The key for the entire healthcare debate is the phrase "under current law(UCL)".
We must always remember that phrase. Things change as laws change. Please understand I find these figures below to be embarrassing. We get paid to have healthcare. It does not feel right to me. Many people are paying for it, and in fact paying for us. Things WILL change. I also do not pay taxes on my income, since the capital gains tax rate is 0% for my income level. Also embarrassing, also not right, and it will also change someday(hops off soapbox).
UCL- income is EVERYTHING. Net worth is NOTHING. Your healthcare costs will be based on income, not net worth. If you own a billion dollars of Berkshire Hathaway, and own nothing else, you have $0 income(BRK does not pay dividends), and are eligible for ALL programs that only look at income. UCL, you would go onto your state poverty health plan at no cost (in my state of WI).
UCL, as a FIRE person of 3 years, with an 11 year old, a 19 year old, and a wife, our family is best off with income JUST below 250% of poverty level, high enough to stay off of state insurance, while qualifying for a premium reduction AND cost share reductions through ACA. We can buy and sell what we need to keep us in this zone.
When CSR payments were suspended last year, insurance company raised premiums to offset the loss of those payments, resulting in a larger subsidy for me. My monthly premium this year is $1.50 for our family of 4, for a silver plan with a CSR. The payments were suspended. The law requiring the CSR's to be OFFERED was not suspended. That would take a repeal of either that provision, or the ACA as a whole.
It remains to be played out, but now that there is no penalty for not having a compliant ACA plan, logic will imply that healthy people paying high premiums (income too high for subsidies) will leave ACA plans. That will again raise premiums for the rest in the plans. UCL, for ME, my premiums will again rise, and my subsidy will again rise, and I will again pay NOTHING for health insurance for 2019(it might go up about $1 per month).
Also likely would be a larger portion of healthcare claims going unpaid next year, as some of those healthy folks will have rolled the dice, and lost(getting sick and racking up large bills they can not pay). The result? You guessed it: higher premiums, and a higher subsidy for me.
The 1 concern would be if insurance companies stop offering ACA compliant plans. UCL, that seems unlikely, since by removing the penalty, there will be a higher percentage of people getting subsidies, and therefore a greater chance of the insurance company getting paid. The best check is a government check, am I right?
If I was on ACA, and could not control my income, and did not receive a subsidy, you bet I would look into buying one of the catastrophic plans that will be offered again starting next year. We have the cash to handle a few catastrophic events. Unfortunately, we are not insurable at any cost, due to preexisting conditions.
If we get back to full ACA repeal, our family will look at all possibilities, including dropping our income poverty level, or leaving the country.
Also new this year: with the elimination of exemptions and higher standard exemption, it might be beneficial for children to NOT be dependents. I will look into this before I make our final "income" sells of stocks. Maybe it is time for my 11 year old to get a place of her own.