Author Topic: Medicaid work requirements for the "able-bodied"  (Read 18678 times)

swampwiz

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Medicaid work requirements for the "able-bodied"
« on: January 23, 2018, 09:54:15 PM »
I will presume that a lot of folks here are in the same situation as me: early retired, with a decent level of liquid assets, but not generating a high income - I am such that I live off of 5-year seasoned conversion basis Roth IRA distributions, and therefore don't generate any income towards AGI (I do generate some income with Roth IRA conversion going forward, but only at the 0% federal tax bracket).  I am also on the ObamaRomneyHeritageCare Medicaid expansion - something that technically I am forced to take in lieu of an Exchange plan since my AGI is less than poverty, and I am ineligible for the premium tax credit.  But the rage across the nation is for those EVIL "able-bodied" folks - even those that have worked, and have built up a retirement nest egg, and now enjoying that - to not get Medicaid, so as to "restore dignity".  What, being able to retire early is not dignified?  Who says?

Now, if the law were changed so that American citizens could get the premium tax credit for an income below poverty - something that non-citizens are allowed (WHERE IS THE OUTRAGE FROM THE MAGA CROWD?) - this would not be an issue as I would simply pay the $500 or so in net costs for my coverage (i.e., including out-of-pocket), but with a broken government until 2021 (when the Democrats finally come to the rescue), this is the situation.  (Of course, one could always simply be "optimistic" in his income projection and hit the poverty level and essentially work around this ridiculous part of ORHC, but I digress.)

I am wondering how my fellow moustachers (I prefer the classic French spelling) feel about this, and what they plan to do about it.

jim555

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Re: Medicaid work requirements for the "able-bodied"
« Reply #1 on: January 24, 2018, 12:11:14 AM »
You can always move to a blue state that doesn't require work or generate additional income to get out of Medicaid and into the ACA metal plans.

The whole thing is illegal since it would require a change in the law.  They tried and failed to change the law last year now they come up with this as a swipe to the ACA.   

swampwiz

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Re: Medicaid work requirements for the "able-bodied"
« Reply #2 on: January 24, 2018, 12:24:18 AM »
You can always move to a blue state that doesn't require work or generate additional income to get out of Medicaid and into the ACA metal plans.

The whole thing is illegal since it would require a change in the law.  They tried and failed to change the law last year now they come up with this as a swipe to the ACA.   

There is no real need to generate additional income - only the "prediction" that somehow such income will be generated, and no way to prosecute anyone for doing this, as it would not be "due process" to expect someone for not performing perfect prognostication - but this is still an interesting dilemma for folks here, as we were firm adherents of "hard-working cheapskate" Calvinism in earlier days, and the political impetus for this is from those Calvinists who weren't a combination of income-generating & cheap as we were in their earlier days.

Monkey Uncle

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Re: Medicaid work requirements for the "able-bodied"
« Reply #3 on: January 24, 2018, 04:19:13 AM »
Just make sure your IRA conversions are large enough to get you out of Medicaid and onto an exchange plan, but not large enough to exceed the 0% tax bracket.

CBnCO

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Re: Medicaid work requirements for the "able-bodied"
« Reply #4 on: January 24, 2018, 11:41:18 AM »
Interesting post.

We are now in a position that if we structure our investments properly to minimize AGI, we could qualify for Medicaid coverage as well. Given how expensive insurance and care are getting be, this is definitely compelling; but, I do have a bit of a moral dilemma in whether someone who has chosen to FIRE with a substantial nest egg and spending habits that don't require much income (Moustacherians) should take advantage of the Medicaid benefit that is supposed to be a safety net for poor people.

On one hand, we want to do what is moral and ethical; but, I also think the ridiculous cost of health care and insurance is a direct result of government over-regulation (immoral & unethical), so why not take advantage of the rules as they are to benefit ourselves until such time the system becomes more rational and we can purchase healthcare services at reasonable and competitive rates???

As for the work requirement push..maybe you can form an LLC and work a few hours of week for yourself

VoteCthulu

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Re: Medicaid work requirements for the "able-bodied"
« Reply #5 on: January 24, 2018, 12:08:24 PM »
Many states with medicaid have claw-back provisions, so an average mustatian on medicaid is only getting a loan from the state that gets repaid at their death.

Eric

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Re: Medicaid work requirements for the "able-bodied"
« Reply #6 on: January 24, 2018, 12:54:54 PM »
Many states with medicaid have claw-back provisions, so an average mustatian on medicaid is only getting a loan from the state that gets repaid at their death.

Do you have any more info on this? 

hoping2retire35

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Re: Medicaid work requirements for the "able-bodied"
« Reply #7 on: January 24, 2018, 01:06:01 PM »
Many states with medicaid have claw-back provisions, so an average mustatian on medicaid is only getting a loan from the state that gets repaid at their death.

Do you have any more info on this? 
it is 5 years, just like Medicare

jim555

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Re: Medicaid work requirements for the "able-bodied"
« Reply #8 on: January 24, 2018, 01:15:28 PM »
From what I have gathered on estate recovery it may or may not apply, it depends on your state and how they interpret the Federal law.  It MIGHT apply from >54 yo only.  The states have a lot less incentive to go after it since the Feds pay 90% of ACA expansion and the states pay 10%, so they are not recovering like traditional Medicaid which is 50/50.

Jrr85

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Re: Medicaid work requirements for the "able-bodied"
« Reply #9 on: January 24, 2018, 01:24:24 PM »
I will presume that a lot of folks here are in the same situation as me: early retired, with a decent level of liquid assets, but not generating a high income - I am such that I live off of 5-year seasoned conversion basis Roth IRA distributions, and therefore don't generate any income towards AGI (I do generate some income with Roth IRA conversion going forward, but only at the 0% federal tax bracket).  I am also on the ObamaRomneyHeritageCare Medicaid expansion - something that technically I am forced to take in lieu of an Exchange plan since my AGI is less than poverty, and I am ineligible for the premium tax credit.  But the rage across the nation is for those EVIL "able-bodied" folks - even those that have worked, and have built up a retirement nest egg, and now enjoying that - to not get Medicaid, so as to "restore dignity".  What, being able to retire early is not dignified?  Who says?

Now, if the law were changed so that American citizens could get the premium tax credit for an income below poverty - something that non-citizens are allowed (WHERE IS THE OUTRAGE FROM THE MAGA CROWD?) - this would not be an issue as I would simply pay the $500 or so in net costs for my coverage (i.e., including out-of-pocket), but with a broken government until 2021 (when the Democrats finally come to the rescue), this is the situation.  (Of course, one could always simply be "optimistic" in his income projection and hit the poverty level and essentially work around this ridiculous part of ORHC, but I digress.)

I am wondering how my fellow moustachers (I prefer the classic French spelling) feel about this, and what they plan to do about it.

You are really upset that you are not able to collect on a means tested benefit without trying to work? 

I get taking government benefits you qualify for even if you arguably are not intended to benefit by the spirit of the law/regulation; our tax and spending policies are detached enough from morality that I don't think it's unreasonable for people to argue that they should pay as little as possible and take as much as possible and address any inequity through personal giving to actual needy people/worthy causes. 

I can get people complaining about SS and Medicare becoming less generous than they expected.  Even though they are straight welfare programs, they have been "pitched" to americans as some combination of retirement and insurance program that they "pay into" (as if they don't "pay into" TANF, Section 8, Medicaid, the Military, DOT, etc). 

But why would it bother you that a means tested program is actually doing something to be more effective at being means tested? 

Eric

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Re: Medicaid work requirements for the "able-bodied"
« Reply #10 on: January 24, 2018, 01:44:25 PM »
Many states with medicaid have claw-back provisions, so an average mustatian on medicaid is only getting a loan from the state that gets repaid at their death.

Do you have any more info on this? 
it is 5 years, just like Medicare

I don't know what that means.  There is no 5 year maximum for Medicare.  Most people are on Medicare for decades and none of them have any issues with needing to deal with a "claw back".

VoteCthulu

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Re: Medicaid work requirements for the "able-bodied"
« Reply #11 on: January 24, 2018, 02:18:05 PM »
Many states with medicaid have claw-back provisions, so an average mustatian on medicaid is only getting a loan from the state that gets repaid at their death.

Do you have any more info on this? 
it is 5 years, just like Medicare

I don't know what that means.  There is no 5 year maximum for Medicare.  Most people are on Medicare for decades and none of them have any issues with needing to deal with a "claw back".
Just Google "medicaid clawback" for as much info as you care to read. In many states, any assets you have in your estate or gifted to anyone in the last 5 years before you died can be taken by the state to reimburse any medicaid expenses you incurred.

Telecaster

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Re: Medicaid work requirements for the "able-bodied"
« Reply #12 on: January 24, 2018, 02:28:48 PM »

Just Google "medicaid clawback" for as much info as you care to read. In many states, any assets you have in your estate or gifted to anyone in the last 5 years before you died can be taken by the state to reimburse any medicaid expenses you incurred.

That's different than what you said up above, and it still isn't correct.     

VoteCthulu

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Re: Medicaid work requirements for the "able-bodied"
« Reply #13 on: January 24, 2018, 02:33:32 PM »

Just Google "medicaid clawback" for as much info as you care to read. In many states, any assets you have in your estate or gifted to anyone in the last 5 years before you died can be taken by the state to reimburse any medicaid expenses you incurred.

That's different than what you said up above, and it still isn't correct.   
What in my two posts is above is inconsistant? What exactly do you think is inaccurate? Or are you just trolling?

WhiteTrashCash

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Re: Medicaid work requirements for the "able-bodied"
« Reply #14 on: January 24, 2018, 02:37:31 PM »
Our President says that taking advantage of laws that save you money makes you "smart" no matter the ethical concerns. So listen to Donald Trump, keep doing what you are doing, and move to a blue state to escape persecution if you have to. Trump has a hot wife so he knows what he is talking about.

hoping2retire35

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Re: Medicaid work requirements for the "able-bodied"
« Reply #15 on: January 24, 2018, 02:47:10 PM »
Many states with medicaid have claw-back provisions, so an average mustatian on medicaid is only getting a loan from the state that gets repaid at their death.

Do you have any more info on this? 
it is 5 years, just like Medicare

I don't know what that means.  There is no 5 year maximum for Medicare.  Most people are on Medicare for decades and none of them have any issues with needing to deal with a "claw back".

Yes, on for decades, but they look up to 5 years before you started.

Dr. Pepper

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Re: Medicaid work requirements for the "able-bodied"
« Reply #16 on: January 24, 2018, 02:54:42 PM »
Just curious why they don't means test medicaid?  Seems silly to just base it off AGI, for obvious reasons. There are probably creative ways to dispose of assets before death, to avoid the clawback thing.

VoteCthulu

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Re: Medicaid work requirements for the "able-bodied"
« Reply #17 on: January 24, 2018, 03:08:41 PM »
Why is anyone talking about Medicare in this thread? The OP is talking about Medicaid and the two programs have very different rules.

Eric

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Re: Medicaid work requirements for the "able-bodied"
« Reply #18 on: January 24, 2018, 03:09:44 PM »
Many states with medicaid have claw-back provisions, so an average mustatian on medicaid is only getting a loan from the state that gets repaid at their death.

Do you have any more info on this? 
it is 5 years, just like Medicare

I don't know what that means.  There is no 5 year maximum for Medicare.  Most people are on Medicare for decades and none of them have any issues with needing to deal with a "claw back".

Yes, on for decades, but they look up to 5 years before you started.

I still have no idea what you're talking about.  Can you use more than one sentence to explain?  What do "they look up" 5 years before starting Medicare?  And why is this applicable in a thread talking about Medicaid?

Eric

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Re: Medicaid work requirements for the "able-bodied"
« Reply #19 on: January 24, 2018, 03:20:24 PM »
Just Google "medicaid clawback" for as much info as you care to read. In many states, any assets you have in your estate or gifted to anyone in the last 5 years before you died can be taken by the state to reimburse any medicaid expenses you incurred.

Okay.  So how is that relevant to this thread?  Unless the OP is planning to die in 5 years or less, I'm not seeing how it's applicable.  Presumably they could be on Medicaid through age 65 and then switch to Medicare for the rest of their life.  Assuming that they live to age 70, it doesn't appear to me that the Medicaid portion would be subject to any claw back, which is why I asked for more info.

VoteCthulu

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Re: Medicaid work requirements for the "able-bodied"
« Reply #20 on: January 24, 2018, 03:39:04 PM »
Just Google "medicaid clawback" for as much info as you care to read. In many states, any assets you have in your estate or gifted to anyone in the last 5 years before you died can be taken by the state to reimburse any medicaid expenses you incurred.

Okay.  So how is that relevant to this thread?  Unless the OP is planning to die in 5 years or less, I'm not seeing how it's applicable.  Presumably they could be on Medicaid through age 65 and then switch to Medicare for the rest of their life.  Assuming that they live to age 70, it doesn't appear to me that the Medicaid portion would be subject to any claw back, which is why I asked for more info.
It's relevant because there's less reason to worry about high net worth people with low incomes gaming medicaid or being EVIL (as the OP puts it). Instead they are just taking a loan from the government to pay for medical expenses that their heirs will pay for (by receiving less of an inheritance).

Eric

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Re: Medicaid work requirements for the "able-bodied"
« Reply #21 on: January 24, 2018, 03:45:07 PM »
Just Google "medicaid clawback" for as much info as you care to read. In many states, any assets you have in your estate or gifted to anyone in the last 5 years before you died can be taken by the state to reimburse any medicaid expenses you incurred.

Okay.  So how is that relevant to this thread?  Unless the OP is planning to die in 5 years or less, I'm not seeing how it's applicable.  Presumably they could be on Medicaid through age 65 and then switch to Medicare for the rest of their life.  Assuming that they live to age 70, it doesn't appear to me that the Medicaid portion would be subject to any claw back, which is why I asked for more info.
It's relevant because there's less reason to worry about high net worth people with low incomes gaming medicaid or being EVIL (as the OP puts it). Instead they are just taking a loan from the government to pay for medical expenses that their heirs will pay for (by receiving less of an inheritance).

You haven't provided any evidence of this.  The only claw back feature I'm aware of is for Medicaid spending that came at the end of their life.  That's to help offset the cost of nursing home and/or long term care.  So unless there is some provision that I'm not aware of (again, feel free to post evidence), then this whole line of thinking is completely irrelevant to the early retiree looking for health care coverage prior to Medicare eligibility. 

radram

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Re: Medicaid work requirements for the "able-bodied"
« Reply #22 on: January 24, 2018, 03:53:40 PM »
I will presume that a lot of folks here are in the same situation as me: early retired, with a decent level of liquid assets, but not generating a high income - I am such that I live off of 5-year seasoned conversion basis Roth IRA distributions, and therefore don't generate any income towards AGI (I do generate some income with Roth IRA conversion going forward, but only at the 0% federal tax bracket).  I am also on the ObamaRomneyHeritageCare Medicaid expansion - something that technically I am forced to take in lieu of an Exchange plan since my AGI is less than poverty, and I am ineligible for the premium tax credit.  But the rage across the nation is for those EVIL "able-bodied" folks - even those that have worked, and have built up a retirement nest egg, and now enjoying that - to not get Medicaid, so as to "restore dignity".  What, being able to retire early is not dignified?  Who says?

Now, if the law were changed so that American citizens could get the premium tax credit for an income below poverty - something that non-citizens are allowed (WHERE IS THE OUTRAGE FROM THE MAGA CROWD?) - this would not be an issue as I would simply pay the $500 or so in net costs for my coverage (i.e., including out-of-pocket), but with a broken government until 2021 (when the Democrats finally come to the rescue), this is the situation.  (Of course, one could always simply be "optimistic" in his income projection and hit the poverty level and essentially work around this ridiculous part of ORHC, but I digress.)

I am wondering how my fellow moustachers (I prefer the classic French spelling) feel about this, and what they plan to do about it.

You are really upset that you are not able to collect on a means tested benefit without trying to work? 

I get taking government benefits you qualify for even if you arguably are not intended to benefit by the spirit of the law/regulation; our tax and spending policies are detached enough from morality that I don't think it's unreasonable for people to argue that they should pay as little as possible and take as much as possible and address any inequity through personal giving to actual needy people/worthy causes. 

I can get people complaining about SS and Medicare becoming less generous than they expected.  Even though they are straight welfare programs, they have been "pitched" to americans as some combination of retirement and insurance program that they "pay into" (as if they don't "pay into" TANF, Section 8, Medicaid, the Military, DOT, etc). 

But why would it bother you that a means tested program is actually doing something to be more effective at being means tested?

I think I understand swamps frustration. Last year, we were "too poor" for ACA subsidies for our children while my wife and I qualified. The result was no fee care for our children, and a subsidy that covered about 85% of the premium for my wife and I. I wanted all of us to be in the ACA plan, but we did not make enough. The only choices were :
1. Have children go on medicaid.
2. Self insure children at full cost.
3. Earn more to get into an ACA plan.

Last year I took option 1, but it was a bit of a sticky wicket. If our annual  income came in too low, then we would have had to pay back the ACA subsidies for the wife and I. If too high, then the children were then  uninsured. It creates a financial ledge that places healthcare costs at risk, and you need to know a year ahead of time what your income will be. If you are wrong in 1 direction or the other, you owe. It seems almost purposefully confusing.

This led to some very silly financial decisions, like keep cash in checking so we don't make "too much".

This year I went with option 3, in part due to the foolishness I just mentioned regarding cash.


At this point, the sweet spot  for our family of 4 (1 in college)seems to be about $45,000 of annual income to earn enough to get off medicaid and still get an ACA subsidy while they still last. We will use the ROTH conversion to hit that threshold. I plan to do it in December instead of January because you can no longer re-characterize it in a market downturn.

While I do feel a little dirty about it, I will still play by the rules and take the subsidy. I also take my standard deduction, deduct my property taxes (for 1 more year), pay 0% taxes on long term capital gains for the first $75,000 or so, and defer all of my taxes owed on my unrealized gains forever (since there will be no gains due to step-up once I am dead).

One thing that may change is that once I am out of IRA money to convert to a Roth, I may force myself to realize gains I do not need right now for the sole purpose of generating income to get us to the sweet spot.

At least taxes are simpler :)

Cpa Cat

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Re: Medicaid work requirements for the "able-bodied"
« Reply #23 on: January 24, 2018, 03:55:22 PM »
It's a bad idea to rely on subsidized health insurance (either through an Obamacare subsidy or Medicaid) for FIRE, regardless of your situation. The political climate surrounding those subsidies is filled with uncertainty.

If you don't qualify for Medicaid because you won't work and you don't qualify for a subsidy because you don't show any AGI, then the answer is that you don't qualify.

Those programs weren't designed to help you. It is possible that those programs will accidentally help you, but that is not their intent.

At no point during policy development is anyone feeling bad about an early retiree with no taxable income, but plenty of assets. No one is concerned about the unfairness that you might not get your health insurance paid for. You are not part of an at-risk group that needs help with that.

CBnCO

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Re: Medicaid work requirements for the "able-bodied"
« Reply #24 on: January 24, 2018, 04:08:38 PM »
Our President says that taking advantage of laws that save you money makes you "smart" no matter the ethical concerns. So listen to Donald Trump, keep doing what you are doing, and move to a blue state to escape persecution if you have to. Trump has a hot wife so he knows what he is talking about.

Ha! Now that's funny. Don't forget about his hot, porn star girlfriend while you are at it!

MidWestLove

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Re: Medicaid work requirements for the "able-bodied"
« Reply #25 on: January 24, 2018, 05:05:15 PM »
"
If you don't qualify for Medicaid because you won't work and you don't qualify for a subsidy because you don't show any AGI, then the answer is that you don't qualify.

Those programs weren't designed to help you. It is possible that those programs will accidentally help you, but that is not their intent.

At no point during policy development is anyone feeling bad about an early retiree with no taxable income, but plenty of assets. No one is concerned about the unfairness that you might not get your health insurance paid for. You are not part of an at-risk group that needs help with that.

"
+1 basically that.  realize what a fortunate situation you are already in and adjust from there.

and be thankful that that we are not 'democratic'  and 'socialistic'  (left wing authoritarian statist/fascists)  enough as whole enlightened states in western Europe our blue states try to emulate that came up with things like wealth tax on everything you own.   since clearly you are the evil rich that stole from others in the eyes of the left wing , and should be dealt with accordingly through taxation..

on a more serious note, if you really want earned income to leverage specific programs how about generating some through working? is there truly nothing you want to do at all?


VoteCthulu

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Re: Medicaid work requirements for the "able-bodied"
« Reply #26 on: January 24, 2018, 05:19:45 PM »
Just Google "medicaid clawback" for as much info as you care to read. In many states, any assets you have in your estate or gifted to anyone in the last 5 years before you died can be taken by the state to reimburse any medicaid expenses you incurred.

Okay.  So how is that relevant to this thread?  Unless the OP is planning to die in 5 years or less, I'm not seeing how it's applicable.  Presumably they could be on Medicaid through age 65 and then switch to Medicare for the rest of their life.  Assuming that they live to age 70, it doesn't appear to me that the Medicaid portion would be subject to any claw back, which is why I asked for more info.
It's relevant because there's less reason to worry about high net worth people with low incomes gaming medicaid or being EVIL (as the OP puts it). Instead they are just taking a loan from the government to pay for medical expenses that their heirs will pay for (by receiving less of an inheritance).

You haven't provided any evidence of this.  The only claw back feature I'm aware of is for Medicaid spending that came at the end of their life.  That's to help offset the cost of nursing home and/or long term care.  So unless there is some provision that I'm not aware of (again, feel free to post evidence), then this whole line of thinking is completely irrelevant to the early retiree looking for health care coverage prior to Medicare eligibility.
https://www.medicaid.gov/medicaid/eligibility/estate-recovery/index.html
The details of how they implement this vary by state.

Eric

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Re: Medicaid work requirements for the "able-bodied"
« Reply #27 on: January 24, 2018, 05:58:10 PM »
Just Google "medicaid clawback" for as much info as you care to read. In many states, any assets you have in your estate or gifted to anyone in the last 5 years before you died can be taken by the state to reimburse any medicaid expenses you incurred.

Okay.  So how is that relevant to this thread?  Unless the OP is planning to die in 5 years or less, I'm not seeing how it's applicable.  Presumably they could be on Medicaid through age 65 and then switch to Medicare for the rest of their life.  Assuming that they live to age 70, it doesn't appear to me that the Medicaid portion would be subject to any claw back, which is why I asked for more info.
It's relevant because there's less reason to worry about high net worth people with low incomes gaming medicaid or being EVIL (as the OP puts it). Instead they are just taking a loan from the government to pay for medical expenses that their heirs will pay for (by receiving less of an inheritance).

You haven't provided any evidence of this.  The only claw back feature I'm aware of is for Medicaid spending that came at the end of their life.  That's to help offset the cost of nursing home and/or long term care.  So unless there is some provision that I'm not aware of (again, feel free to post evidence), then this whole line of thinking is completely irrelevant to the early retiree looking for health care coverage prior to Medicare eligibility.
https://www.medicaid.gov/medicaid/eligibility/estate-recovery/index.html
The details of how they implement this vary by state.

Hmmm, interesting.  Minimum age for any of this is 55, and it sounds like it's still mostly focused on nursing home care (for good reason), although the option is there for each state to go further.

jim555

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Re: Medicaid work requirements for the "able-bodied"
« Reply #28 on: January 24, 2018, 07:04:04 PM »
"
If you don't qualify for Medicaid because you won't work and you don't qualify for a subsidy because you don't show any AGI, then the answer is that you don't qualify.

Those programs weren't designed to help you. It is possible that those programs will accidentally help you, but that is not their intent.

At no point during policy development is anyone feeling bad about an early retiree with no taxable income, but plenty of assets. No one is concerned about the unfairness that you might not get your health insurance paid for. You are not part of an at-risk group that needs help with that.

"
+1 basically that.  realize what a fortunate situation you are already in and adjust from there.

and be thankful that that we are not 'democratic'  and 'socialistic'  (left wing authoritarian statist/fascists)  enough as whole enlightened states in western Europe our blue states try to emulate that came up with things like wealth tax on everything you own.   since clearly you are the evil rich that stole from others in the eyes of the left wing , and should be dealt with accordingly through taxation..

on a more serious note, if you really want earned income to leverage specific programs how about generating some through working? is there truly nothing you want to do at all?
some of wacko liberals would love to see European style universal healthcare for all despite increased taxes. At least it would be simpler.than trying to figure out the ACA ;-).
Back OT: So is this making Medicaid receipents work really a thing? How do they define able bodied? How much do you have to work? Will others on subsidies also be required to do means testing? I know that means testing has proven too difficult in the past so what's changed?
Some states applied for a 1115 waiver to permit the work requirement.  This will be challenged in court since the law doesn't have any work requirement and a 1115 waiver is for demo projects to further the ends of the program.  This is not furthering anything but knocking people off Medicaid and loosing coverage.  A state can always opt out of the expansion if they want to.  Obama did not approve these requests, now Trump is approving them.

Edit add:
The lawsuits have begun.  http://thehill.com/policy/healthcare/370517-groups-file-lawsuit-challenging-trump-admins-medicaid-work-requirements
« Last Edit: January 24, 2018, 07:18:33 PM by jim555 »

GU

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Re: Medicaid work requirements for the "able-bodied"
« Reply #29 on: January 24, 2018, 09:28:17 PM »
Our President says that taking advantage of laws that save you money makes you "smart" no matter the ethical concerns. So listen to Donald Trump, keep doing what you are doing, and move to a blue state to escape persecution if you have to. Trump has a hot wife so he knows what he is talking about.

I swear I've seen people banned or censored for less obnoxious trolling than this.

MidWestLove

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Re: Medicaid work requirements for the "able-bodied"
« Reply #30 on: January 25, 2018, 07:07:02 AM »
 some of wacko liberals would love to see European style universal healthcare for all despite increased taxes. At least it would be simpler.than trying to figure out the ACA ;-).
[/quote]

Ha! I think all of us want it (whichever artificial label one wants to put on any viewpoint) - the problem is that collectively we do not want to pay what it would cost . Try to sell national VAT plus say French income tax rates plus wealth tax and see how fast it would go down and how fast both political parties would run away from it , screaming . Also, US is an amazing laboratory where you can compare real people making real decisions on where to live and move to and look at examples like say New Jersey vs states like Texas (incoming/leaving resident ratios). In my state of Illinois, I believe I read that 62 as a number (out of 100 people moved, 38 moved into Illinois and 62 moved out).

back on topic, I am interested in this as well as early retired/FI person who has to worry about healthcare...

wenchsenior

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Re: Medicaid work requirements for the "able-bodied"
« Reply #31 on: January 25, 2018, 07:20:30 AM »
Our President says that taking advantage of laws that save you money makes you "smart" no matter the ethical concerns. So listen to Donald Trump, keep doing what you are doing, and move to a blue state to escape persecution if you have to. Trump has a hot wife so he knows what he is talking about.

I swear I've seen people banned or censored for less obnoxious trolling than this.

Pretty sure this is sarcasm.  Though honestly, I'm now realizing I don't really know the difference between sarcasm and trolling in this context.

goatmom

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Re: Medicaid work requirements for the "able-bodied"
« Reply #32 on: January 25, 2018, 07:43:59 AM »
I am not sure of the exact definition of "able bodied."  For social security disability - I think they use the Walmart greeter test.  If you can do that - you can work.  I am really surprised at times with the people that get denied for disability.  I am also surprised sometimes at the people that apply for it!  I imagine it would be similar.  I am more concerned with people with serious health issues that can't work and get turned down for disability.   Currently, there are loopholes that allow you to qualify - but really should hard working people have to work harder to you don't have to?  I don't mind paying for people that can't work. I agree that you should have a plan on how to finance your healthcare in early retirement.  Interesting information about the clawback.  I know New York State can get pretty aggressive with an estate when Grandma dies and she has been in a nursing home paid by medicaid.

jim555

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Re: Medicaid work requirements for the "able-bodied"
« Reply #33 on: January 25, 2018, 11:24:21 AM »
If they start means testing Medicaid medical insurance (like they do with traditional Medicaid) and don't allow people in the OPs situation to go on expanded Medicaid, will they allow them to qualify for subsidies?

I just did a quick glance at the subsidy amounts and it looks like someone just above the Medicaid cutoff could get almost all their premiums covered, as well as cost sharing for out of pocket stuff. So the taxpayers will still be footing a large cost for the able bodied low income/high asset person even if no longer on Medicaid. Although it may be cheaper to pay out thousands of tax dollars in premium subsidies and cost shares to private insurers for each low income person no longer on Medicaid then to pay for actual medical expenses for all those people. Wonder if any one has run those numbers and compared costs?

In any case I can see that if they end up requiring means testing and/or employment for able bodied people on Medicaid they might require the same for people receiving subsidies.
The ACA subsidy level has a range of 100-400% FPL so as long as you get over 100 they should let a person get a subsidized plan.

Medicaid is probably cheaper than paying subsidies.

It is unlikely they would require work with the ACA subsidies as that would require a law re-write.  The only reason they are trying it with Medicaid is because they are trying to slip the change into a waiver.  This way they are hoping it will stick without a change in the law, having tried and failed in that effort last year.

swampwiz

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Re: Medicaid work requirements for the "able-bodied"
« Reply #34 on: January 25, 2018, 09:50:46 PM »
Our President says that taking advantage of laws that save you money makes you "smart" no matter the ethical concerns. So listen to Donald Trump, keep doing what you are doing, and move to a blue state to escape persecution if you have to. Trump has a hot wife so he knows what he is talking about.
BINGO!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

swampwiz

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Re: Medicaid work requirements for the "able-bodied"
« Reply #35 on: January 25, 2018, 10:11:09 PM »
I've seemed to hit on a good subject, so I will take it further in its development.

It seems that the "hard work is moral" crowd - who are firmly behind whom has to be the most morally debased man to ever occupy the White House - is basically saying that Medicaid should be akin to an Earned Income Tax Credit.  But it would also seem that to be consistent, the ACA Premium Tax Credit should also only be given to folks who show the "morality" of getting a job (I suppose that we could presume that everyone could get a job no matter what his circumstances are) as well. 

And, to paraphrase Otter from Animal House, if we go that far, then shouldn't we make other tax credits and deductions subject to a "morality test"?  Perhaps we could say that someone who is a vulture capitalist is not moral, and therefore tax him - and his underground garage with elevator on the California coast even though he is politician from Massachusetts or Utah or whatever - at a higher rate than someone who earns his income in a more "moral way"?  Could the libertarians who don't want to spend on the poor accept a tax regime that decides what income is more moral, and therefore more worthy of a lower tax rate?  Wouldn't this be on the slippery slope of social Marxism?  Well, I for one am not going to sit here and have the USA turn into the Killing Fields of the Khmer Rouge.  GENTLEMEN!
« Last Edit: January 25, 2018, 10:13:19 PM by swampwiz »

swampwiz

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Re: Medicaid work requirements for the "able-bodied"
« Reply #36 on: January 25, 2018, 10:20:54 PM »
The ACA subsidy level has a range of 100-400% FPL so as long as you get over 100 they should let a person get a subsidized plan.

Medicaid is probably cheaper than paying subsidies.
It is, and that's why it was done that way.  Basically, the social meme of the law is that Medicaid is the most cost-efficient health care program, but we need to make sure that most folks don't get the good deal, so as to keep up "The (Health Care) Matrix".

slackmax

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Re: Medicaid work requirements for the "able-bodied"
« Reply #37 on: January 26, 2018, 07:07:14 AM »
Just make sure your IRA conversions are large enough to get you out of Medicaid and onto an exchange plan, but not large enough to exceed the 0% tax bracket.

Around $16,660 I think was the minimum MAGI you needed in 2017 tax year to qualify for the ACA.  That puts you in the 10% tax bracket. The zero percent tax bracket is way down around $10,000 or so, isn't it?

I'm always in the 10% tax bracket after I get my MAGI up to $16,660 and end up owing about $600 in federal taxes. What am I doing wrong?

CBnCO

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Re: Medicaid work requirements for the "able-bodied"
« Reply #38 on: January 26, 2018, 10:55:21 AM »
I've seemed to hit on a good subject, so I will take it further in its development.

It seems that the "hard work is moral" crowd - who are firmly behind whom has to be the most morally debased man to ever occupy the White House - is basically saying that Medicaid should be akin to an Earned Income Tax Credit.  But it would also seem that to be consistent, the ACA Premium Tax Credit should also only be given to folks who show the "morality" of getting a job (I suppose that we could presume that everyone could get a job no matter what his circumstances are) as well. 

And, to paraphrase Otter from Animal House, if we go that far, then shouldn't we make other tax credits and deductions subject to a "morality test"?  Perhaps we could say that someone who is a vulture capitalist is not moral, and therefore tax him - and his underground garage with elevator on the California coast even though he is politician from Massachusetts or Utah or whatever - at a higher rate than someone who earns his income in a more "moral way"?  Could the libertarians who don't want to spend on the poor accept a tax regime that decides what income is more moral, and therefore more worthy of a lower tax rate?  Wouldn't this be on the slippery slope of social Marxism?  Well, I for one am not going to sit here and have the USA turn into the Killing Fields of the Khmer Rouge.  GENTLEMEN!

Hmm...the only moral question I orignally saw in this issue originally is whether a millionaire MMM'er should be proactive in order to qualify for Medicaid and/or subsidized health insurance. But, you now open another can of worms entirely.

Starts with the moral question of whether the government (guys with guns and jails and authority to use force) should be able to take your property (money) against your will under the guise of democracy (mob rule) and apply it to programs and causes you don't agree with?

Further, the libertarian argument has never been to foresake the poor; but, to make all associations voluntary. Any historian would agree that the poor in a society must be supported or ultimately a society will meet it's demise. The libertarian view advocates private, voluntary donations of time and money to privately run charities instead of forced taxation to the inefficient and corrupt government administered system we have today. Personally, if I am to donate money to a charity, I want to see that it's run in an efficient and responsible manner and that its recipients, along with the assistance they receive, are doing what they can to improve their plight. (And, "doing what they can" does not mean voting for whatever politician or party that gives the best handouts).

There are too many nuances to the "able bodied should work" argument to have a single answer for all; but, in general I think both sides of the argument need to give a little. If a person is truly able bodied and can work to even partially support themselves and/or their family, they should make the effort to do so. For those that do not have this ability, we should all band together and provide assistance. Then, we can have the argument as to whether voluntary donations to charity or tax funded, politician run, government programs are the best tactical method to assist the poor.

Coming full circle, it's my conclusion that in a vacuum a millionaire MMM'er would not be acting morally in taking assistance meant for the poor. But, alas, we do not live in a vacuum and that MMM'er has probably paid obscene amounts of taxes over the years into a morally corrupted and grossly indebted ($20T!) government apparatus that has over-regulated and partnered with the donor class of the medical realm (Ins cos, pharma, hospital congolmerates, AMA, etc..etc. etc.) to create a mostly unaffordable health care system that leads us here to this discussion. So, I say take the subsidy while you can if you can qualify.

shenlong55

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Re: Medicaid work requirements for the "able-bodied"
« Reply #39 on: January 26, 2018, 11:17:15 AM »
I've seemed to hit on a good subject, so I will take it further in its development.

It seems that the "hard work is moral" crowd - who are firmly behind whom has to be the most morally debased man to ever occupy the White House - is basically saying that Medicaid should be akin to an Earned Income Tax Credit.  But it would also seem that to be consistent, the ACA Premium Tax Credit should also only be given to folks who show the "morality" of getting a job (I suppose that we could presume that everyone could get a job no matter what his circumstances are) as well. 

And, to paraphrase Otter from Animal House, if we go that far, then shouldn't we make other tax credits and deductions subject to a "morality test"?  Perhaps we could say that someone who is a vulture capitalist is not moral, and therefore tax him - and his underground garage with elevator on the California coast even though he is politician from Massachusetts or Utah or whatever - at a higher rate than someone who earns his income in a more "moral way"?  Could the libertarians who don't want to spend on the poor accept a tax regime that decides what income is more moral, and therefore more worthy of a lower tax rate?  Wouldn't this be on the slippery slope of social Marxism?  Well, I for one am not going to sit here and have the USA turn into the Killing Fields of the Khmer Rouge.  GENTLEMEN!

Hmm...the only moral question I orignally saw in this issue originally is whether a millionaire MMM'er should be proactive in order to qualify for Medicaid and/or subsidized health insurance. But, you now open another can of worms entirely.

Starts with the moral question of whether the government (guys with guns and jails and authority to use force) should be able to take your property (money) against your will under the guise of democracy (mob rule) and apply it to programs and causes you don't agree with?

Further, the libertarian argument has never been to foresake the poor; but, to make all associations voluntary. Any historian would agree that the poor in a society must be supported or ultimately a society will meet it's demise. The libertarian view advocates private, voluntary donations of time and money to privately run charities instead of forced taxation to the inefficient and corrupt government administered system we have today. Personally, if I am to donate money to a charity, I want to see that it's run in an efficient and responsible manner and that its recipients, along with the assistance they receive, are doing what they can to improve their plight. (And, "doing what they can" does not mean voting for whatever politician or party that gives the best handouts).

There are too many nuances to the "able bodied should work" argument to have a single answer for all; but, in general I think both sides of the argument need to give a little. If a person is truly able bodied and can work to even partially support themselves and/or their family, they should make the effort to do so. For those that do not have this ability, we should all band together and provide assistance. Then, we can have the argument as to whether voluntary donations to charity or tax funded, politician run, government programs are the best tactical method to assist the poor.

Coming full circle, it's my conclusion that in a vacuum a millionaire MMM'er would not be acting morally in taking assistance meant for the poor. But, alas, we do not live in a vacuum and that MMM'er has probably paid obscene amounts of taxes over the years into a morally corrupted and grossly indebted ($20T!) government apparatus that has over-regulated and partnered with the donor class of the medical realm (Ins cos, pharma, hospital congolmerates, AMA, etc..etc. etc.) to create a mostly unaffordable health care system that leads us here to this discussion. So, I say take the subsidy while you can if you can qualify.

If I were a libertarian who believed that the government was inefficient and corrupt, I would be working on creating the private entity that would take the place of the government programs that I didn't like instead of running for a government position.  After all, why would we need a food stamps program if Libertarian Charity X was already making sure all Americans are fed?  In the absence of Libertarian Charity X however, it just makes one seem cruel to advocate for ending an imperfect solution to hunger in favor of an imaginary perfect solution.

Jrr85

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Re: Medicaid work requirements for the "able-bodied"
« Reply #40 on: January 26, 2018, 11:24:18 AM »
I've seemed to hit on a good subject, so I will take it further in its development.

It seems that the "hard work is moral" crowd - who are firmly behind whom has to be the most morally debased man to ever occupy the White House - is basically saying that Medicaid should be akin to an Earned Income Tax Credit.
  I'm not sure anybody is saying Medicaid should be akin to an earned income tax credit.  I think they are saying it is a welfare program meant for the poor, and if you are able bodied and not trying to work, that's a pretty good sign you are not poor. 


  But it would also seem that to be consistent, the ACA Premium Tax Credit should also only be given to folks who show the "morality" of getting a job (I suppose that we could presume that everyone could get a job no matter what his circumstances are) as well. 
  I think a lot of people would agree it is ridiculous to subsidize rich people just because they choose not to work or choose not to work full time.  But ACA Premium subsidies were pitched as something between what people consider "true welfare" like medicaid and what people consider "not welfare" even though it is like social security and medicare.  If you're ok with non-means tested welfare, then it's logical that the work requirement would apply to medicaid and not to non-means tested welfare programs.  The work requirement serves a purpose of ensuring that the welfare program for the poor and needy actually goes to the poor and needy.  If you support welfare programs for the middle class and rich, then the work requirement doesn't do anything to ensure that the welfare goes to the intended beneficiaries. 


Tabaxus

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Re: Medicaid work requirements for the "able-bodied"
« Reply #41 on: January 26, 2018, 12:19:05 PM »
I've always found the idea that people that are voluntarily retired and under a certain age are eligible for ACA subsidies to be totally ridiculous.  I support early retirement as a concept.  I certainly should not have my tax dollars funding it, though.  (I actually support universal healthcare, but as long as we're not at that stage, I view early retirees claiming ACA subsidies as a 100% system bust.)  Same goes for Medicaid/Medicare, etc.  You aren't FI if you have to rely on government assistance to be FI.  I'm not saying that people shouldn't claim every penny they're entitled to claim, but I certainly don't think you should in fact be entitled to claim it.

the_fixer

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Re: Medicaid work requirements for the "able-bodied"
« Reply #42 on: January 26, 2018, 02:00:47 PM »
I am guessing it would cost more to means test than to just let the small percentage of people that have wealth but qualify for either subsidy or free healthcare have it.

I am sure the government would love having more forms, more employees and more departments to spend 5m to save 500k.


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Eric

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Re: Medicaid work requirements for the "able-bodied"
« Reply #43 on: January 26, 2018, 03:02:15 PM »
I've always found the idea that people that are voluntarily retired and under a certain age are eligible for ACA subsidies to be totally ridiculous.  I support early retirement as a concept.  I certainly should not have my tax dollars funding it, though.  (I actually support universal healthcare, but as long as we're not at that stage, I view early retirees claiming ACA subsidies as a 100% system bust.)  Same goes for Medicaid/Medicare, etc.  You aren't FI if you have to rely on government assistance to be FI.  I'm not saying that people shouldn't claim every penny they're entitled to claim, but I certainly don't think you should in fact be entitled to claim it.

Exactly.  Those early retirees better not be using the library that my tax dollars pay for.  They better not drive on any roads paid for by taxes either.  They shouldn't be allowed to use police or fire department resources either.  They shouldn't be able to send their kids to public school.  They shouldn't be able to claim a mortgage interest tax deduction.  If they do any of these things, then it's obvious that they're relying on government assistance and are therefore not really FI.  My tax dollars shouldn't support early retirees in any way.

See how ridiculous that sounds?

SimpleCycle

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Re: Medicaid work requirements for the "able-bodied"
« Reply #44 on: January 26, 2018, 03:05:03 PM »
Medicaid used to have asset tests and they were eliminated with the ACA for certain groups of people, namely non-elderly non-disabled adults.  I am not sure the reasoning, I think they could have just raised the asset levels and indexed them to inflation, but maybe there was a policy problem that was solved by eliminating the asset test.  At the very least, it greatly simplified qualifying for Medicaid and didn't require poor families to stay poor or lose insurance.

OP, just think that it could be worse.  You could be an ACTUAL poor person in a non-expansion state.  I honestly have no problem with people with enough assets to FIRE needing to pay sticker price for an ACA plan to avoid work requirements.

SimpleCycle

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Re: Medicaid work requirements for the "able-bodied"
« Reply #45 on: January 26, 2018, 03:06:19 PM »
I am guessing it would cost more to means test than to just let the small percentage of people that have wealth but qualify for either subsidy or free healthcare have it.

I am sure the government would love having more forms, more employees and more departments to spend 5m to save 500k.


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Medicaid was almost always asset tested before the ACA, and it still asset tested for several groups with categorical eligibility.

Tabaxus

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Re: Medicaid work requirements for the "able-bodied"
« Reply #46 on: January 26, 2018, 03:15:27 PM »
I've always found the idea that people that are voluntarily retired and under a certain age are eligible for ACA subsidies to be totally ridiculous.  I support early retirement as a concept.  I certainly should not have my tax dollars funding it, though.  (I actually support universal healthcare, but as long as we're not at that stage, I view early retirees claiming ACA subsidies as a 100% system bust.)  Same goes for Medicaid/Medicare, etc.  You aren't FI if you have to rely on government assistance to be FI.  I'm not saying that people shouldn't claim every penny they're entitled to claim, but I certainly don't think you should in fact be entitled to claim it.

Exactly.  Those early retirees better not be using the library that my tax dollars pay for.  They better not drive on any roads paid for by taxes either.  They shouldn't be allowed to use police or fire department resources either.  They shouldn't be able to send their kids to public school.  They shouldn't be able to claim a mortgage interest tax deduction.  If they do any of these things, then it's obvious that they're relying on government assistance and are therefore not really FI.

See how ridiculous that sounds?

If this post my me roll my eyes any harder, it would have blinded me.  I'm not going to get into all of the ways that this is a ridiculous false equivalence.

Eric

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Re: Medicaid work requirements for the "able-bodied"
« Reply #47 on: January 26, 2018, 03:30:34 PM »
I've always found the idea that people that are voluntarily retired and under a certain age are eligible for ACA subsidies to be totally ridiculous.  I support early retirement as a concept.  I certainly should not have my tax dollars funding it, though.  (I actually support universal healthcare, but as long as we're not at that stage, I view early retirees claiming ACA subsidies as a 100% system bust.)  Same goes for Medicaid/Medicare, etc.  You aren't FI if you have to rely on government assistance to be FI.  I'm not saying that people shouldn't claim every penny they're entitled to claim, but I certainly don't think you should in fact be entitled to claim it.

Exactly.  Those early retirees better not be using the library that my tax dollars pay for.  They better not drive on any roads paid for by taxes either.  They shouldn't be allowed to use police or fire department resources either.  They shouldn't be able to send their kids to public school.  They shouldn't be able to claim a mortgage interest tax deduction.  If they do any of these things, then it's obvious that they're relying on government assistance and are therefore not really FI.

See how ridiculous that sounds?

If this post my me roll my eyes any harder, it would have blinded me.  I'm not going to get into all of the ways that this is a ridiculous false equivalence.

Ah yes, the ol' "don't use my own words against me" argument.  Excellent choice!

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Re: Medicaid work requirements for the "able-bodied"
« Reply #48 on: January 26, 2018, 03:40:51 PM »
I've always found the idea that people that are voluntarily retired and under a certain age are eligible for ACA subsidies to be totally ridiculous.  I support early retirement as a concept.  I certainly should not have my tax dollars funding it, though.  (I actually support universal healthcare, but as long as we're not at that stage, I view early retirees claiming ACA subsidies as a 100% system bust.)  Same goes for Medicaid/Medicare, etc.  You aren't FI if you have to rely on government assistance to be FI.  I'm not saying that people shouldn't claim every penny they're entitled to claim, but I certainly don't think you should in fact be entitled to claim it.

The issue I have with this is prior to ACA, I could buy insurance outright for $400 per month cheaper. ACA changed what sort of policies were available for me to buy. ACA subsidies were part of the deal to lower that cost back down. There are penalties for not buying the insurance that the government wants you to buy.

the_fixer

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Re: Medicaid work requirements for the "able-bodied"
« Reply #49 on: January 26, 2018, 03:40:57 PM »
I am guessing it would cost more to means test than to just let the small percentage of people that have wealth but qualify for either subsidy or free healthcare have it.

I am sure the government would love having more forms, more employees and more departments to spend 5m to save 500k.


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Medicaid was almost always asset tested before the ACA, and it still asset tested for several groups with categorical eligibility.
I admit I know very little about what they use to qualify people. I was just pointing out that with the small percentage of people that have large sums of money qualifying and abusing it is likely minimal and not worth going after.

I have been known to be wrong before :)

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