The most recent set of rules for the ACA contained two major new individual mandate exemptions:
1) People can claim a hardship exemption if all affordable plans cover abortion
2) People can claim a hardship exemption if their county of residence only has a single insurer.
All of this is only relevant for 2018 as the mandate penalty zeroes out on 1/1/19.
I am not sure how big of a deal this is in terms of how many people would drop coverage this year with these two new exemptions that they otherwise would have kept. The individual mandate penalty this year is 2.5% of income or $695 for a single adult, which ever is greater. There is a current hardship exemption for people who would need to pay more than 8.05% of their income for the least expensive Metal plan.
A good chunk of the country has to earn over $70,000 a year for a single 40 year old to not qualify for that mandate exemption. A family of three has to earn well over 600% Federal Poverty Level in a lot of Healthcare.gov states to not qualify for a hardship exemption.
Intuitively, a lot of people have an out from the ACA if they wanted to take it already. This makes me lean towards thinking that these two exemptions are primarily messaging rules and not rules with significant pragmatic impact.
Brachiator
I can really see religious leaders and conservative media pushing the abortion exemption, but I’m not sure how many people will make that election.
David Anderson
@Brachiator: It decreased slightly in 2018
Brachiator
@David Anderson:
Yep. Noted and revised my comment. Thanks.
Aardvark Cheeselog
That word, “hardship,” I do not think it means what they think it means.
stinger
The messaging is clearly “Join us in hating women.”
Mnemosyne
I realize I’m an asshole for even thinking this, but I’m hoping that everyone who chooses the abortion “hardship” waiver then has a covered pregnant family member contract listeria. Sorry, you’ll have to pay out of pocket to get that dead fetus removed before you get a septic infection since you chose not to be covered for that eventuality.
Brachiator
@Mnemosyne: I’m guessing that this “hardship” waiver will be chosen by a lot of young, healthy people, especially men, just as a way of avoiding having to get health insurance. All these little ways of nibbling away at ACA.
Monala
“A good chunk of the country has to earn over $70,000 a year for a single 40 year old to not qualify for that mandate exemption. A family of three has to earn well over 600% Federal Poverty Level in a lot of Healthcare.gov states to not qualify for a hardship exemption.”
This just isn’t true. I’ve been doing taxes for hundreds of people this tax season. I am shocked at how few people qualify for the hardship exemption based on income/affordability. Basically, you have to be ages 60-64 (so paying the highest rates possible), with extremely low income before you qualify. A 40 year old with income of $22,000 and average monthly premiums of $400? Even though that’s 22% of his income and the “coverage is unaffordable” exemption is supposed to apply if the monthly premium is over 8.05%? The tax software will still say, “You don’t qualify.”
Likewise, even though our income was nowhere close to 400% of poverty (we were about 300%), we always paid 100% of our premium for my husband’s ACA policy. No matter what software was used, we were told that we didn’t qualify for the tax credit subsidy.
I don’t understand why it works out this way. Just in my experience, what should be considered affordable on paper or in policy, never works out that way once the software crunches the numbers.
Monala
I have to admit, this tax season has made me angry about the ACA, and up to this point, I have been a fan. The ACA literally saved my husband’s life, since he was uninsured for several years even though he was working full time, and unable to get insurance due to pre-existing conditions. The ACA enabled us to insure him, just in time before his health worsened.
I thought we were a fluke of the system, in terms of falling within the income guidelines for a subsidy and being told we didn’t qualify. This tax season I have seen too many people with similar situations: uninsured, and well within the income guidelines for Medicaid, or for hardship exemptions, and yet being told they don’t qualify for either. It’s making me feel like, WTF??!
David Anderson
@Monala: I don’t know why the software is kicking out those responses but in both of those cases, the default assumption is that significant subsidies apply. I can think of a few corner cases (family glitch, some immigration status issues) where the default is wrong.
The 40 year old earning $22,000 is making about 190% FPL and the benchmark Silver is about 6.5% of income for a CSR 87 plan or $120/month at the benchmark. (I’m working from memory right now) so I am not sure how they are getting a $400/month plan after subsidies in most cases.
Aardvark Cheeselog
@Mnemosyne: When I catch myself at something like this (as often happens) I tell myself something like “may they attain insight, so that their delusions are dispelled and they cease in their hatred. May they be filled with compassion so that they devote every remaining moment of their waking lives to undoing the harm they have caused.”
It’s unlikely to happen, but at least as probable as wishing that they could all flogged to death.
Monala
@David Anderson: I was making up those numbers, btw, because I don’t remember the specifics. The way the software works is that it looks for the lowest price bronze and silver plans in your county, and then compares it those numbers to your income. Which could be $400, or whatever, on an income of $22,000. My point is, we are seeing people whose monthly income is clearly too little to pay for the lowest price bronze or silver healthcare plan available in their county for someone in their age range, and despite this, the software is saying that they don’t qualify for an affordability exemption. And we’re seeing this situation play out repeatedly. And again, my husband and I had the same situation when we purchased his ACA policy – we were told that despite the upper limit of qualifying for a subsidy being $94,000 for our family size, and the fact that our income was about $65,000, we didn’t qualify. This is happening to people over and over again.
Monala
@David Anderson: And it really does differ by county. I have had taxpayers who moved to my locale from other parts of the country in 2017, and been shocked when I plug in their information to see how much more expensive health care is in, say, the south, than where I live on the West Coast, for the same aged individual.