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ProSense

(116,464 posts)
6. This is not the final rule, and
Thu Jan 31, 2013, 10:21 PM
Jan 2013

it likely needs to be clarified.

Fact Sheet on Proposed Affordable Care Act Regulations
http://www.democraticunderground.com/10022291387

Still, the NY Times article and other reports appear to be making incomplete assumptions

In 2012, according to an annual survey by the Kaiser Family Foundation, total premiums for employer-sponsored health insurance averaged $5,615 a year for single coverage and $15,745 for family coverage. The employee’s share of the premium averaged $951 for individual coverage and more than four times as much, $4,316, for family coverage.

Under the I.R.S. rule, such costs would be considered affordable for a family making $35,000 a year, even though the family would have to spend 12 percent of its income for full coverage under the employer’s plan.

Is this a single-income family? If this is based on two incomes, what would prevent either parent from covering both kids (assuming neither parent earns more than $26,000)?

The Medicaid subsidies are up to 400 percent of FPL (about $90,000 for a family of four), and a family of three qualifies for full Medicaid up to $26,344.

A key element of the Affordable Care Act (ACA) is the expansion of Medicaid to nearly all individuals with incomes up to 138 percent of the federal poverty level (FPL) ($15,415 for an individual; $26,344 for a family of three in 2012) in 2014. Medicaid currently provides health coverage for over 60 million individuals, including 1 in 4 children, but low parent eligibility levels and restrictions in eligibility for other adults mean that many low income individuals remain uninsured. The ACA expands coverage by setting a national Medicaid eligibility floor for nearly all groups. By 2016, Medicaid, along with the Children’s Health Insurance Program (CHIP), will cover an additional 17 million individuals, mostly low-income adults, leading to a significant reduction in the number of uninsured people.

http://www.democraticunderground.com/10022159929

The assumptions about children are also wrong:

<...>

Who qualifies for CHIP?

Every state operates a CHIP, although most states have unique names for their programs like Child Health Plus (New York), Healthy Families (California), and Hoosier Healthwise (Indiana). In several states, CHIP and Medicaid are combined into one program.

Here are some CHIP basics:

  • Basic eligibility for CHIP: Children up to age 19 in families with incomes up to $45,000 per year (for a family of four) are likely to be eligible for coverage. In many states, children in families with higher incomes can also qualify.

  • Eligibility and pregnancy: Pregnant women may be eligible for CHIP. Coverage for expectant mothers generally includes lab testing and labor and delivery costs, and at least 60 days of care after delivery.

  • Citizenship and immigration status: CHIP covers U.S. citizens and certain legal immigrants. States have the option of covering children and pregnant women who are lawfully residing in the United States. Undocumented immigrants aren’t eligible for CHIP.
http://www.healthcare.gov/using-insurance/low-cost-care/childrens-insurance-program/index.html


http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Childrens-Health-Insurance-Program-CHIP/Childrens-Health-Insurance-Program-CHIP.html

Also, what would prevent the other family members (spouse and children) from securing health care on the exchange?

Latest Discussions»General Discussion»Kids of the Working Poor ...»Reply #6