Obamacare numbers

[rusty]

While I was unemployed a few years ago, I was able to purchase catastrophic care. Is this really not available any more? That sounds nasty.

That's the kind of coverage I would want. For reasons unrelated to this thread, I usually shun "conventional" medical care and go the holistic route (have had much success with a couple of issues) and that stuff hardly ever gets covered by insurance anyways. I don't want to pay for care I don't want. I want it for cases of accidents, etc.

Unfortunately the politicians have decided that everyone needs to have strong coverage whether you like it or not.  As far as premiums, it all depends on your income in 2014.  This may change as ACA moves along, but for now, it's based on your 2014 income. 
 
HSA plans are no longer attractive either really.  The pricing difference between high deductible health plans (HSA + HDHP) and "full" major medical plans are not as much as they used to be.  You could buy an HSA plan anyway if you want access to tax free savings.  However, the people who receive subsidies often pick an "enhanced" silver plan that has lower deductibles and slightly more premium as opposed to a 5k deductible bronze plan with low/no premium.  Remember those who have low incomes end up comparing "enhanced" silver plans (cost share reduction + subsidy) with low copays, low deductibles, and low out of pocket maximums with standard bronze plans with $5k deductibles. 

It is much hard to explain it to people now because pricing is based on your income.  "Enhanced" silver plans often have better coverage and much lower premiums than platinum plans.  So with low income people, you get platinum plans that cost more and cover less.

[iris lily]

...While I was unemployed a few years ago, I was able to purchase catastrophic care. Is this really not available any more? That sounds nasty...

Catastrophic coverage is allowed for those under a certain age, I think the age is 30.

Doesn't mean that this isn't a nasty piece of legislation, however.  :)

[randymarsh]

...While I was unemployed a few years ago, I was able to purchase catastrophic care. Is this really not available any more? That sounds nasty...

Catastrophic coverage is allowed for those under a certain age, I think the age is 30.

Doesn't mean that this isn't a nasty piece of legislation, however.  :)

Yes, people under 30 can buy catastrophic coverage. However when I looked, the prices weren't very low compared to regular plans. I think one I looked at was ~$150. Meanwhile a silver plan was ~$200-250

[TreeTired]

Trying to address some of the questions asked upthread.

We live in NC which has no state exchange,  so the request for additional documentation came from the feds.  We logged onto our (my wife's)  dotgov ACA account and uploaded the documents.   I could not find the page that had the document upload feature so I had to call for help.  I was incredibly annoyed that I couldn't find it myself on the website, but ultimately it wasn't too difficult.  We couldn't upload a word document explaining what we were doing because the website couldn't handle that filetype!  Only pictures and PDFs.  LOL!     I will come back when (if?)  I get a  response.

We are 2 people, aged 61 living in NC.  Our natural passive income - dividends and interest - is around $30k.   I used this calculator to figure out our marginal ACA "tax rate" ,  ie how much will our ACA tax credit (I mean, "subsidy",  no, I mean tax credit)  be reduced for each additional $ of income. 

http://kff.org/interactive/subsidy-calculator/


First of all, the calculator tells me that if we only make $15,000 we get no subsidy and must pay full freight for our health insurance (about $1550 per month)  so it is imperative that we make more than $15k,  which fortunately for us is not a problem.  At the $30,000 income level every $1000 of income produced a decrease in the subsidy of 14 - 16%.   This would be on top of 6% or more state taxes and possibly 10% federal tax.  I don't see the point of doing a Roth conversion at this income level to pay 20% or 30% in taxes when I can just leave it to grow in my traditional IRA.   I have been doing Roth conversions the past 5 years that generated almost no additional tax liability.

If our MAGI is $62,000 our ACA subsidy would be $10,284.   If our MAGI is $63,000 or higher the subsidy disappears, so it really makes no financial sense to intentionally (with a Roth conversion) bump MAGI up to $63,000.    I do some minimum wage work that I enjoy that might make me $3000 this year.   Between social security, federal and state and reduction in ACA tax credit my effective marginal tax rate on this minimum wage work could be as high as 35%.

Here are the results from the calculator showing our ACA tax credit (subsidy) at income (MAGI) levels from $15k to $63k,  including the percentage change, as a percent of the income change.

MAGI       subsidy     pct change
$15,000.00        $0.00   
$16,000.00       $15,854.00   
$17,000.00       $15,834.00   -2.00%
$18,000.00       $15,814.00   -2.00%
$19,000.00       $15,794.00   -2.00%
$20,000.00       $15,774.00   -2.00%
$21,000.00       $15,514.00   -26.00%
$22,000.00       $15,399.00   -11.50%
$23,000.00       $15,276.00   -12.30%
$24,000.00       $15,162.00   -11.40%
$25,000.00       $15,045.00   -11.70%
$26,000.00       $14,923.00   -12.20%
$27,000.00       $14,795.00   -12.80%
$28,000.00       $14,661.00   -13.40%
$29,000.00       $14,521.00   -14.00%
$30,000.00       $14,375.00   -14.60%
$31,000.00       $14,223.00   -15.20%
$32,000.00       $14,087.00   -13.60%
$33,000.00       $13,948.00   -13.90%
$34,000.00       $13,803.00   -14.50%
$35,000.00       $13,655.00   -14.80%
$36,000.00       $13,501.00   -15.40%
$37,000.00       $13,344.00   -15.70%
$38,000.00       $13,181.00   -16.30%
$39,000.00       $13,018.00   -16.30%
$40,000.00       $12,862.00   -15.60%
$41,000.00       $12,703.00   -15.90%
$42,000.00       $12,540.00   -16.30%
$43,000.00       $12,373.00   -16.70%
$44,000.00       $12,202.00   -17.10%
$45,000.00       $12,028.00   -17.40%
$46,000.00       $11,850.00   -17.80%
$47,000.00       $11,709.00   -14.10%
$48,000.00       $11,614.00   -9.50%
$49,000.00       $11,519.00   -9.50%
$50,000.00       $11,424.00   -9.50%
$51,000.00       $11,329.00   -9.50%
$52,000.00       $11,234.00   -9.50%
$53,000.00       $11,139.00   -9.50%
$54,000.00       $11,044.00   -9.50%
$55,000.00       $10,949.00   -9.50%
$56,000.00       $10,854.00   -9.50%
$57,000.00       $10,759.00   -9.50%
$58,000.00       $10,664.00   -9.50%
$59,000.00       $10,569.00   -9.50%
$60,000.00       $10,474.00   -9.50%
$61,000.00       $10,379.00   -9.50%
$62,000.00       $10,284.00   -9.50%
$63,000.00       $0.00   

[iris lily]

Trying to address some of the questions asked upthread.

Thanks for this clear information. I knew that the subsidies dropped off at $62,000 and the sweet spot was considerably less, but this is very helpful.

[teen persuasion]

Whoah, I had not thought about that aspect of it. I'm in a No-Medicaid expansion state. While it would be unlikely that I would choose a retirement scenario that has us having  no income for a year, I hadn't thought about the effect of that choice on ACA qualifications. One CAN go too low to play the game, Check.

Yes, this is something early retirees should keep in mind.   I too am in a no-expansion state (although hopefully that will be changed soon).   If I don't make enough in a year to be above poverty for family size, I would wind up not qualifying for any subsidies and have to pay full price for ACA coverage.   It's still an improvement, IMO, to know that I can't be denied coverage, have premiums jacked up or dropped if I get very sick, etc, but I'd prefer to qualify for a subsidy and will keep this in mind when I'm closer to planning ER.

And even if you are in a Medicaid expanded state as I am, you may not want to go on Medicaid. But, if your taxable income is too low, it's your only choice short of paying 100% of your premiums without subsidies and buying directly from an insurer. This is what I am doing right now until I do something to increase my taxable income, or I'd have to go on Medicaid (don't wanna) or use the VA Hospital (don't wanna either). And with no more inexpensive catastrophic plans allowed, that can be quite costly. So for the very low taxable income people, you may want to plan on adding a little bit more  taxable income to your income stream just to get the subsidies. Rightly or wrongly (from an ethical POV) you can probably balance it so you get almost 100% subsidized health insurance premiums without having to go on Medicaid.

I'm finding my family in this boat, too.  DH recently quit his job, and has a job prospect out there, but a strike has HR dragging their feet, so our insurance goes poof at the end of the month.  Getting above the Medicaid threshold depends on family size and income, both of which are fuzzy.  Do we include DS2 who is in college and not our dependent (except to financial aid) but is on our insurance until age 26?  The bits of info I've found say not to count him, or his income, but somehow he can get insurance on ours.  We do seem to need to include dependents like DD3, who is also in college, and their income, but she may not count as a dependent on our 2014 return.  Our income for the year? Depends on when/if DH gets an offer.  The two younger boys and DD3 may be eligible for CHIPS, but DD3 only until she turns 19 in a few months!  Way too many moving parts and guesstimates.

[TreeTired]

If you need to generate income (MAGI) to get above the Medicaid level and qualify for ACA subsidies - especially if you live in a non Medicaid expansion state like NC -  if you have a traditional IRA then converting part of that to a Roth IRA will produce taxable income.  The first time we did this was in 2008 when we had almost no income, but we replace our A/C units and had an energy tax credit.  Rather than waste the tax credit I did a Roth conversion and paid no federal income taxes that year.

[Spartana]

And for those of you doing Trad IRA to Roth IRA conversions now to get added income to qualify for ACA subsidies, remember that when you start taking those Roth IRA withdrawals they will be tax free and not counted as income towards ACA then. So if your plan at age 59 1/2 was to start taking your tax free Roth IRA you won't be able to count that Roth money towards your income for ACA purposes and need to have a another "taxable" income source until you are old enough for Medicare at age 65 unless you live in a Medicaid expanded state and are OK going on Medicaid for those 5 years.

[teen persuasion]

If you need to generate income (MAGI) to get above the Medicaid level and qualify for ACA subsidies - especially if you live in a non Medicaid expansion state like NC -  if you have a traditional IRA then converting part of that to a Roth IRA will produce taxable income.  The first time we did this was in 2008 when we had almost no income, but we replace our A/C units and had an energy tax credit.  Rather than waste the tax credit I did a Roth conversion and paid no federal income taxes that year.

Possibly ok for a couple, but in our situation with kids, an increase in AGI means a loss of EITC and college financial aid.

[WannabeDone]

And for those of you doing Trad IRA to Roth IRA conversions now to get added income to qualify for ACA subsidies, remember that when you start taking those Roth IRA withdrawals they will be tax free and not counted as income towards ACA then. So if your plan at age 59 1/2 was to start taking your tax free Roth IRA you won't be able to count that Roth money towards your income for ACA purposes and need to have a another "taxable" income source until you are old enough for Medicare at age 65 unless you live in a Medicaid expanded state and are OK going on Medicaid for those 5 years.

Good point to bring up.  Thanks.

[Daisy]

And for those of you doing Trad IRA to Roth IRA conversions now to get added income to qualify for ACA subsidies, remember that when you start taking those Roth IRA withdrawals they will be tax free and not counted as income towards ACA then. So if your plan at age 59 1/2 was to start taking your tax free Roth IRA you won't be able to count that Roth money towards your income for ACA purposes and need to have a another "taxable" income source until you are old enough for Medicare at age 65 unless you live in a Medicaid expanded state and are OK going on Medicaid for those 5 years.

Yikes! Sounds like a quandary. Which is a more bitter pill to swallow - going on Medicaid or actually *gasp* getting a job for some income? Could you possibly get a part time job at one of your volunteering gigs?

This stuff scares me. Not so much these specific rules, but the fact that when Spartana retired, there's no way she could have known that this law would be passed and affect her in such a way. It seems like no matter how much planning you do, some law could get changed in the future that affects your plans. For example, a lot of us are depending on doing Traditional to Roth conversions. Will something here change that torpedoes our plans? I guess we will never know.

[geekette]

But you can spend the Roth conversion money and still convert more from your tIRA, no?  Unless you have converted all of a rather small tIRA by then.

[Daisy]

But you can spend the Roth conversion money and still convert more from your tIRA, no?  Unless you have converted all of a rather small tIRA by then.

I assume from her comments that she has dwindled down the traditional IRA.

Even more of a reason to load up on the 401k and traditional IRA to have some "income" to play with. But who knows, the rules could change in the future and we can get dinged another way.

BTW, is Medicaid that bad? I genuinely don't know.

Also, is Social Security considered income for ACA purposes? Maybe she just needs some income to tie her over until Social Security kicks in.

[Gin1984]

But you can spend the Roth conversion money and still convert more from your tIRA, no?  Unless you have converted all of a rather small tIRA by then.

I assume from her comments that she has dwindled down the traditional IRA.

Even more of a reason to load up on the 401k and traditional IRA to have some "income" to play with. But who knows, the rules could change in the future and we can get dinged another way.

BTW, is Medicaid that bad? I genuinely don't know.

Also, is Social Security considered income for ACA purposes? Maybe she just needs some income to tie her over until Social Security kicks in.

Depends on the state. 

[dabears847]

So many questions jump out from this now for me.

1. 72t applies in what way if I'm drawing down my 401k? 3 different withdrawal options...

2. IRA conversion will result in income each year I convert funds, correct? Say I go with the five year plan of converting 40,000 each year to a Roth so at the fifth year I have no Roth penalty.

Thoughts?
 

[Spartana]

And for those of you doing Trad IRA to Roth IRA conversions now to get added income to qualify for ACA subsidies, remember that when you start taking those Roth IRA withdrawals they will be tax free and not counted as income towards ACA then. So if your plan at age 59 1/2 was to start taking your tax free Roth IRA you won't be able to count that Roth money towards your income for ACA purposes and need to have a another "taxable" income source until you are old enough for Medicare at age 65 unless you live in a Medicaid expanded state and are OK going on Medicaid for those 5 years.

Yikes! Sounds like a quandary. Which is a more bitter pill to swallow - going on Medicaid or actually *gasp* getting a job for some income? Could you possibly get a part time job at one of your volunteering gigs?

This stuff scares me. Not so much these specific rules, but the fact that when Spartana retired, there's no way she could have known that this law would be passed and affect her in such a way. It seems like no matter how much planning you do, some law could get changed in the future that affects your plans. For example, a lot of us are depending on doing Traditional to Roth conversions. Will something here change that torpedoes our plans? I guess we will never know.

You make a good point Daisy - what type of medical coverage is available when people begin ER might not be available forever. When I retired at 42 I just bought an inexpensive catastrophic policy that did me very well until Obamacare started and it was cancelled in Jan.  I also had use of the VA healthcare system for free or low cost because I have a military-service connected injury/disability. But I can't get subsidies AND use the VA - it's one or the other (and I'm too low taxable income to get subsidies anyways). So when my policy was cancelled I had to buy a much more expensive unsubsidized policy as, for reasons everyone is probably well aware of now, I really don't want to depend 100 % on the VA.  So I have the private policy and will probably continue to do that until I am old enough to go on Medicare and SS (more than a decade away). Fortunately have the funds to buy that myself.   But for those contemplating ER and planning to use the ACA, it might not be available 10 or 20 years from now (heck even 3 years from now) and you may still be too young for Medicare. Having a back up plan is always a good idea.

[Spartana]

 
BTW, is Medicaid that bad? I genuinely don't know.

Also, is Social Security considered income for ACA purposes? Maybe she just needs some income to tie her over until Social Security kicks in.

That's a good question. I really don't know. Since I think a person can get SS at age 62 but can't go on Medicare until 65 then for those 3 years they'd be using ACA subsidies and that SS income might not qualify as "taxable income" for ACA purposes. Probably something people need to look at when deciding if they want early SS or not.

I also don't know anything about Medicaid but if it's anything like the VA Healthcare system... well I think I'll pass :-)!

 

[TreeTired]

Also, is Social Security considered income for ACA purposes?

http://laborcenter.berkeley.edu/healthcare/MAGI_summary13.pdf

Apparently,  the taxable portion of Social Security benefits is included in MAGI   (Modified Adjusted Gross Income)  which is the number used to determine eligibility for ACA.   Now,  determining how much of your social security benefits are taxable is a different problem.   

This whole ACA is providing some really warped incentives due to the need to show sufficient income to qualify for subsidies.  Typically when determining eligibility for a subsidy,  lower is better (income),  so it is very strange to have to show a minimum amount of income or else you are screwed.

[Eric]

So many questions jump out from this now for me.

1. 72t applies in what way if I'm drawing down my 401k? 3 different withdrawal options...

2. IRA conversion will result in income each year I convert funds, correct? Say I go with the five year plan of converting 40,000 each year to a Roth so at the fifth year I have no Roth penalty.

Thoughts?

Any distribution from an IRA/401k is considered income and is taxed at ordinary income rates.  This was all tax free money initially, so you're now paying income tax on it, whether it's a rollover or 72t direct withdrawal.

Why would you stop your tIRA to Roth conversion after 5 years?  You're still going to want money in year 6, 7, 8, etc, are you not?  You'll pull your money out of your Roth tax free, but you'll still need to continue to convert tIRA to Roth for future use.  (assuming you have more than $200K in your tIRA)

[iris lily]

Also, is Social Security considered income for ACA purposes?

http://laborcenter.berkeley.edu/healthcare/MAGI_summary13.pdf

Apparently,  the taxable portion of Social Security benefits is included in MAGI   (Modified Adjusted Gross Income)  which is the number used to determine eligibility for ACA.   Now,  determining how much of your social security benefits are taxable is a different problem.   

This whole ACA is providing some really warped incentives due to the need to show sufficient income to qualify for subsidies.  Typically when determining eligibility for a subsidy,  lower is better (income),  so it is very strange to have to show a minimum amount of income or else you are screwed.

This is not defense but explanation: The ACA intended Medicaid to be expanded in states. That requirement was struck down by the Supreme Court and hence most states declined to participate in expanded Medicaid. Therefore, poor people who need health care can't get it under the ACA. Cwazy, but it's popular to blame it all on the red states/Repubs.

I repeat, nasty piece of legislation.

[rtrnow]

 
BTW, is Medicaid that bad? I genuinely don't know.

Also, is Social Security considered income for ACA purposes? Maybe she just needs some income to tie her over until Social Security kicks in.

I also don't know anything about Medicaid but if it's anything like the VA Healthcare system... well I think I'll pass :-)!

Medicaid varies state to state, but it's not a healthcare system like the VA but more an insurance plan. The networks of doctors accepting medicaid can be quite small but that's also true for ACA plans at least here in GA.

[anisotropy]

Forgive my ignorance, I must confess I don't know much about how ACA subsidy works. From NC_MJ's post it looked like people (or is it households) making below 15,000 and over 63,000 are screwed?

Are the numbers States specific? I am curious about how the cut-offs were determined.

Thanks.

[Emilyngh]

Forgive my ignorance, I must confess I don't know much about how ACA subsidy works. From NC_MJ's post it looked like people (or is it households) making below 15,000 and over 63,000 are screwed?

Are the numbers States specific? I am curious about how the cut-offs were determined.

Thanks.

It all depends on whether or not your state is fucking its people over by not expanding medicaid as part of the ACA and as paid for by the ACA (and doesn't change this before you retire).   If you are in a state that expanded medicaid, there is no "hole" and if you make too little to qualify for an ACA subsidy, you will qualify for medicaid.   Here's a graphic of states who have/haven't expanded: http://www.advisory.com/daily-briefing/resources/primers/medicaidmap

If you live in a state like Va that still hasn't expanded, then, if you make at or below the poverty level for your family size, but not low enough to qualify for medicaid under your state rules (google for poverty level tables and state medicaid requirements) you will not qualify for ACA subsidies b/c the law was written to expand medicaid to cover all of these folks, but some states are refusing to follow this part of the original law. 

[Eric]

Forgive my ignorance, I must confess I don't know much about how ACA subsidy works. From NC_MJ's post it looked like people (or is it households) making below 15,000 and over 63,000 are screwed?

Are the numbers States specific? I am curious about how the cut-offs were determined.

Thanks.

Emilyngh tackled the Medicaid part, for too little income.  The upper end with too much income is at 400% of federal poverty level to qualify for any subsidy.  This varies based on household size.  Commonly sited statistics are $45K for a single person and $94K for a family of 4.  So if you make less than 400% of federal poverty level, then you'll qualify for subsidies.  It's a sliding scale, so the further away, the more you'll get.

[brooklynguy]

It all depends on whether or not your state is fucking its people over by not expanding medicaid as part of the ACA and as paid for by the ACA (and doesn't change this before you retire).   If you are in a state that expanded medicaid, there is no "hole" and if you make too little to qualify for an ACA subsidy, you will qualify for medicaid.

It's a little more complicated for those with flexible/uncertain annual incomes near the cutoff threshold, which probably includes a significant amount of early retirees.  If you anticipate that your income for the year will be sufficient to qualify you for subsidies (so you go ahead and purchase a heavily subsidized ACA plan), but then at the end of the year it turns out that you overestimated and your income was just below the cutoff (which means you qualified for Medicaid if you're in a state with expanded Medicaid, but this does you no good for that year because you already opted for an ACA plan), now you're going to have to pay back all those subsidies at tax time.  This is why early retirees relying on the ACA need to manage their income very carefully.

[WannabeDone]

I believe I read that the main reason for some states not opting to expand Medicaid is that the federal government only committed to helping fund that program for a few years.  States didn't want to be left on the hook for funding it after the federal government stopped.  Did I understand that correctly?

[anisotropy]

I see, thanks guys (and girls).

400% of 45k/94k, ACA should cover the majority of Americans , as long as one does not live in cerntain States.

I am Canadian, so ya.... all this is quite new to me.

[Gin1984]

I believe I read that the main reason for some states not opting to expand Medicaid is that the federal government only committed to helping fund that program for a few years. States didn't want to be left on the hook for funding it after the federal government stopped.  Did I understand that correctly?

They would not be on the hook for funding it.  The states don't have to keep it at that income level, any more than they have to be at it now.  But for now, the feds were going to pay and refusing it just screws the poor.

[Eric]

I believe I read that the main reason for some states not opting to expand Medicaid is that the federal government only committed to helping fund that program for a few years.  States didn't want to be left on the hook for funding it after the federal government stopped.  Did I understand that correctly?

It depends on how cynical you are.  It could be argued, and looking at the map, I think it's a reasonable argument, that the main reason these states opted out of Medicaid expansion was in an effort to say fuck you to Obamacare.  The goal being to make this piece of legislation as dysfunctional as possible, then the public would have no choice but to realize how terrible it was and vote to get it reversed in the next election.  Of course that didn't happen.

As far as your reason, the feds were going to pick up 100% of the expansion for 3 years, and then that drops to 90% after that (forever).  So yes, technically some funding disappears, but the vast majority stays.  Which leads me back to my first idea.

http://www.politifact.com/truth-o-meter/statements/2014/jan/13/marco-rubio/marco-rubio-says-medicaid-expansion-money-will-go-/

[Emilyngh]

I believe I read that the main reason for some states not opting to expand Medicaid is that the federal government only committed to helping fund that program for a few years.  States didn't want to be left on the hook for funding it after the federal government stopped.  Did I understand that correctly?

The federal gov't is not going to stop contributing, but after covering 100% until 2016 will ramp down to contributing 90% for all years after that.   And the reality is that states aren't really even going to be spending the full remaining 10% b/c they will also save money vs what they are currently spending on the uninsured.   Instead of the federal gov't "leaving states on the hook," there is a guaranteed overall saving for states for the next couple of years, with then at worst a minimal 2-3% or so net investment required from them after that (see below), and possibly a net savings for at least some states for the foreseeable future.

"CBO estimates show that the federal government will bear nearly 93 percent of the costs of the Medicaid expansion over its first nine years (2014-2022).  The federal government will pick up 100 percent of the cost of covering people made newly eligible for Medicaid for the first three years (2014-2016) and no less than 90 percent on a permanent basis.

The additional cost to the states represents a 2.8 percent increase in what they would have spent on Medicaid from 2014 to 2022 in the absence of health reform, the CBO estimates indicate.

This 2.8 percent figure significantly overstates the net impact on state budgets because it does not reflect the savings that state and local governments will realize in other health care spending for the uninsured.  The Urban Institute has estimated that overall state savings in these areas will total between $26 and $52 billion from 2014 through 2019.  The Lewin Group estimates state and local government savings of $101 billion in uncompensated care."

http://www.cbpp.org/cms/?fa=view&id=3801

[WannabeDone]

Great information.  Thanks for the detailed replies about Medicaid expansion.

[Spartana]

I think a big part of the reason States didn't want to fund expanded Medicaid is that it does not require means testing for assets like it currently does. So many ER people (mustachians of course) may have low "taxable" income yet have million in assets. Since there is no means testing, there is no limit on the amount of money a person can have "stashed" away, or the number of houses, cars, RVs, yachts, etc.... that someone can have. Many states felt that Medicaid SHOULD be funded for truly poor or low income people and didn't want to use tax payer money to fund free health care for those who could easily pay for it themselves.

Also, since the income needed to qualify for subsidies is based on taxable income and MAGI, a person with a higher income can max out those tax deferred things like 401Ks, IRAs, college funds, and a whole host of other things to reduce their incomes in order to qualify as "low income enough" to get subsidies. 

[randymarsh]

I think a big part of the reason States didn't want to fund expanded Medicaid is that it does not require means testing for assets like it currently does. So many ER people (mustachians of course) may have low "taxable" income yet have million in assets. Since there is no means testing, there is no limit on the amount of money a person can have "stashed" away, or the number of houses, cars, RVs, yachts, etc.... that someone can have. Many states felt that Medicaid SHOULD be funded for truly poor or low income people and didn't want to use tax payer money to fund free health care for those who could easily pay for it themselves.

I really don't think the Republican governors and legislators in non-expansion states gave it that much thought. It's pretty obvious they didn't support it because they have to be against everything Obama supports. Medicaid is a handout and they're quite honest that they don't like handouts.

Even if you're in a state that expanded, the max income for a family of 4 is 33K. A lot of MMM readers might be able to live on that, but the general public will not. The number of income & asset poor people who would benefit from expansion greatly outnumber the asset rich but income poor.

I hope this chart isn't too big to be distracting on the forum but it's an easy way to see the cut offs:

[Emilyngh]

I think a big part of the reason States didn't want to fund expanded Medicaid is that it does not require means testing for assets like it currently does. So many ER people (mustachians of course) may have low "taxable" income yet have million in assets. Since there is no means testing, there is no limit on the amount of money a person can have "stashed" away, or the number of houses, cars, RVs, yachts, etc.... that someone can have. Many states felt that Medicaid SHOULD be funded for truly poor or low income people and didn't want to use tax payer money to fund free health care for those who could easily pay for it themselves.

Also, since the income needed to qualify for subsidies is based on taxable income and MAGI, a person with a higher income can max out those tax deferred things like 401Ks, IRAs, college funds, and a whole host of other things to reduce their incomes in order to qualify as "low income enough" to get subsidies.

I have heard a great deal of noise about why republicans don't want to expand, and I've never once heard this as a reason.   I'd love it if you have any source verifying any politician ever mentioning this as a concern.   

The reality is that most Americans are far, far from Mustachian and feel that they can barely live on $100k, let alone the $30kish that would be required for them to qualify for medicaid.  Even if one maxes out 401ks etc, they'd still have to be able to live on what's leftover, which would not be "doable" at an amount low enough for medicaid for most.

Actually, in thinking about it, we live a mustachian life and maximize all of our tax credits and deductions to the point that we have a negative federal liability, and yet still, looking at the chart, would not currently qualify for medicaid (if our state expanded).

[Spartana]

I think a big part of the reason States didn't want to fund expanded Medicaid is that it does not require means testing for assets like it currently does. So many ER people (mustachians of course) may have low "taxable" income yet have million in assets. Since there is no means testing, there is no limit on the amount of money a person can have "stashed" away, or the number of houses, cars, RVs, yachts, etc.... that someone can have. Many states felt that Medicaid SHOULD be funded for truly poor or low income people and didn't want to use tax payer money to fund free health care for those who could easily pay for it themselves.

Also, since the income needed to qualify for subsidies is based on taxable income and MAGI, a person with a higher income can max out those tax deferred things like 401Ks, IRAs, college funds, and a whole host of other things to reduce their incomes in order to qualify as "low income enough" to get subsidies.

I have heard a great deal of noise about why republicans don't want to expand, and I've never once heard this as a reason.   I'd love it if you have any source verifying any politician ever mentioning this as a concern.   

The reality is that most Americans are far, far from Mustachian and feel that they can barely live on $100k, let alone the $30kish that would be required for them to qualify for medicaid.  Even if one maxes out 401ks etc, they'd still have to be able to live on what's leftover, which would not be "doable" at an amount low enough for medicaid for most.

Actually, in thinking about it, we live a mustachian life and maximize all of our tax credits and deductions to the point that we have a negative federal liability, and yet still, looking at the chart, would not currently qualify for medicaid (if our state expanded).

Oops, my bad. I wasn't clear as I was making 2 different points. One was that I have heard that numerous states where opposed to the "no means testing" for Medicaid expansion in their states as all those that did not still have asset means testing to get Medicaid and not just income alone. The second paragraph was in regards to high income earners who normally wouldn't qualify for subsidies (not Medicaid) under the ACA but who, by using the various tax deferral programs allowed, can reduce their incomes enough to get those subsidies (again not Medicaid). So if I make $50K I wouldn't qualify for subsidies. But if I max out a 401K or Trad IRA I could probably get a fairly large premium subsidy. But yes, you'd have to be fairly mustachian to live on that little but many here do.

[Emilyngh]

]Oops, my bad. I wasn't clear as I was making 2 different points. One was that I have heard that numerous states where opposed to the "no means testing" for Medicaid expansion in their states as all those that did not still have asset means testing to get Medicaid and not just income alone. The second paragraph was in regards to high income earners who normally wouldn't qualify for subsidies (not Medicaid) under the ACA but who, by using the various tax deferral programs allowed, can reduce their incomes enough to get those subsidies (again not Medicaid). So if I make $50K I wouldn't qualify for subsidies. But if I max out a 401K or Trad IRA I could probably get a fairly large premium subsidy. But yes, you'd have to be fairly mustachian to live on that little but many here do.

My comments still hold for your first paragraph then: (1) I'd love to see an article where a politician mentions the lack of means-tested as their main issue with expanding medicaid under the ACA, (2) and the income requirements are so very low for medicaid qualification (lower than what some mustachians live on) that I doubt there will be a statistically significant portion of the population who will have income low enough to qualify while sitting on huge assets.   

As far as the second paragraph, yes, I agree this is more doable and would be more common (eg., we would qualify for subsidies).   Although, still, I think it'd be surprising to see how few people who could take advantage of it actually do (because they "need" to spend $50-100k a yr to get by).   Regardless, I'm not clear what it has to do with medicaid expansion....

 

[Spartana]

]Oops, my bad. I wasn't clear as I was making 2 different points. One was that I have heard that numerous states where opposed to the "no means testing" for Medicaid expansion in their states as all those that did not still have asset means testing to get Medicaid and not just income alone. The second paragraph was in regards to high income earners who normally wouldn't qualify for subsidies (not Medicaid) under the ACA but who, by using the various tax deferral programs allowed, can reduce their incomes enough to get those subsidies (again not Medicaid). So if I make $50K I wouldn't qualify for subsidies. But if I max out a 401K or Trad IRA I could probably get a fairly large premium subsidy. But yes, you'd have to be fairly mustachian to live on that little but many here do.

My comments still hold for your first paragraph then: (1) I'd love to see an article where a politician mentions the lack of means-tested as their main issue with expanding medicaid under the ACA, (2) and the income requirements are so very low for medicaid qualification (lower than what some mustachians live on) that I doubt there will be a statistically significant portion of the population who will have income low enough to qualify while sitting on huge assets.   

As far as the second paragraph, yes, I agree this is more doable and would be more common (eg., we would qualify for subsidies).   Although, still, I think it'd be surprising to see how few people who could take advantage of it actually do (because they "need" to spend $50-100k a yr to get by).   Regardless, I'm not clear what it has to do with medicaid expansion....

Well as I said, my second paragraph had nothing to do with Medicaid expansion. It was just to let people know that even if they appear to be in too high of an income bracket to get subsidies, they may really not be if they take certain deductions to their taxable income.

As for my comment about some states saying that one of the reasons they didn't like Medicaid expansion was due to lack of means testing.... well that was awhile ago but I'll see if I can find some articles. And I wouldn't say it was their main issue in not wanting expansion, cost was the main issue.  However the rationale I heard used was that, because of lack of means testing, many more people who have normally been too high asset to qualify for their states Medicaid programs will become eligible for the expanded Medicaid under ACA rules and that will greatly increase costs to the states - or just the federal tax payers in their states who have to pay a greater portion in fed taxes to support the newly added Medicaid recipients.  And that would mean fewer funds to go around for the low asset poor or disabled.  Whether that would happen or not I don't know. However, just looking at myself (high asset/low taxable income) and other's on this kind of ER boards, I believe that many people would be able to qualify. Heck that million dollar Roth IRA isn't taxable no matter how much income you withdraw.  Earning under $16K a year in taxable income combined with non-taxable income is easy for many who are ER. I'm one of them.

 

[Gin1984]

]Oops, my bad. I wasn't clear as I was making 2 different points. One was that I have heard that numerous states where opposed to the "no means testing" for Medicaid expansion in their states as all those that did not still have asset means testing to get Medicaid and not just income alone. The second paragraph was in regards to high income earners who normally wouldn't qualify for subsidies (not Medicaid) under the ACA but who, by using the various tax deferral programs allowed, can reduce their incomes enough to get those subsidies (again not Medicaid). So if I make $50K I wouldn't qualify for subsidies. But if I max out a 401K or Trad IRA I could probably get a fairly large premium subsidy. But yes, you'd have to be fairly mustachian to live on that little but many here do.

My comments still hold for your first paragraph then: (1) I'd love to see an article where a politician mentions the lack of means-tested as their main issue with expanding medicaid under the ACA, (2) and the income requirements are so very low for medicaid qualification (lower than what some mustachians live on) that I doubt there will be a statistically significant portion of the population who will have income low enough to qualify while sitting on huge assets.   

As far as the second paragraph, yes, I agree this is more doable and would be more common (eg., we would qualify for subsidies).   Although, still, I think it'd be surprising to see how few people who could take advantage of it actually do (because they "need" to spend $50-100k a yr to get by).   Regardless, I'm not clear what it has to do with medicaid expansion....

Well as I said, my second paragraph had nothing to do with Medicaid expansion. It was just to let people know that even if they appear to be in too high of an income bracket to get subsidies, they may really not be if they take certain deductions to their taxable income.

As for my comment about some states saying that one of the reasons they didn't like Medicaid expansion was due to lack of means testing.... well that was awhile ago but I'll see if I can find some articles. And I wouldn't say it was their main issue in not wanting expansion, cost was the main issue.  However the rationale I heard used was that, because of lack of means testing, many more people who have normally been too high asset to qualify for their states Medicaid programs will become eligible for the expanded Medicaid under ACA rules and that will greatly increase costs to the states. And that would mean fewer funds to go around for the low asset poor or disabled.  Whether that would happen or not I don't know. However, just looking at myself (high asset/low taxable income) and other's on this kind of ER boards, I believe that many people would be able to qualify. Heck that million dollar Roth IRA isn't taxable no matter how much income you withdraw.  Earning under $16K a year in taxable income combined with non-taxable income is easy for many who are ER. I'm one of them.

OK just a quick 2 second look found one article from a couple years ago - there were several more too. I didn't read the whole thing though: http://www.denverpost.com/ci_19654608

In not read it fully did you miss this: "Their argument comes despite the fact that the new federal health care law bars states from adding asset tests and despite prior experience in Colorado and elsewhere that such tests aren't worth the time or money."  They used to have an asset test, and the tests are not worth the time or money.  So then, if they know that, what other reason could they be saying no?  Mmmm, let us see, they gave up a free for three years increase in health care for their citizens for what?  Because obviously it is not because of the asset test, they KNOW it is not worth the funds to require it.

[Emilyngh]

Heck that million dollar Roth IRA isn't taxable no matter how much income you withdraw.  Earning under $16K a year in taxable income combined with non-taxable income is easy for many who are ER. I'm one of them.

Well, any of the million dollar Roth this is non-qualified earnings would be taxable (if ER), so one would have to basically have a million in contributions/conversions for it all to be untaxable.   And considering the $5500/ yr max in contributions, one hardly as the 181 years required to contribute such in time to ER.   One can use the traditional-Roth conversion pipeline to bump this, if they're willing to pay the taxes of transferring a million between accounts in few enough years to make any real use of medicaid before medicare (which would probably negate any medicaid benefits), so that doesn't seem like it'd make sense.   

And yes, of course there are Mustachians with large assets living on $16k.   And as common as it may feel on here, the number of Americans who would have $400k+ in assets, but choose to live on less than $16k, is really just not common at all.   Certainly low enough that I can't see how anyone in their right mind would use it as an excuse to refuse to expand medical coverage to thousands of poor sick people.

[Spartana]

Heck that million dollar Roth IRA isn't taxable no matter how much income you withdraw.  Earning under $16K a year in taxable income combined with non-taxable income is easy for many who are ER. I'm one of them.

Well, any of the million dollar Roth this is non-qualified earnings would be taxable (if ER), so one would have to basically have a million in contributions/conversions for it all to be untaxable.   And considering the $5500/ yr max in contributions, one hardly as the 181 years required to contribute such in time to ER.   One can use the traditional-Roth conversion pipeline to bump this, if they're willing to pay the taxes of transferring a million between accounts in few enough years to make any real use of medicaid before medicare (which would probably negate any medicaid benefits), so that doesn't seem like it'd make sense.   

And yes, of course there are Mustachians with large assets living on $16k.   And as common as it may feel on here, the number of Americans who would have $400k+ in assets, but choose to live on less than $16k, is really just not common at all.   Certainly low enough that I can't see how anyone in their right mind would use it as an excuse to refuse to expand medical coverage to thousands of poor sick people.

You're probably right that there are far fewer non-mustachian people with high assets living on or under $16K taxable per year (even though they may actually living on a higher, yet still modest, income from an additional non-taxable sources). I wasn't arguing whether it was right or wrong to eliminate means testing (I personally think it was wrong to eliminate it but I think they need to make them much higher) for Medicaid eligibility, and I do think that the states are silly for not allowing expanded Medicaid - even if I think they should still have means testing. I was just throwing some info out that I have heard as a reason some states didn't want to expand Medicaid.  And hey, if the kind hearted US taxpayers out their don't have a problem funding Medicaid for me so I can ER at 42 and spend my days playing beach volleyball, then who am I too complain :-)! (yes that was sarcasm - well a little bit)

[Spartana]

And since we're on the topic: Those of you who do plan to use Medicaid be aware that if you are between age 55 and 65 when you use Medicaid services, on your death the government can have ALL that money repaid to them from your estate - or your spouses estate if they pass away after you. Probably some loopholes to that but just a heads up.

From this article:  http://www.dailykos.com/story/2013/10/17/1248425/-Medicaid-Estate-Recovery-ACA-Unintended-Consequences#

We haven't had lots of people younger than 65 on Medicaid, because in most states simply earning less than the Federal Poverty Level did not qualify one for Medicaid.

And we haven't had many people with lots of assets on Medicaid, because in most places you have to have less than around $2400 to your name before Medicaid will cover you. You can keep your house and your car, but Medicaid reserves the right to put liens on them and take them when you die.

But now we have the Affordable Care Act, and its expectation that everyone in the lower tier of income will end up in the Medicaid system. To accomplish this, they have dropped  the asset test. So now we will have lots of people ages 55-64, who have assets but not a lot of income right now, for whatever reason, on Medicaid.

The kicker of it is, if you make the right amount to qualify for a subsidized health insurance plan, your costs are going to be shared and subsidized by the government. But if you go on Medicaid, you owe the entire amount that Medicaid spends on you from the day you turn 55.
 

[geekette]

As a (relatively) high asset, low income couple, we don't want Medicaid, but we do want insurance.  Let them means test for subsidies, I don't care.  I just want access to health insurance without having to get a full time job, and without the risk of a claim getting us kicked out of the pool.

[iris lily]

...Even if you're in a state that expanded, the max income for a family of 4 is 33K. A lot of MMM readers might be able to live on that, but the general public will not. The number of income & asset poor people who would benefit from expansion greatly outnumber the asset rich but income poor.

That's not the issue I see represented by Spartana.

People like me can adjust my income to whatever it needs to be in order to qualify for free benefits if income is the only measure. I don't need income to live on, I can dip into my 'stache to fund trips to Europe and my wine bill or even to pay the electric bill.

I don't know if Spartana is right about  prescient red states (good for them if so!) and I had not understood that ACA called for lowest income people who would qualify for Medicaid to go on Medicaid, outside of usual qualifying activities for Medicaid. Interesting.

As usual, this thread is providing so very much useful information.

[iris lily]

As a (relatively) high asset, low income couple, we don't want Medicaid, but we do want insurance.  Let them means test for subsidies, I don't care.  I just want access to health insurance without having to get a full time job, and without the risk of a claim getting us kicked out of the pool.

How much are you willing to pay annually for that health insurance you describe? Are you ok with $15,000 for two adults?

[geekette]

As a (relatively) high asset, low income couple, we don't want Medicaid, but we do want insurance.  Let them means test for subsidies, I don't care.  I just want access to health insurance without having to get a full time job, and without the risk of a claim getting us kicked out of the pool.

How much are you willing to pay annually for that health insurance you describe? Are you ok with $15,000 for two adults?

Yup.

[Spartana]

]Oops, my bad. I wasn't clear as I was making 2 different points. One was that I have heard that numerous states where opposed to the "no means testing" for Medicaid expansion in their states as all those that did not still have asset means testing to get Medicaid and not just income alone. The second paragraph was in regards to high income earners who normally wouldn't qualify for subsidies (not Medicaid) under the ACA but who, by using the various tax deferral programs allowed, can reduce their incomes enough to get those subsidies (again not Medicaid). So if I make $50K I wouldn't qualify for subsidies. But if I max out a 401K or Trad IRA I could probably get a fairly large premium subsidy. But yes, you'd have to be fairly mustachian to live on that little but many here do.

My comments still hold for your first paragraph then: (1) I'd love to see an article where a politician mentions the lack of means-tested as their main issue with expanding medicaid under the ACA, (2) and the income requirements are so very low for medicaid qualification (lower than what some mustachians live on) that I doubt there will be a statistically significant portion of the population who will have income low enough to qualify while sitting on huge assets.   

As far as the second paragraph, yes, I agree this is more doable and would be more common (eg., we would qualify for subsidies).   Although, still, I think it'd be surprising to see how few people who could take advantage of it actually do (because they "need" to spend $50-100k a yr to get by).   Regardless, I'm not clear what it has to do with medicaid expansion....

Well as I said, my second paragraph had nothing to do with Medicaid expansion. It was just to let people know that even if they appear to be in too high of an income bracket to get subsidies, they may really not be if they take certain deductions to their taxable income.

As for my comment about some states saying that one of the reasons they didn't like Medicaid expansion was due to lack of means testing.... well that was awhile ago but I'll see if I can find some articles. And I wouldn't say it was their main issue in not wanting expansion, cost was the main issue.  However the rationale I heard used was that, because of lack of means testing, many more people who have normally been too high asset to qualify for their states Medicaid programs will become eligible for the expanded Medicaid under ACA rules and that will greatly increase costs to the states. And that would mean fewer funds to go around for the low asset poor or disabled.  Whether that would happen or not I don't know. However, just looking at myself (high asset/low taxable income) and other's on this kind of ER boards, I believe that many people would be able to qualify. Heck that million dollar Roth IRA isn't taxable no matter how much income you withdraw.  Earning under $16K a year in taxable income combined with non-taxable income is easy for many who are ER. I'm one of them.

OK just a quick 2 second look found one article from a couple years ago - there were several more too. I didn't read the whole thing though: http://www.denverpost.com/ci_19654608

In not read it fully did you miss this: "Their argument comes despite the fact that the new federal health care law bars states from adding asset tests and despite prior experience in Colorado and elsewhere that such tests aren't worth the time or money."  They used to have an asset test, and the tests are not worth the time or money.  So then, if they know that, what other reason could they be saying no?  Mmmm, let us see, they gave up a free for three years increase in health care for their citizens for what?  Because obviously it is not because of the asset test, they KNOW it is not worth the funds to require it.

I did read that also and I have heard that elsewhere before - at least if it applied to means testing for both ACA subsidies and expanded Medicaid. And with millions more people signing up for Medicaid I imagine it would be even costlier to means test now then before. However the states and feds still means test for just about every other social welfare program and must have determined that the cost for those is worth it. Why is Medicaid any different? Heck even the VA Healthcare system does income and asset means testing annually for vets who get treatment for something other than a service-connected injury - and they count EVERYTHING including Granny's old silver you inherited.  I'm personally an advocate of a taxpayer funded universal healthcare system for the USA that includes everyone - rich or poor, assetless or assets up the butt - but that's not what we have and allowing asset rich people to get free healthcare while truly poor people can't get any if they aren't in Medicaid expanded states is just wrong IMHO.  Again, I wasn't trying to argue about it, just saying that some republican governors used the means testing as an reason against expansion of Medicaid in their states because they felt it would allow too many people on Medicaid that could fund their own care.

[Spartana]

As a (relatively) high asset, low income couple, we don't want Medicaid, but we do want insurance.  Let them means test for subsidies, I don't care.  I just want access to health insurance without having to get a full time job, and without the risk of a claim getting us kicked out of the pool.

How much are you willing to pay annually for that health insurance you describe? Are you ok with $15,000 for two adults?

Yup.

If your incomes are too low for subsidies you might want to try and increase them just enough qualify as you can probably get close to 100% of the premium covered by subsidies. Not sure of the cut off for 2 people but it's posted above somewhere - but about $16K for a single person. Below that you can't get subsidies and can only go on Medicaid if you are in a Medicaid expanded state, or go without, or pay the full amount yourself. Probably worth increasing your income a little bit if under the cut off as that could save you each several hundred bucks a month in premiums.

[Spartana]

...Even if you're in a state that expanded, the max income for a family of 4 is 33K. A lot of MMM readers might be able to live on that, but the general public will not. The number of income & asset poor people who would benefit from expansion greatly outnumber the asset rich but income poor.

That's not the issue I see represented by Spartana.

People like me can adjust my income to whatever it needs to be in order to qualify for free benefits if income is the only measure. I don't need income to live on, I can dip into my 'stache to fund trips to Europe and my wine bill or even to pay the electric bill.

And that's just "taxable" income you have to count. If the wino stash is sitting somewhere that is non-taxable or is just earning  a small amount of interest or dividends (lets see...what's the interest on a million dollar wine-stash in laddered CDs at 1%? :-)) you're actual income may be low enough to go on free Medicaid if you wanted. Or at least get high subsidies.

[Gin1984]

]Oops, my bad. I wasn't clear as I was making 2 different points. One was that I have heard that numerous states where opposed to the "no means testing" for Medicaid expansion in their states as all those that did not still have asset means testing to get Medicaid and not just income alone. The second paragraph was in regards to high income earners who normally wouldn't qualify for subsidies (not Medicaid) under the ACA but who, by using the various tax deferral programs allowed, can reduce their incomes enough to get those subsidies (again not Medicaid). So if I make $50K I wouldn't qualify for subsidies. But if I max out a 401K or Trad IRA I could probably get a fairly large premium subsidy. But yes, you'd have to be fairly mustachian to live on that little but many here do.

My comments still hold for your first paragraph then: (1) I'd love to see an article where a politician mentions the lack of means-tested as their main issue with expanding medicaid under the ACA, (2) and the income requirements are so very low for medicaid qualification (lower than what some mustachians live on) that I doubt there will be a statistically significant portion of the population who will have income low enough to qualify while sitting on huge assets.   

As far as the second paragraph, yes, I agree this is more doable and would be more common (eg., we would qualify for subsidies).   Although, still, I think it'd be surprising to see how few people who could take advantage of it actually do (because they "need" to spend $50-100k a yr to get by).   Regardless, I'm not clear what it has to do with medicaid expansion....

Well as I said, my second paragraph had nothing to do with Medicaid expansion. It was just to let people know that even if they appear to be in too high of an income bracket to get subsidies, they may really not be if they take certain deductions to their taxable income.

As for my comment about some states saying that one of the reasons they didn't like Medicaid expansion was due to lack of means testing.... well that was awhile ago but I'll see if I can find some articles. And I wouldn't say it was their main issue in not wanting expansion, cost was the main issue.  However the rationale I heard used was that, because of lack of means testing, many more people who have normally been too high asset to qualify for their states Medicaid programs will become eligible for the expanded Medicaid under ACA rules and that will greatly increase costs to the states. And that would mean fewer funds to go around for the low asset poor or disabled.  Whether that would happen or not I don't know. However, just looking at myself (high asset/low taxable income) and other's on this kind of ER boards, I believe that many people would be able to qualify. Heck that million dollar Roth IRA isn't taxable no matter how much income you withdraw.  Earning under $16K a year in taxable income combined with non-taxable income is easy for many who are ER. I'm one of them.

OK just a quick 2 second look found one article from a couple years ago - there were several more too. I didn't read the whole thing though: http://www.denverpost.com/ci_19654608

In not read it fully did you miss this: "Their argument comes despite the fact that the new federal health care law bars states from adding asset tests and despite prior experience in Colorado and elsewhere that such tests aren't worth the time or money."  They used to have an asset test, and the tests are not worth the time or money.  So then, if they know that, what other reason could they be saying no?  Mmmm, let us see, they gave up a free for three years increase in health care for their citizens for what?  Because obviously it is not because of the asset test, they KNOW it is not worth the funds to require it.

I did read that also and I have heard that elsewhere before - at least if it applied to means testing for both ACA subsidies and expanded Medicaid. And with millions more people signing up for Medicaid I imagine it would be even costlier to means test now then before. However the states and feds still means test for just about every other social welfare program and must have determined that the cost for those is worth it. Why is Medicaid any different? Heck even the VA Healthcare system does income and asset means testing annually for vets who get treatment for something other than a service-connected injury - and they count EVERYTHING including Granny's old silver you inherited.  I'm personally an advocate of a taxpayer funded universal healthcare system for the USA that includes everyone - rich or poor, assetless or assets up the butt - but that's not what we have and allowing asset rich people to get free healthcare while truly poor people can't get any if they aren't in Medicaid expanded states is just wrong IMHO.  Again, I wasn't trying to argue about it, just saying that some republican governors used the means testing as an reason against expansion of Medicaid in their states because they felt it would allow too many people on Medicaid that could fund their own care.

First, they are means testing, just not asset testing and no, not all states do asset test.  Most have gone away from that, for exactly that reason, it costs too much and does not give the state a benefit and second, I can see that they are trying to blame the lack of asset testing as the reason but given that many had approved of removing the asset test, it does not seem honest.  And, even if it WAS the first three years the fed paid 100% so why not give their poor Medicaid for that time period! it costs the states not one penny.

[Gin1984]

As a (relatively) high asset, low income couple, we don't want Medicaid, but we do want insurance.  Let them means test for subsidies, I don't care.  I just want access to health insurance without having to get a full time job, and without the risk of a claim getting us kicked out of the pool.

How much are you willing to pay annually for that health insurance you describe? Are you ok with $15,000 for two adults?

Yup.

If your incomes are too low for subsidies you might want to try and increase them just enough qualify as you can probably get close to 100% of the premium covered by subsidies. Not sure of the cut off for 2 people but it's posted above somewhere - but about $16K for a single person. Below that you can't get subsidies and can only go on Medicaid if you are in a Medicaid expanded state, or go without, or pay the full amount yourself. Probably worth increasing your income a little bit if under the cut off as that could save you each several hundred bucks a month in premiums.

I don't think you are getting what this person is say, he is saying it does not care if it means paying the whole premium, he is happy to be able to access health insurance even at its full cost and I agree.  Prior to this I aged out of my mother's insurance and could not buy any, for any price.  I COBRAed and it was $575/month just for me.  If that is the cost paid by my mother's employer and the private industry was change to make it more like the employer covered, I just assumed I would be paying COBRA level costs.  And honestly I am fine with that, happy even.  It means I can retire early, it means that if I lose my job I don't lose my insurance.  Yes, it is expense, so is housing, I still pay my mortgage.