this is NOT the fault of Obamacares....

This is the fault of his state governor.

Do you think this is the first time someone with a low post count tried to blame Obamacares for this?


Your own link points this out...

There's a big divide between the states that participated in Obamacare's Medicaid expansion and those that didn't. States that signed up extended Medicaid eligibility to all adults earning up to 138 percent of the federal poverty level, or about $16,105 for an individual.

But if you live in one of the 23 states that didn't expand coverage, the limits can be really strict, according to a new report from the Kaiser Family Foundation. The result is that a lot of people end up being caught in a gap where they make too much money to qualify for Medicaid but too little to get assistance through the new Obamacare health insurance exchanges.

I am not blaming Obamacare and I'm NOT a troll...jerk! I'm honestly seeking some solutions not just spouting off about Obamacare. Yes it IS the fault of that state but is there ANY solution to my friend's problem??? Desperate.

YOU did "spout off" about Obamacares....read your title out loud...

HIS or HER governor is the problem....NOT Obamacares!

And you are talking to someone who was unemployed (got full unemployment) who's governor DID expand Medicaid....and I paid only $61 a month for Silver Level Blue Cross and Blue Shield.

my brother went through the same thing while in between jobs. It is a problem.

If out of pocket cost for the insurance is more than 8% of his income he does not have to pay the penalty.

Any penalty since his state did not expand medicaid.

So, welcome to the ranks of the uninsured in the South...

But what I do know is that this guys problem has nothing to do with Obamacares...

I work as an adjunct Professor and cannot and have been without insurance for 3 years now. I just recently moved to TX, from FL (no help there) and find myself in a place with an even worse clinic system for people like myself who fall through the cracks.

Welcome to the new America where being a Professor earns you less than your friends in fast food when you break down the hours...

it should a human right, like breathing.

are a poor mix.

The OP is asking an appropriate question about what options their friend has.

He is going to have to address his or her governor about this...

"I came here looking for help...silly me. n/t"


silly me.....no one ever came here to complain about Obamacares and said that before!

See the little red x on the upper corner of your browser? Click it.

I guess it was assumed that every governor would step up and do the right thing for his or her citizens when it came right down to it. Once again, we misunderestimated the sheer mean spirited viciousness of Republicans, many of whom are perfectly willing to see their citizens die in the streets to prove Obamacare is a failure. On edit: your friend could look into moving to a different state, one that cares about the health of its citizens.

wealth-extraction system of the private insurers; those with not only the infrastructure in place, but the economic and political clout to oppose a more universal and cost-effective system.

at least a temporary stop gap. He doesn't have time to take on his state.

If he is a veteran, the VA might help him. If he's elderly, social services might help him. Some counties have programs to assist low income residents. All you can do is start looking around and asking various social services agencies. We can't help because we don't live there, and we don't know his exact circumstances.

It mandated Medicaid expansion and the Supremes struck that down.

fuck Roberts and Kennedy.

does include a form to apply for hardship exemption but the pages for explanations of specific hardships won't open.

I investigated the marketplace recently and found that in MT, where we recently implemented some form of expanded Medicaid, I made a few hundred $$ too much to qualify for Medicaid (I only worked for 6 months this year) and all the high deductible plans on the marketplace are over $600/month which is $150 more than I pay for rent. Then the web site offers to look further for you but only if you agree to allow them to look at your bank accts, and all other financial info as well as approach your relatives, like mother, to collect if you blow it. I would not agree to that because my 88yo mother has nothing to do with my personal life and/or expenses. So I was kicked out of the system.

SO they will be taking more than half of my income tax return which I normally use for over a month of bills while work is nowhere to be found in my area.

I think this system sucks and I think the penalty/tax is illegal and unfair. I understand the stated intent for the ACA but it falls way too short of helping those who need it and is ruinously punitive to those who fall through the cracks.

accomplishing something nobody else could do.

It is step one...

Important step, and step two is a version of medicare for all.

...any better, unless you are extremely poor and just above the poverty line and live in a state that expanded Medicaid coverage. Many, many more (including me) fall into the gaping donut hole. We had our chance and we blew it.

As an example: cheapest available Marketplace insurance in South Carolina for someone not eligible for our non-expanded Medicaid would be BC/BS bronze plan @ $519.00 per month with a $6,300.00 dollar deductible, $6,850.00 out of pocket, no co-pays and 20% co-insurance across the board after meeting the deductible. There are only two providers (well "three", but one is a subsidiary of BC/BS,) BC/BS and Aetna, with the latter at the high range. My former insurer, Consumer's Choice, pulled out this year - one of the 12 of 20 co-ops to call it quits nationwide. I make far too much to qualify for hardship or subsidies, but not nearly enough to afford this.

I am so sick of this shit

No wonder we got our asses kicked in 2010

Listen, I'm one of those that "benefits" from no pre-existing condition clause, (Hodgkins Lymphoma - 1990, heart attack with three stents while uninsured - 2010.) But, if you can't afford your FUCKING MONTHLY PAYMENT or your FUCKING DEDUCTIBLE what the FUCKING HELL DOES IT MATTER???

I'll tell you why we lost big in 2010 is because we DIDN"T TAKE ADVANTAGE OF THE MAJORITIES WE ENJOYED IN THE WH AND CONGRESS! We lost our nerve and tried to be "accommodating" and see where that got us.....NOWHERE!

Every time I read of real life examples like you've given I get heartsick. Are we "all created equal" or not?

why would it ask about your Mom's money if you're not a defendant or vice versa? it would not.

and discussed what it was saying with the navigator before declining to accept those terms. I can read and comprehend legalese, that is what the choice was and I could not accept those terms. I doubt I could be considered a dependent since I'm about 60, but the text said what it said and I couldn't agree to the terms described. We were way past the "estimate income" part at that point. I found that I don't qualify for my state's extremely low income cap for medicaid and I certainly couldn't even consider the premiums for the cheapest available plan which cast me into the "let us help you figure this out" part where I was prompted to accept unacceptable terms in order to proceed beyond that point and the system bid good day and cast me out of the system.

A few days later I got a letter explaining that I was shut out of the process because I would not accept the unacceptable terms. These are legal terms and agreements and every word matters.

So, contrary to your summation, yes it did ask that.

Clearly you would not have to guess if either you or your Mom file the other as dependents, or were planning to.
Something is off here.

She's 1800 miles away and I live alone. It doesn't matter if it makes sense to you, it didn't make sense to me or the navigator...

All I know is what I read very carefully and that is all there is to it. I live in a red state where the expansion was just implemented on 11/1/15. I would really like to have a health care policy so I can go to the dentist and eye doctor and maybe have a "just in case" protection but, as is true for the majority of my life, it's just not there for me. I sure can't afford what the market was offering nor can I afford the penalty for not having coverage, which I think is a crock of poo and only enriches the insurance cabal by forcing us to pay them a monthly fee for "just in case".

They didnt ask for that...

Would cost over 10 percent of your income, you are exempt from paying the penalty.

Now to get some documentation or whatever to make sure I don't lose 3/4 of my tax return which is vital to my bill paying ability for 90 days before work begins down in tourist town where I work.

More accurately, "help, friend sinking into poverty due to TX governor's rejection of Medicaid expansion", costing approximately $100 billion in federal cash over the decade, being covered by taxes and insurance premiums paid by the state's businesses and residents.

Texas has the second-highest insurance premiums in the nation, after Florida, another non-Medicaid expansion state. And Texas has the third-highest property taxes in the U.S.

But I guess my point was there is a perfect storm created between certain state's decisions on Medicaid and Obamacare that needs to get resolved right away...somehow.

https://www.healthinsurance.org/texas-medicaid/

-- who would otherwise be eligible due to low or no income -- they are NOT subject to penalties and they are NOT required to pay for any insurance.

Your friend needs to talk to a human being at one of the numbers listed on the exchange. He's misinterpreting something he's reading online.

Stop saying that....its not true..

That's one good reason why property taxes, sales taxes, car tag fees, professional license fees, and all that are high.

Texas is not a low-tax state. They just say they are.

I live in Texas, again, and I hear these suckers brag about not having to pay taxes. Even when I point out the sales tax, proprty tax, user fees, etc., they'll say yeah, but no taxes! Add that to the occasional Hispanic Texan that loves Trump. I can't wait to get outta here.

My insurance is nowhere near that $450/month.

I'm not sure why his premiums are so high...I think he applied for Obamacare not understanding that it didn't apply to him due to his unemployment (nontaxpayer) status and so they automatically shifted it over to full coverage...or something like that. But it IS true. Any coverage recommendations would be welcome.

I'm a self-employed freelancer. He needs to call and speak with someone.

My husbands plan runs 350.00, that's the total WITH a subsidy. Just got word that it'll go up 120.00 in January with another 6000.00 deductible.

Please don't get me wrong, we are very lucky to have this insurance. My husband is currently awaiting a liver/kidney transplant. Obama care has been a lifesaver but it is far from perfect. We can barely afford the premium but we do because we don't have many other choices.

Just thought I'd give you another example.

should qualify. Or not?


It is possible for many that health insurance costs alot. Obamacare has not fixed all that. It;s okay, but it needs to be known that affordable healthcare is still miles away.

If that's possible then that DOES sound like the best solution for now. I'm not sure of all the details surrounding his coverage that has become so costly, but I'm guessing he could figure out how to drop it and just pay the fee annually?

At that income level (from where I wonder. If he's living off savings 8k a year means he has some serious wealth. If it's from other sources then I have to question reporting choices) I am not sure he'd even have to pay at all.

And I don't think he had any but minor health issues/visits prior to all of this. He's healthy.

Haven't seen anything beyond 3% for years and years and that's if you tie it up for a generation. He could be in higher paying dividend stocks of course but even that would make him pretty well off and very brave if he's risking all his capital and only source of income there.

So your friend can continue to pay for care out of pocket - and be in the same situation as before the ACA (echoing the comments above - while the ACA did not fix your friend's problems because his governor is a world class jerk, the ACA most definitely did did not cause them).

Your friend could also look for short term insurance. I randomly picked Houston, Texas, non-smoker, age 25 and found 4 plans for 50-60/month. $1000 deductible, coinsurance of 20% for the next $1000 out of pocket.

Here is one source: https://www.ehealthinsurance.com/short-term-health-insurance

(It is also possible that some of the ACA plans will be affordable - so those should be thrown in the mix, even if there aren't subsidies available because, again, your friend's governor is a world class jerk.)

don't you want to help your "friend"?

I'm trying to reply to ALL of the posts and help as fast as I can.
Only just saw #10.

it was a confusing mess.
aca assumes the medicaid is available....
thank god my wife got a job with group coverage

And questioning the absolute perfection of ACA is one of those things.

I have someone very close to me--right here in very blue California--in a very similar situation. We have not been able to find anyone, not accountants, not attorneys, and certainly not anyone who may at some point actually answer the phone at CoveredCA, who knows all the rules well enough to advise on this particular situation.

It's like going to window A at the DMV, and they tell you to go to window C. At window C you are told you need to go to window A.

I changed my post title so as not to encourage the flame
response. Some folks have been helpful so I'll weed through
the rest. I believe in universal care and think the Obama plan
hit its own perfect storm. But something has to be done fast
to fill these huge gaps because it truly is ruinous for many
in that gap. My friend's situation brought that home to me.

8,000/yr, you don't pay taxes, thus you have no penalty for not buying insurance.

regardless of income. Kind of like auto insurance.

if you DON'T, then we will tax you on April 15 with a 'penalty'".

Obama didn't want to face up to the fact that he was raising taxes, but that's what he did with ACA.

would that penalty still apply? It's all so confusing...I'm still not
sure I understand exactly what this guy is or is not supposed to
do or is required to do.

and who don't qualify for Medicaid in their state. It took me 2 days to find a table that showed what 138% of poverty was (for 2015 anyway). (Actually, they say '133% of poverty, which is effectively 138% of poverty' -- another absolutely useless statement they insist on including in page after page of useless statements.) I should have bookmarked it because I expect it will take me 2 days to find it a 2nd time.

I will fall into the gap next year, and may fall well fall into it this year. From what I've been able to glean, I can avoid the penalty by applying for the waiver.

The only thing I've seen as far as how to apply for the waiver is that you do it on your income tax return. Other than that, just referrals to page after page of goblety-gook and, as mentioned above, a bucketload of circular referrals to pages that refer you back to the page you came from but never give clear instructions on anything.

I'll either apply for the waiver -- if I can figure out how the eff to do that -- or pay the effing penalty.

I'm planning on calling to see if I can get an answer at the end of this week. Hopefully the phones won't be too busy now that some big, stupid deadline is past. I'm dreading going into my email again. I'm so effing sick of their effing reminders, warnings and threats.

Also, if your friend has health insurance, then he doesn't need to pay any penalty. It doesn't have to be insurance from ACA -- it just needs to meet the requirements of ACA. He needs to file an income tax return even though he doesn't earn enough to pay taxes. He just fills out the return, including the part that asks about insurance.

I have gotten hardship exemptions the past 2 years because tennessee did not expand medicaid and my income is under the 133 percent of the federal poverty level.

The first paragraph in your link even states that this is the fault of that asshole Governors that refused to expand medicare & had nothing to do with ACA in general.

But hey why let facts get in the way.

Because I didn't jump on the evil ACA train? Don't worry you'll find plenty to play the woe is you game.

to look up community clinics in his state, that charge on a sliding scale,
he may not have to pay anything.
Bernie Sanders helped get this state clinic provision through after the scotus gutted the aca medicaid
coverage for the working poor.
good luck.

my understanding is that everyone has to carry health insurance.
Is that not accurate? Otherwise why would people without Obamacare
have to pay a penalty?

sounds like he won't have to pay penalty.

here:--1-800-318-2596 or

https://www.healthcare.gov/

good luck.

But his work on this had been exceptional.

Bernie cares.

therefore Obamacare did not affect him at all.

We live in Missouri and there is no expansion here. The person I helped had too low of an income to qualify for a tax credit and would have qualified for Medicaid if we had the expansion.

She is low income and because of that, the ACA website said that she would not be penalized. She does not have to pay a penalty and is considered exempt, as are most that fall "in the hole".

carry any insurance at all and is exempt from penalties?

When they filled out their forms on the Healthcare.gov site they should have received a notice telling them if they qualified or not for subsidies. If they didn't qualify for being too low income it should have stated that they would be exempt from the penalty and given a code stating such.

I read the letter the other day and all that info was stated in it.

You know because of the ACA I got insurance for the first time in years. Though still expensive for me at 115 dollars a month it saved my life when I got hit by a car last January and had to spend 2 months in a hospital and then a few more months doing physical therapy

And I can tell you the ACA has some serious suckage issues.

It has loop holes and weaknesses and large parts where even when it does fix a problem doesn't' always make it known to the people who need it most. That includes people already using it. (once again I have to renew after the deadline and hope they give me an extension because I couldn't' balance the time it takes to sort through the web site issues with my real life needs)

I have insurance because of the ACA. My room mate who is in the same position as the friend from the OP does not.

It doesn't' matter is this is the fault of Obama or the Democrats or the Republicans or Governors or whatever (In my home state it was a joint collaboration between our republican state legislature and reactionary voters) because the fact remains we have too many people who aren't' being helped and either don't' have options or don't' know what their options are

And all some of you could do was flame the guy. Thank you for the ones that tried to help but the rest of you suck.

Some of us have become so afraid of even appearing to give conservatives an inch in a debate we become just as bad as they are.

"It doesn't' matter is this is the fault of Obama or the Democrats or the Republicans or Governors". It most certainly the fuck does. The people who messed this up for a lot of folks don't get to skate. Expanded Medicaid in all the states, plus proper federal funding of the coops would have eliminated a lot of the initial pain. Then having a congress who might want to work on getting the copays down, instead of fucking around with 50 bills to "kill Obamacare".

Do not give me this shit that it doesn't matter who's to blame. It most certainly the fuck does.

Sorry for all the swearing.

Well said.

of the year as a deadline for getting on 'the plan'? People already get suicidal over the financial and emotional burdens this month brings.....Merrrrrrrry Christmas!......but to add this to the mix? REALLY???

If he lived in a civilized state, he'd be fine.

Enjoy!

It's verboten to say so on DU, but Jesus, this system is insanely bad. I have a friend, single, mid-30s, paying $80 a month for insurance who was dumped by his employer (everyone gets the exchange!). Now, in Covered California, he gets to pay $400 a month, pretty much nothing is covered (he was billed for basic labs), and hoooray for deductibles!

But, no. This is brilliant. Best thing ever. Just ask anyone on a message board,

I have no experience with this topic and don't know anyone who does, but it seems like there are enough people that are getting screwed by it so I would like to hear a more balanced assessment here. The cheerleaders for the ACA just seem to attack those that have a problem with it, but don't really offer any facts or case studies to underscore their assertion that this is a good thing for a majority of citizens.

I really don't know, was it better off when people were just uninsured and went to the emergency room? Not for the taxpayer, but maybe for that person. $400-$500 per month is a huge amount of money when you are under or unemployed. I think I might rather take my chances if I was in a tight spot than be forced to fork over that much money for something I may never need or not need until I had gainful employment again.

Now I pay $1600 a year for concierge care because of the lack of coverage.

Some people won. Pre-existing conditions is a big one. The previously uninsurable. But that comes on the backs of a lot of people who now have to pay tons for no care.

Somehow, Politicians figure they could just make people pay $400 a month to receive no health care, and this would be a brilliant idea.

My friend pays $400 and does not go to the doctor because he can't pay for shit. What a wonderful system.

Just got coverage for 102 a month. 31 years old. 500 deductible/500 max out of pocket. No charge after deductible. How about that for a real life story.

just curious because I don't know anyone who has tried to make use of it yet. Thanks.

went to the ER for a kidney stone. I didn't have insurance at the time (coverage gap between old job and new job). I refused the ultrasound because I already knew what it was-I'd had one before. I was seen by a practitioner, had a UA, was given Tylenol and a script for Flomax, along with a prescription for Diflucan. (I also had a yeast infection with the kidney stone, because that's how I roll.) Flomax was $20 and Diflucan was $5 at the pharmacist.

I received my bill in the mail three weeks later from the hospital. I also received two other bills, one from the company that hired the ER physicians and one that hired the lab techs. (Both were different companies.) For my services, along with a consult from a doctor whom I never saw, I was charged $2900.

Premiums go up based on age. A 50 year old's premium will be considerably higher than a 30 year old's.

Where does he live. I know that the Harris County Hospital District has something called a "gold card". It's just a piece of paper and it's not gold, but anyone with an income below a certain level can get very reasonably priced medical care at one of the clinics around the Houston area. I had a gold card when I was living on disability but not yet eligible for Medicare. At the time (2012) the limit was about $19K for a single person.

Travis County (Austin) has a thing called a MAP card (Medical Access Program) for people whose income is at the poverty line or below.

I imagine most urban counties have some kind of low income program through their hospital district. It's far cheaper for the county to pay for clinics than to have people using emergency rooms for primary care.

complaining about being confused on the deadline is kind of foolish. but I think there's another one coming up to get insurance for 1/15. They should talk to a navigator before that.

I'm in another Red State that used to be called the most progressive state in the South. We also have mean spirited GOP members who'd rather have people die than allow Obama or any Democrat to get credit for anything.

It's not clear what the consequences are yet for overestimating one's income for the forthcoming year, but premiums are based on estimated income, not past income. So an income in a certain sweet spot enables a full federal subsidy. Your friend may in fact earn that income in the forthcoming year. Who knows?

The alternative is to not have any insurance and not pay any premium. One isn't penalized if one's state doesn't expand Medicaid. So your friend could just do what people in the US have done for years, which is go to the ER for emergencies and have the rest of us pick up the cost (instead of Single Payer or Medicaid Expansion).

Sorry the Repubs in your state want your friend to just go ahead and die if he gets sick. That's the situation in our state. They'll have a lot of company in Hell.

You get the maximum subsidies on the plans. It has been reported that people who do this will not be penalized for it.

which receives federal monies. they usually have a sliding fee scale for those without insurance or who have minimal insurance. your friend can set up a payment plan for care. your friend cannot be refused service. your friend can only do what your friend can do monetarily speaking.

the other option is your friend can either move or go to a border town community health clinic.

is your friend able to advocate for him/herself? if your friend is a senior, contact senior services in the community.

good luck and hopefully, your friend votes for a more empathic government representative at all levels of government.

Anyone remember this from two elections ago? From a PAC or "Obama for America"?

for next to nothing.