[mikepavone]

> The "logic" there (from reading discussions of the cutoff) is that, "well, if you're below the poverty line, you should be on Medicaid and not on the ACA exchanges at all, silly!" Okay, but if you have wildly varying income, and a high income from previous years, you don't know that you'll be "in poverty" this year, and won't qualify because of the past year.

This wasn't setup this way because it was thought to be a good design, but as a political compromise. At the time, it was seen as important to keep the headline cost of the bill below some arbitrary threshold and for it to be revenue neutral (the wisdom of this is questionable in hindsight since the moderate Dems that supported the bill mostly got wiped out anyway and it never got any Republican support). Medicaid is cheaper for the government than ACA subsidies (at least for low income people given the way the subsidies are structured), partly because the government has a lot of negotiating power and partly because Medicaid is stingy.

This was made worse when the Supreme Court ruled that the federal government couldn't make receiving existing Medicaid funding conditional on Medicaid expansion (Medicaid is partially funded by the federal government, but the program is administered by individual states) so whether the Medicaid expansion is even available to you largely depends on whether your state is run by Democrats or Republicans (with a few notable exceptions).

[chubbyFIREthrwy]

People like me are an extreme edge case, I doubt this was a big factor in any debate.