[curun1r]

My own personal "why I hate the ACA"...

In 2016, I decided to take off from work and travel outside the US. I did what I thought was the responsible thing and purchased a travel insurance plan. In total, I was gone for a year...I had an amazing trip.

When I got home, I wanted to sign up for insurance again. But since it wasn't a life event, I wasn't eligible to enroll until the open enrollment period. And when that time rolled around, I wasn't eligible for the subsidized plans because I hadn't gotten a job yet and my monthly salary was $0/mo. Nevermind that I'd done enough contracting work during my trip such that if you divided my annual earnings by 12 to arrive at a monthly earning, it would've easily qualified me for a subsidy to stay on a plan that let me see my previous doctor. But I did eventually get signed up for Medicaid for the month between open enrollment and when I found a job, so...yay?

Then tax time rolls around and, it turns out, you need to be out of the country for 11 out of 12 calendar months to qualify as a non-resident. Since my trip didn't start on Jan 1st, despite being out of the country for an entire year, I didn't qualify as a non-resident for either 2016 or 2017 and had to pay the ACA penalty for the entire time I was gone because I didn't buy health coverage that would've only been useful in a country I wasn't present in. And adding insult to "please don't let me get injured", I had to pay a penalty for the time I was uninsured between when I got home and open enrollment.

In short, I feel like the ACA was rushed and they never seriously considered what was right for people not working a 9-5 job getting regular pay checks. By deciding to opt out of the workforce and do my own thing for a while, even doing it responsibly, the ACA cost me thousands because I somehow managed to find corner cases that were simply not considered or poorly handled by those writing the bill.

[lsc]

So there's a lower bound on how much you can make and still get the subsidized plan? that seems broken in a very American sort of way.

I think a lot of the bureaucratic issues might be the nature of insurance companies? My (pre-aca) experience was that any lapse in coverage and they don't let you back on. All this 'life event' stuff, I think, was part of how group plans worked back in the day, the rules about when you could change things and when they could kick you off.

I guess what I'm saying is that (aside from charging you the extra tax) I don't think it's worse than it used to be.

[gizmo686]

There is a lower bound on income to qualify for ACA subsidies because the ACA also expanded medicaid to cover people below that threshold.

Unfortunately, the portion of the ACA requiring states to expand medicaid was ruled unconstitutional. As a result, 19 states have choosen not to expand medicaid, leaving a portion of the population to poor to qualify for ACA subsidies, but too rich to qualify for medicaid.

I should also point out, that the medicade expansion is 90% funded by the federal government starting from 2020 into perpetuity. Prior to then is a ramp up period where the federal government pays an even larger share.

[lsc]

Am I right in thinking this is uniquely American? The states that need welfare the most seem to be most strongly against said welfare, even when the more wealthy states are footing most of the bill.

[arethuza]

There was a similar thing here in the UK with the Brexit vote - the regions that got the least money from the EU voted most strongly to remain and the regions that got the most money voted to leave:

https://www.prospectmagazine.co.uk/politics/which-uk-regions...

[bitwize]

Should've not stopped travelling outside the US and settled in a civilized country.

[tschwimmer]

If your income was zero, couldn't you have gone on Medicaid?

[curun1r]

Once open enrollment rolled around, yes. But the point was I didn't want Medicaid, I wanted a plan that let me keep my previous doctor. And I was willing and able to pay (savings), but the ACA didn't allow me to take the subsidy in lieu of Medicare. And also, there was the matter of the nearly 4 months between when I returned to the US and when I was allowed to enroll during open enrollment. For a law that's designed to help people get healthcare, mandating that someone wait to get healthcare seems like an odd choice.

[JamesBarney]

Not necessarily, depends on the state. Texas for instance has no adult medicaid.