What comes after the ACA?

[MDM]

...Congress admitted it just forgot....

Perhaps understandable in a 6 year old, but Congress could have just put on its big boy and girl pants and fixed it.  Or they could still do so.  Not that Congress has a stellar reputation, but "they forgot" is a particularly lame excuse for any executive order.

[sol]

...Congress admitted it just forgot....

Perhaps understandable in a 6 year old, but Congress could have just put on its big boy and girl pants and fixed it.  Or they could still do so.  Not that Congress has a stellar reputation, but "they forgot" is a particularly lame excuse for any executive order.

In this case, "they forgot" is shorthand for "were distracted just long enough by an obstructionist minority who shut down the federal government in order to protest expanding healthcare access to more Americans."

[MDM]

...Congress admitted it just forgot....

Perhaps understandable in a 6 year old, but Congress could have just put on its big boy and girl pants and fixed it.  Or they could still do so.  Not that Congress has a stellar reputation, but "they forgot" is a particularly lame excuse for any executive order.

In this case, "they forgot" is shorthand for "were distracted just long enough by an obstructionist minority who shut down the federal government in order to protest expanding healthcare access to more Americans."

Which brings us full circle back to "should the president do things constitutionally assigned to Congress, and does one's answer depend on whether one agrees with what the president does?" :)

[obstinate]

Which brings us full circle back to "should the president do things constitutionally assigned to Congress, and does one's answer depend on whether one agrees with what the president does?" :)

#44 believed the CSRs were not constitutionally assigned to congress. The first federal judge the lawsuit was appealed to disagreed, but that does not mean #44 was wrong. It means one federal judge thought he was wrong.

Moreover, there are different definitions of "should," depending on what you're optimizing for. Morally? Whose moral framework? Practically? With a short, medium, or long view? Legally?

Finally, the constitution was written by a bunch of old farts who had no idea what this country would become, and viewing it as some sort of sacred cow is unhealthy. Most other countries have rewritten their constitution several times since ours was ratified, and it seems pretty clear that better ideas of good governance have emerged since the 18th century.

[sol]

...Congress admitted it just forgot....

Perhaps understandable in a 6 year old, but Congress could have just put on its big boy and girl pants and fixed it.  Or they could still do so.  Not that Congress has a stellar reputation, but "they forgot" is a particularly lame excuse for any executive order.

In this case, "they forgot" is shorthand for "were distracted just long enough by an obstructionist minority who shut down the federal government in order to protest expanding healthcare access to more Americans."

Which brings us full circle back to "should the president do things constitutionally assigned to Congress, and does one's answer depend on whether one agrees with what the president does?" :)

I'm not convinced. A supermajority of Congress wanted to expand healthcare to more Americans. A minority of Congress did not, so they prevented the majority of Congress from doing what it wanted. 

If we're going to talk about the failures of our checks and balances, how about we start there?  That's like a basic democracy fail.  You're seriously complaining that the Executive restored the will of Congress over the opposition of the congressional minority?

[MDM]

  You're seriously complaining that the Executive restored the will of Congress over the opposition of the congressional minority?

Yes.

It's akin to free speech.  Easy to defend when one agrees with what is being said.  Problematic when one disagrees.

[SecondBreakfast]

I'm not sure if the American system of government really works for modern America. Or anywhere else, to be honest. Most countries that apply American-style constitutional democracy seem to collapse into endless bickering, gridlock and corruption pretty quickly. No, what you need is the swift, authoritative action of a parliamentary system, preferably under the oversight of a divinely-appointed monar- *is dragged off and dumped in Boston harbour*

[former player]

I'm not sure if the American system of government really works for modern America. Or anywhere else, to be honest. Most countries that apply American-style constitutional democracy seem to collapse into endless bickering, gridlock and corruption pretty quickly. No, what you need is the swift, authoritative action of a parliamentary system, preferably under the oversight of a divinely-appointed monar- *is dragged off and dumped in Boston harbour*

Ha!

I suspect that any variety of democratic system would be OK as long as it can change as needed with changing times.  When you set a system in stone, gradual adaptation goes out of the window and it ossifies until the point of civil war or revolution.  The USA problem is not the constitution per se, it's that the constitution is not sufficiently amenable to change *joins SecondBreakfast in a harbour swim*.

(The only people who have got this right are us English, who with one or two minor interruptions have kept legal and constitutional continuity within a framework of human rights since 1066.)

[nereo]

I'm not sure if the American system of government really works for modern America. Or anywhere else, to be honest. Most countries that apply American-style constitutional democracy seem to collapse into endless bickering, gridlock and corruption pretty quickly. No, what you need is the swift, authoritative action of a parliamentary system, preferably under the oversight of a divinely-appointed monar- *is dragged off and dumped in Boston harbour*

Ha!

I suspect that any variety of democratic system would be OK as long as it can change as needed with changing times.  When you set a system in stone, gradual adaptation goes out of the window and it ossifies until the point of civil war or revolution.  The USA problem is not the constitution per se, it's that the constitution is not sufficiently amenable to change *joins SecondBreakfast in a harbour swim*.

(The only people who have got this right are us English, who with one or two minor interruptions have kept legal and constitutional continuity within a framework of human rights since 1066.)

There are some interesting threads on different forms of governance throughout the world, along with how US perceptions differ sharply from other western developed nations.
Let's keep this thread focused on "what comes after the ACA" and not have it devolve into nation-bashing.

[DavidAnnArbor]

  You're seriously complaining that the Executive restored the will of Congress over the opposition of the congressional minority?

Yes.

It's akin to free speech.  Easy to defend when one agrees with what is being said.  Problematic when one disagrees.

These cost-sharing subsidies are in the ACA law. The Congress can choose to not fund it, but then the government will be sued in federal court, and lose, and have to pay them with interest. Paying interest on a lost case is not a way to keep the federal budget in control. 

[DavidAnnArbor]

Some people think these short term health plans will be a great way to keep health insurance costs cheaper, but these short-term plans lack the ACA protections against insurance company chicanery.

Magellan on Bogleheads has a great post about this:
https://www.bogleheads.org/forum/viewtopic.php?f=2&t=229476&p=3574790#p3573723

"Here are 3 common tricks, often spelled out only in the plan's fine print, that insurers use on these policies to trip people up:
1) Deny claims if anything was incorrect or omitted on the application, even if the error is not intentional or material.
2) Limit max payout per year, or exclude certain types of coverage (eg hospital, outpatient, drugs)
3) Exclude coverage of some outpatient procedures or some prescription drugs.

The last one is particularly pernicious because you have to basically be a medical expert and read the policy's fine print and drug formulary to learn what's covered. Some plans cover some prescription drugs, but exclude all or most chemotherapy drugs. This can leave a 6 figure hole in your coverage even if everything else checks out."

[former player]

There are some interesting threads on different forms of governance throughout the world, along with how US perceptions differ sharply from other western developed nations.
Let's keep this thread focused on "what comes after the ACA" and not have it devolve into nation-bashing.

Constitution-bashing is different from nation-bashing, right?

One of the fundamental problems with "what comes after the ACA" is the dysfunctional legislative system that created it in its current illogical form and then prevents it from being amended or replaced in any logical fashion, whether those changes are from a republican or democrat point of view.   And that dysfunctional legislative system derives from a poorly functioning constitution as well as from political problems in making changes to the legislative system which the current constitution would allow.

And, honestly, part of the problem with legislative failures on the ACA, taxes, infrastructure and spending is that they have driven the President to look for "wins" in foreign policy instead, which is now becoming a problem for the whole fucking world, given North Korea and Iran.  Maybe if a solution could be found for the ACA he would settle down and back off on the international front.

[nereo]

There are some interesting threads on different forms of governance throughout the world, along with how US perceptions differ sharply from other western developed nations.
Let's keep this thread focused on "what comes after the ACA" and not have it devolve into nation-bashing.

Constitution-bashing is different from nation-bashing, right?

Well for countries that are fundamentally based on a constitution, it's hard to make a distinction

One of the fundamental problems with "what comes after the ACA" is the dysfunctional legislative system that created it in its current illogical form and then prevents it from being amended or replaced in any logical fashion, whether those changes are from a republican or democrat point of view.   And that dysfunctional legislative system derives from a poorly functioning constitution as well as from political problems in making changes to the legislative system which the current constitution would allow.

That is all fine and well and good topics to discuss.  But the jump from the legislative processes which formed the ACA to the apparent superiority of other nations is where the train runs off the rails.  IMO there's no reason to bring other governmental systems into the discussion while explicitly saying 'this system is different than the one that created or could modify the ACA'.

[boarder42]

Some people think these short term health plans will be a great way to keep health insurance costs cheaper, but these short-term plans lack the ACA protections against insurance company chicanery.

Magellan on Bogleheads has a great post about this:
https://www.bogleheads.org/forum/viewtopic.php?f=2&t=229476&p=3574790#p3573723

"Here are 3 common tricks, often spelled out only in the plan's fine print, that insurers use on these policies to trip people up:
1) Deny claims if anything was incorrect or omitted on the application, even if the error is not intentional or material.
2) Limit max payout per year, or exclude certain types of coverage (eg hospital, outpatient, drugs)
3) Exclude coverage of some outpatient procedures or some prescription drugs.

The last one is particularly pernicious because you have to basically be a medical expert and read the policy's fine print and drug formulary to learn what's covered. Some plans cover some prescription drugs, but exclude all or most chemotherapy drugs. This can leave a 6 figure hole in your coverage even if everything else checks out."

i find the post halfway down about how if you're in a state thats beefing up the cost of silver plans to account for it - you're gonna see a 20% savings.  I just did a hypothetical around our FIRE date and assuming our kids dont have any major medical issues that require constat treatment and the ACA plans are still very affordable in our state.

[iris lily]

I'm not sure if the American system of government really works for modern America. Or anywhere else, to be honest. Most countries that apply American-style constitutional democracy seem to collapse into endless bickering, gridlock and corruption pretty quickly. No, what you need is the swift, authoritative action of a parliamentary system, preferably under the oversight of a divinely-appointed monar- *is dragged off and dumped in Boston harbour*

And good riddance to you, sir! Haha.

Shush dont tell anyone but I am a bit of a monarchist myself. Bring back the Stuarts!

Virescit Vulnere Virtus!

[Malloy]

EnjoyIt:

https://www.vox.com/policy-and-politics/2017/10/16/16357790/health-care-prices-problem

Check it out!  I think this is a good article. I don't totally agree that the ACA has no price control measures (bundling, for example, is a price control measure), but I do agree that bringing prices down was not a goal of the ACA and is a crucial fundamental next step.

My blood was absolutely boiling reading about that 25k MRI.  The hospital response was 100% nonsense.  Plus, the hospital had to know that its price was out of whack with the vast majority of reimbursement rates, and they did not inform the patient ahead of time.  I'd love to see a database of procedure average prices at each hospital.  If Stanford wants to charge 25k for an MRI, they can probably fill all their slots with rich foreign patients, but at least US patients can be warned. 

[MDM]

These cost-sharing subsidies are in the ACA law. The Congress can choose to not fund it, but then the government will be sued in federal court, and lose, and have to pay them with interest. Paying interest on a lost case is not a way to keep the federal budget in control.

Perhaps.  One can also say that money for the CSRs was not appropriated, the president chose to fund them, but then the president was sued in federal court and lost.

[protostache]

These cost-sharing subsidies are in the ACA law. The Congress can choose to not fund it, but then the government will be sued in federal court, and lose, and have to pay them with interest. Paying interest on a lost case is not a way to keep the federal budget in control.

Perhaps.  One can also say that money for the CSRs was not appropriated, the president chose to fund them, but then the president was sued in federal court and lost.

The executive didn't lose the case. One judge found that the House had standing (which surprised everyone, including the House) and accepted their interpretation of the facts. That judge stayed their ruling pending appeal, which the Obama administration was actively pursing until now.

One interpretation of this that that I read today paints this as a huge loss for the Executive and a huge gain for Congress as institutions. That lawsuit was the first of it's kind. Normally Congress and the Executive fight things out with the political process defined in the Constitution, but now with a bare majority they can pass a resolution and file a lawsuit in DC district court anytime they don't like what the Executive is doing. That's one of the primary reason why the Obama administration was fighting it.

[jim555]

Side note for NYers:
New York's open enrollment period for 2018 is the full 90 days, not the shortened 45 days everywhere else.  Since NY runs its own exchange it has the ability to set to OE period.  As usual, the Essential plan and Medicaid plans are open all year.

[MDM]

One interpretation of this that that I read today paints this as a huge loss for the Executive and a huge gain for Congress as institutions.

That's good if one is concerned about a president going rogue; bad if one is concerned about a large group ever being able to take decisive action.

[nereo]

One interpretation of this that that I read today paints this as a huge loss for the Executive and a huge gain for Congress as institutions.

That's good if one is concerned about a president going rogue; bad if one is concerned about a large group ever being able to take decisive action.

It's also worth pondering whether this method of congress regaining its powers is a good thing or not.  I've been advocating since 2001 for congress to step up and reassert its constitutional power of the purse and legislative check on the executive office, but here we've got the WH punting because its a political turd.  Literally no one in congress is happy that they're now responsible.

[protostache]

One interpretation of this that that I read today paints this as a huge loss for the Executive and a huge gain for Congress as institutions.

That's good if one is concerned about a president going rogue; bad if one is concerned about a large group ever being able to take decisive action.

If congress wants to regain power it needs to get together and pass some laws with a veto proof majority that restrict the executive’s power. That’s how this is supposed to work. The judiciary is not supposed to mediate between them like this.

[DavidAnnArbor]

The congress passed the ACA in the first place. No law is ever perfect 100% and it is expected that congress may have to refine laws that are passed.
But when the Republicans took over the Congress rather than compromise over solutions to the ACA, they tried to sabotage the law.
Ultimately the Republicans were unable to come up with their own plan in 2017.
Not funding the CSR's is not a solution, and the government will be forced to fund them because that's the way the ACA law is written.
You can say the Congress has the power of the purse, but when it uses that power to go against the law, then the power is meaningless.
The government will be forced by the courts to fund the CSR.

[MDM]

One interpretation of this that that I read today paints this as a huge loss for the Executive and a huge gain for Congress as institutions.

That's good if one is concerned about a president going rogue; bad if one is concerned about a large group ever being able to take decisive action.

If congress wants to regain power it needs to get together and pass some laws with a veto proof majority that restrict the executive’s power. That’s how this is supposed to work. The judiciary is not supposed to mediate between them like this.

If congress tried to so do, the executive could simply say "that's unconstitutional" and back to the judiciary they go to settle the playground spat.

[MDM]

It's also worth pondering whether this method of congress regaining its powers is a good thing or not.

Agreed.

I've been advocating since 2001 for congress to step up and reassert its constitutional power of the purse and legislative check on the executive office, but here we've got the WH punting because its a political turd.  Literally no one in congress is happy that they're now responsible.

Yes, ducking responsibility is a trait of many politicians.

[MDM]

The congress passed the ACA in the first place. No law is ever perfect 100% and it is expected that congress may have to refine laws that are passed.
But when the Republicans took over the Congress rather than compromise over solutions to the ACA, they tried to sabotage the law.
Ultimately the Republicans were unable to come up with their own plan in 2017.

Yup.  That was a major failure, considering all the posturing they had been doing for 7 years.

Not funding the CSR's is not a solution, and the government will be forced to fund them because that's the way the ACA law is written.
You can say the Congress has the power of the purse, but when it uses that power to go against the law, then the power is meaningless.
The government will be forced by the courts to fund the CSR.

Time will tell.

[ZiziPB]

Looks like it didn't take long for something to be done with CSR funding:  http://www.cnn.com/2017/10/17/politics/health-care-csr-payments-deal-reached/index.html

[Exflyboy]

Looks like it didn't take long for something to be done with CSR funding:  http://www.cnn.com/2017/10/17/politics/health-care-csr-payments-deal-reached/index.html

And Trump still spinning it like its a success.. which it is.. because HE failed.. again!

[teamzissou00]

Sorry if this has already been asked/answered: what is the plan for everyone's healthcare at this point- for those under 62. 

It looks like insuring our family will cost 1800/mo 20k a year - is that was Mr Money Mustache is paying or is he self insuring?  This is the highest deductible plan available for a family of 4 that I can see.

[HPstache]

Sorry if this has already been asked/answered: what is the plan for everyone's healthcare at this point- for those under 62. 

It looks like insuring our family will cost 1800/mo 20k a year - is that was Mr Money Mustache is paying or is he self insuring?  This is the highest deductible plan available for a family of 4 that I can see.

If you're religious, look into health sharing ministry, $500/mo -ish.  Hopefully the law will change soon and we can start a new heath sharing ministry for those who subscribe to the MMM philosophy!

https://forum.mrmoneymustache.com/ask-a-mustachian/let%27s-talk-about-health-share/

[DavidAnnArbor]

Sorry if this has already been asked/answered: what is the plan for everyone's healthcare at this point- for those under 62. 

It looks like insuring our family will cost 1800/mo 20k a year - is that was Mr Money Mustache is paying or is he self insuring?  This is the highest deductible plan available for a family of 4 that I can see.

Many will try to live within an income in the subsidies range

[jim555]

Sorry if this has already been asked/answered: what is the plan for everyone's healthcare at this point- for those under 62. 

It looks like insuring our family will cost 1800/mo 20k a year - is that was Mr Money Mustache is paying or is he self insuring?  This is the highest deductible plan available for a family of 4 that I can see.

If you're religious, look into health sharing ministry, $500/mo -ish.  Hopefully the law will change soon and we can start a new heath sharing ministry for those who subscribe to the MMM philosophy!

https://forum.mrmoneymustache.com/ask-a-mustachian/let%27s-talk-about-health-share/

The big downside to this is the health sharing ministry has no legal obligation to pay your bills.  To me this kinda defeats the purpose of being insured. 

[frugalecon]

Looks like it didn't take long for something to be done with CSR funding:  http://www.cnn.com/2017/10/17/politics/health-care-csr-payments-deal-reached/index.html

Sorry to burst your bubble, but nothing has been passed. I wouldn’t count on it just yet.

[boarder42]

Sorry if this has already been asked/answered: what is the plan for everyone's healthcare at this point- for those under 62. 

It looks like insuring our family will cost 1800/mo 20k a year - is that was Mr Money Mustache is paying or is he self insuring?  This is the highest deductible plan available for a family of 4 that I can see.

If you're religious, look into health sharing ministry, $500/mo -ish.  Hopefully the law will change soon and we can start a new heath sharing ministry for those who subscribe to the MMM philosophy!

https://forum.mrmoneymustache.com/ask-a-mustachian/let%27s-talk-about-health-share/

Healthshare seems like a great solution.  Though I did just rerun the calc on the gov site for my state and it said 1800 a year for a family of 4 with an agi at the top of the 15% bracket. So what are you doing to reach 1800 a month. 

[Monkey Uncle]

Looks like it didn't take long for something to be done with CSR funding:  http://www.cnn.com/2017/10/17/politics/health-care-csr-payments-deal-reached/index.html

Sorry to burst your bubble, but nothing has been passed. I wouldn’t count on it just yet.

News this morning is that the deal is getting a chilly reception from Republican leadership in the Senate, and the crazies in the House are downright hostile.  All the support from Democrats and moderate Republicans won't matter if it never comes up for a vote.

[ZiziPB]

Looks like it didn't take long for something to be done with CSR funding:  http://www.cnn.com/2017/10/17/politics/health-care-csr-payments-deal-reached/index.html

Sorry to burst your bubble, but nothing has been passed. I wouldn’t count on it just yet.

News this morning is that the deal is getting a chilly reception from Republican leadership in the Senate, and the crazies in the House are downright hostile.  All the support from Democrats and moderate Republicans won't matter if it never comes up for a vote.

Yeah, heaven forbid they do something that actually helps people...

[Psychstache]

Looks like it didn't take long for something to be done with CSR funding:  http://www.cnn.com/2017/10/17/politics/health-care-csr-payments-deal-reached/index.html

Sorry to burst your bubble, but nothing has been passed. I wouldn’t count on it just yet.

News this morning is that the deal is getting a chilly reception from Republican leadership in the Senate, and the crazies in the House are downright hostile.  All the support from Democrats and moderate Republicans won't matter if it never comes up for a vote.

Yeah, heaven forbid they do something that actually helps people...

Only if it gets a W for the Red Team. All that matters these days is the scoreboard.

[JLee]

Looks like it didn't take long for something to be done with CSR funding:  http://www.cnn.com/2017/10/17/politics/health-care-csr-payments-deal-reached/index.html

Sorry to burst your bubble, but nothing has been passed. I wouldn’t count on it just yet.

News this morning is that the deal is getting a chilly reception from Republican leadership in the Senate, and the crazies in the House are downright hostile.  All the support from Democrats and moderate Republicans won't matter if it never comes up for a vote.

Yeah, heaven forbid they do something that actually helps people...

Only if it gets a W for the Red Team. All that matters these days is the scoreboard.

I'd venture to say that all that matters these days is making the other team angry...scores be damned.

[jim555]

Remember Trump signed some EOs that everyone thought meant the IRS will no longer fine those without health insurance.  Well that isn't happening, the IRS is still following the law.

IRS to block, suspend tax returns that lack Obamacare disclosures
https://www.cnbc.com/2017/10/19/irs-to-block-suspend-tax-returns-that-lack-obamacare-disclosures.html?__source=yahoo%7Cfinance%7Cheadline%7Cheadline%7Cstory&par=yahoo&doc=104784114&yptr=yahoo

[AdrianC]

A State-By-State Guide To Those Wonky Obamacare Payments You Keep Hearing About

https://fivethirtyeight.com/features/a-state-by-state-guide-to-those-wonky-obamacare-payments-you-keep-hearing-about/?ex_cid=SigDig

For us: Ohio - Only applied to silver marketplace plans

We have a Silver plan now, no subsidy. Next year we should be getting a subsidy, so we are probably be good. Probably go to a bronze plan, which will be quite cheap with subsidy. 

[DavidAnnArbor]

A State-By-State Guide To Those Wonky Obamacare Payments You Keep Hearing About

https://fivethirtyeight.com/features/a-state-by-state-guide-to-those-wonky-obamacare-payments-you-keep-hearing-about/?ex_cid=SigDig

For us: Ohio - Only applied to silver marketplace plans

We have a Silver plan now, no subsidy. Next year we should be getting a subsidy, so we are probably be good. Probably go to a bronze plan, which will be quite cheap with subsidy.

Subsidies are the way to go with this ACA.

[Threshkin]

A State-By-State Guide To Those Wonky Obamacare Payments You Keep Hearing About

https://fivethirtyeight.com/features/a-state-by-state-guide-to-those-wonky-obamacare-payments-you-keep-hearing-about/?ex_cid=SigDig

For us: Ohio - Only applied to silver marketplace plans

We have a Silver plan now, no subsidy. Next year we should be getting a subsidy, so we are probably be good. Probably go to a bronze plan, which will be quite cheap with subsidy.

Subsidies are the way to go with this ACA.

Until the subsidies are killed that is......
We are on COBRA this year because it was cheaper than similar Silver plans without subsidies.  Next year we loose COBRA but should qualify for a subsidy.  It will be just our luck if the subsidies are killed just before we can use them.

[Threshkin]

One question.  If we sign up for a subsidy but don't wind up making enough to qualify for it what happens?  I am particularly concerned about falling under the medicaid threshold.  I understand that if we make too much money we will need to repay some or all of the subsidy.  I am concerned about making too little.

I am FIRE and my DW works in Real Estate which has highly variable income.  We are also planning significant overseas travel next year so her income opportunities my be significantly disrupted.  (We also need to make sure we have insurance coverage while we travel.  As I understand it most ACA plans have very limited coverage networks domestically, much less internationally.)

[RedmondStash]

One question.  If we sign up for a subsidy but don't wind up making enough to qualify for it what happens?  I am particularly concerned about falling under the medicaid threshold.  I understand that if we make too much money we will need to repay some or all of the subsidy.  I am concerned about making too little.

I am FIRE and my DW works in Real Estate which has highly variable income.  We are also planning significant overseas travel next year so her income opportunities my be significantly disrupted.  (We also need to make sure we have insurance coverage while we travel.  As I understand it most ACA plans have very limited coverage networks domestically, much less internationally.)

We ran into something like this; spouse & I both freelance, so we have some lean years. My experience with the ACA is that when you put in your expected annual income, you just have to project a number large enough to fall outside the Medicaid window. It's a projection for next year, so it doesn't have to be 100% accurate.

Also don't forget to include investment income (and Social Security, if available) in your projections. I estimated too low and got dumped into Medicaid; then I appealed that and estimated a bit higher and ended up with the plan I wanted plus subsidy.

Basically, the only time the numbers have to be exactly accurate is in next year's tax return. If you fudge them a bit upward now to avoid Medicaid, they (and you) have no way of knowing that you won't actually have income that high.

[ZiziPB]

One question.  If we sign up for a subsidy but don't wind up making enough to qualify for it what happens?  I am particularly concerned about falling under the medicaid threshold.  I understand that if we make too much money we will need to repay some or all of the subsidy.  I am concerned about making too little.

I am FIRE and my DW works in Real Estate which has highly variable income.  We are also planning significant overseas travel next year so her income opportunities my be significantly disrupted.  (We also need to make sure we have insurance coverage while we travel.  As I understand it most ACA plans have very limited coverage networks domestically, much less internationally.)

We ran into something like this; spouse & I both freelance, so we have some lean years. My experience with the ACA is that when you put in your expected annual income, you just have to project a number large enough to fall outside the Medicaid window. It's a projection for next year, so it doesn't have to be 100% accurate.

Also don't forget to include investment income (and Social Security, if available) in your projections. I estimated too low and got dumped into Medicaid; then I appealed that and estimated a bit higher and ended up with the plan I wanted plus subsidy.

Basically, the only time the numbers have to be exactly accurate is in next year's tax return. If you fudge them a bit upward now to avoid Medicaid, they (and you) have no way of knowing that you won't actually have income that high.

But aren't you running the risk that if your income turns out to be too low you don't qualify for a subsidy either?  In other words, what happens at tax time if your actual income turned out to be much lower than expected?  Do you have repay the subsidy you got?

[jim555]

The repayment amounts are limited, see:
https://www.irs.gov/affordable-care-act/individuals-and-families/four-things-to-know-about-advance-payments-of-the-premium-tax-credit

[geekette]

You can increase your income in December by doing a Traditional to Roth IRA conversion, or just sell something in your taxable account.

[DavidAnnArbor]

You can increase your income in December by doing a Traditional to Roth IRA conversion, or just sell something in your taxable account.

+1

[geekette]

Plans are up on healthcare.gov.

[MDM]

Trump doesn't have to resume Obamacare health care subsidies, judge rules.

"The state of California is standing on the courthouse steps denouncing the president for taking away people's health care, when the truth is that California has come up with a solution to that issue that is going to result in better health care for a lot of people"