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” .
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.