You ask, we answer! Can employed people get Obamacare subsidies?
http://www.nytimes.com/2013/01/31/us...rage.html?_r=0
Apparently your employer's only has to meet the ACA's laws by making sure the health care premiums meet 9.5% of the individual employee's AGI and does not have to meet 9.5% of the what it would cost to cover the "family" health premiums.
The IRS ruled on this earlier this year. I just read about it. This affects millions of middle/lower class W-2 employees who usually work for employers with 50-500 employees. Because these employers are required by the ACA to provide "affordable" health coverage or risk a fine. But what the IRS ruling did was define the 9.5% AGI cutoff as making employers make their employees pay up to 9.5% of their individual employee's AGI for their INDIVIDUAL coverage.
Why is this distinction important? Because a family insurance will usually cost cost to 15K a year in premiums alone. We've seen Vermont and now Maryland's proposed 2014 rates. They average is about $1100-1400 a month for a family of 4.
This is a real example since I know this person very well. She is a nurse making $60K, AGI is about 42K after deductions (she has 2 kids, single mother). That's clearly middle class income.
Her employer is a physician's office that currently employs 75. They just enrolled for the upcoming year.
If she were to have just herself on the plan. Her employer would subsidize her $375. She would pay $120 per month with a $2000 high deductible. Her employer's health plan is clearly within the ACA's guidelines since she is not paying more than 9.5% of her AGI.
But they have a "family" plan option that costs...$1200 a month. Yep $1200 a month. It doesn't matter the family size. Can be 2 people, can be 8 people. It will still cost $1200 a month with a $4000 deductible. Since she has 2 kids. She would have to enroll herself and 2 kids into the family plan. So for next year she will have to pay close to $15K in premiums alone. And guess what? Because the IRS ruling state employers only need to consider the employee's part of the premiums in their calculation of the 9.5% AGI, the employer is clearly still within the law's compliance and will not face a fine.
Now to the most important part. Obama (your savior) and the Dems claim the law is "affordable". But the IRS also ruled that
if a employed person has "affordable" healthcare offered by their employer, than they CANNOT qualify for any subsidies in the health exchange. Read the NY Times (one of the most liberal newspapers in the country). They said the administration calculated it would cost 45 billion more per year if they allow employee who have access to "affordable" healthcare to get subsidies.
So nurse I know can still buy insurance on the health exchange. But the plans release by Vermont and Maryland already indicate that it will still end up costing her roughly $1000 a month in premiums ago. $12000 a year in premiums is slightly cheaper than the $15000 she has to pay with her employer. And because her employer offer's "affordable insurance". She will not qualify for any subsidies even though she makes less than 400% of poverty.
Wait wait...wait a second, all you liberal supporters who claim more people will have access to care. Why can't the nurse just put her 2 kids on a pediatric only insurance plan and the nurse goes on the employer's care. That may be cheaper? Right? Nope...Because of the ACA law, all insurance companies have pulled out of the pediatric only insurance market. That isn't an option.
Currently the nurse has opted out of her employer's plan all together for this current year.. It was costing her $900 a month already (before the new $1200 a month increase took place). I got her switched to a $500 a month plan with a $5000 deductible. But next year, she cannot stay with the same plan because that current plan doesn't comply with the ACA's "essential benefits".
Essential Health Benefits - Glossary | HealthCare.gov
The plan she has doesn't cover maternity. Under the ACA, all plans she buys will have to cover maternity. Cool, Obama wants her to have "good insurance" . But does she really need maternity coverage if she's had her tubes tied and a uterine ablation?
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