, I am cold in my house all winter, keeping it only warm enough to keep the pipes from freezing. Electric rates here are nearly the highest in the country. I do not have tv at all. I have a cell phone that costs 100 dollars per year, a “go phone”. There are no luxuries to cut, other than my land line phone (the cell phone does not always work in my house, sometimes I have to go outside to get a signal) and my dial-up internet access (which costs less than 150 dollars a year. Eliminating my land line would not allow me to afford insurance.

Buying insurance would ruin me.

Neither can I afford the fine, euphemistically called a “tax”.

I read that I cannot apply for an exemption from the fine, because affordability of insurance would be calculated assuming I use the subsidies provided by an exchange plan.

“The individual mandate penalty does not apply to those who cannot afford coverage. The implementing regulations apply the exemption if the annual cost of coverage exceeds 8% of household income. But in the calculation of cost, the tax subsidy is subtracted. As a result, millions who would have been exempt are forced to buy coverage.”

See above.

When one is f’d over by the government, one is truly f’d .

I’m sure you have some wise advice.


Please skip: Work fewer hours. I work 40 because I need to.

Also, skip: Get another part-time job and then have your hours cut at your primary job, so your employer will not be fined when you go through an exchange.

How unfair is that to me? I like my job, and I get a paid vacation week every year (which does more for my health than any insurance would), which I’d lose if I did that. Also, from experience, juggling multiple jobs is stressful enough to impact my health. If the government weren’t making unreasonable demands, it would never be a consideration.

Also, skip:: Telling me that if my employer were to “retaliate” by reducing my hours because I bought insurance through an exchange, I could get help from the Fair Labor Relations Board, or some such. An Obamacare “navigator” actually told me that…I am not joking. The perspective is all wrong. First, I would do exactly that in his shoes, to protect my business, not as “retaliation”. That would be a necessary act of self-defense. My employer is not the adversary here.

That scenario is definitely a fantasy. Even if I were foolish enough to believe that it would remedy the hours problem, that is not the kind of hell that I would put either myself or my employer through.

Understand, if you can, my employer is not being irresponsible in not affording a less expensive coverage that I could afford to buy. It is simply not an affordable expense for the business. I have no trouble understanding that. One would have to be in government, playing with the earnings of other peoples’ labor to not understand.

That seems to leave me stuck with a huge fine for being too poor to buy insurance, left out of the exchange by a provision that would impact both my employer and myself in a very unfair and cruel manner, and denied even the right to point out that I can afford neither the insurance nor the fine, much less the loss of my full time status at work.

I need my money (earned by my honest and useful labor —not by investment in for-profit health industries or pharmaceutical corporations) for food, shelter, heat. The basic necessities. Glasses when I need new ones…Obamacare skips eye care.

How dare anyone argue that 1 per cent of a working poor person’s income is negligible. The impact is on the ability to afford basic necessities.

This law and what it means to do it me is in fact making me ill.

Literally. I am under attack.

I am a 60 year old single woman who must work to pay my bills. Now the government threatens me that if I do work my full week for an employer unable to afford to offer me “affordable” insurance, I am then subject to paying for merely being alive and responsible enough to work for a living, while unable to afford insurance. Or I could cheerfully stick my employer with a huge fine, and see how well that works out for us.

So, what is your wise advice?

The individual mandate, like the employer mandate, is wholly immoral. The state of my gall bladder has nothing to do with where I work or who employs me and how many other people are employed by the business I work for. Nothing. Tying national health care to employment by corporations, small businesses, etc., is itself a travesty of justice.

I’d be thrilled to have basic insurance in case I break an arm, but for that, costs would need to be held down, as in civilized nations.

But that is another subject.

Finally, I am under no illusion that this web site is the work of two impartial..strangely unidentified… “guys”, despite the description. It stinks of a very interested party with an agenda. Nevertheless, here you have it.

Sent to https://obamacarefacts.com/contact/ on January 6, 2015

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I agree this whole thing sucks. I can’t afford to buy a policy at $500 a month. I can’t get a subsity because my gross income is too high. I can’t spend my gross income!! My take home pay is such that I can’t take on the premium. I get no consideration from the insurance companies for being healthy. I exercise, eat right and don’t use the doctors. So I very rarely need insurance but I have the same premium as someone who doesn’t do anything but lay on the couch and eat at MacDonald’s all the time. It’s just not right!!
And now all I have to look forward to is 4 more years of another democrat in the WHite House.


Well, for better or worse, it isn’t the Democrats who are to blame for the base cost of healthcare. Thus, no party will magically cure the underlying cost issues.

With that said, more work needs to be done. Basing assistance on Modified Adjusted gross income (not just gross income) is prickly, people have lots of costs like childcare, student debt, mortgage payments, that simply can’t be avoided. When we over-squeeze them then less debts are paid and this has a nasty effect on the economy in the long term.

I’m not sure the solution, but the problem is felt in many places. The only thing I know for sure is that we need more hard work put in to reforming healthcare, I am personally a big fan of section 1332 alternatives as this gives power to the people… unfortunately I haven’t seen a lot of people taking that power and running with it outside of a few plans here in there like WA and CO’s single payer attempts.


I want to pay the premiums for my daughter’s family coverage. They live in another state but already struggle (eat meat only once a week) since their income is $41,000/yr with two kids. Kids are under medicaid. the KP program premiums for the parents to get coveage would by nearly $200./mth. They simply can’t afford it. Would the kids lose their medicaid if I paid the family premiums?


So if you give a person money that they have to claim on their taxes (money that isn’t excluded from taxes) then that is going to hurt their assistance eligibility. Paying someone’s premium is the same as giving them money, but it could well be excluded under the gift tax rules.

Here are the rules for that: https://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/Frequently-Asked-Questions-on-Gift-Taxes and https://www.irs.gov/uac/Eight-Tips-to-Determine-if-Your-Gift-is-Taxable

You should be fine, but you’ll need to check. A much, much, much better idea for them may be for them to open and fund an HSA (they must fund it and lower their income) and then for you to gift them the money to make up the difference. That will up their cost assistance and lower their taxable income. It’s a little bit of juggling, but it may be the smartest solution.

So to sum up they put $6,500 in an HSA, pay lower taxes, get more subsidies, and you give them $6,500 in a gift. Or some variation of that. This is way better than simply paying premiums unless everyone is living paycheck to paycheck. In this situation it means some juggling for them, but I mean when someone is doing you a favor the least you can do is juggle.


For further clarification. Information on affordable coverage can be found on the 8965 instructions. It has to be an arrogate of 8%, so it would have to be 8% per-person. You can find out if you qualify by filling out the worksheet on page 10 of the 8965 – Exemptions worksheet. http://www.irs.gov/pub/irs-pdf/i8965.pdf


I’m a single parent living week to week, I have a house payment and utilities I don’t have any frills in my life. And yes I may have stretched my budget to get out of the “bad part of town” so my daughter could be in a good school district to get a good education and then you tell me I have to make what would be basically a car payment for me, and let’s not forget A third of my pay check goes to taxes social security(which my generation will never see) and what nots. I’m gonna have to file bankruptcy to afford this “affordable healthcare”. To me this sounds like insurance companies got Obama in office in exchange for this crap. $6000 a year that doesn’t go towards anything then $6000 before it does you any good. Yeah that’s helping the country step on the hard working people to help the generations of welfare families!


I can understand your frustration. To settle your mind, I am the co-owner and head writer of ObamaCareFacts.com (guy #1). I am really just a regular person with no political agenda. We aren’t affiliated with any party, and can assure you we get no outside funding. We started the site to help other people avoid the same confusion over the law we had back in 2012. We have tried to retain our privacy because the debate over the law is so heated we didn’t want to jeopardize our personal safety. That being said, we are in the midst of putting up an authorship page which will include a overview of who we are as people. And if you do a quick google search you’ll see our company is dogmediasolutions.com. Anyway, here is the actual answer to your situation.

You DO need to go apply for subsidies on the Marketplace. According to you, you make 165% of the Federal Poverty Level, that means a marketplace plan will cost about 4% of your total income (assuming no other household member earns income, if they do that counts). I based those numbers on your gross income. Your taxable amount (Modified Adjusted Gross Income) should be lower and thus you may qualify for much cheaper coverage (or Medicaid if your state expanded it).

Your employer isn’t going to be punished unless they are very large. For one unless they have more than 100 full-time equivalent workers they don’t have to comply with the mandate until 2016. Even if they do they only have to cover 75% of full-time workers in 2015. So they can simply not offer you coverage to get out of this. Even in 2016 it’s 95% of full-timers and never is it 100%. Even if they can’t offer the full 95%, and someone gets subsidies, their first 30 full-time workers are excluded from the fee.

It is your employers responsibility to offer coverage, not your responsibility to take one for the team. Being loyal to your employer is cool, and admirable really, but not at the expense of you having health insurance at age 60. There is nothing right or OK about that, and your employer should not expect this of you.

The law only comes down hard on truly large businesses, smaller businesses get tax credits, slightly larger are exempt from the fee, and only those with 50 or more full-time equivalents even face it.

Chances are you aren’t the only one who has unaffordable coverage through your employer. So even if you do your employer a favor and go without coverage, someone else might not. Your employer has lots of options, including not offering coverage to their lower earning employees. However, we strongly suggest you take advantage of the fact that you can get free or low cost coverage through the marketplace until Feb 15, 2015.

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