Multi-State Plans Map
Thanks to reader Emily for this link to a government map of states that do and do not offer Multi-State Affordable Care Act plans. If you plan to spend several months of 2014 exploring the country, you probably prefer a plan with participating healthcare providers in more than just one state. Most insurors will cover emergencies out of state; if you can’t enroll in a multi-state plan, make sure yours does at least that much.
The Medicaid Trap
The ACA relies on tax subsidies to make health insurance affordable for the middle class. It offered expanded Medicaid to cover the poor, that is, until the Supreme Court ruled that each state had a choice on whether or not to expand. Under the old rules Medicaid covers children and the disabled whose family incomes fall below 100% of the Federal Poverty Level. Obamacare offers states the choice of extending Medicaid to all its citizens (not just minors and those on disability) whose family incomes total 138% or less of the FPL. If your family income is under $11,400 and you are a family of one, you are not eligible for the ACA subsidies; you do qualify for Medicaid, but only if your state has elected to expand Medicaid coverage. For families of two people, the income floor is $15,400. Earn less than that and you qualify for free Medicaid coverage if your state chose to expand, but you cannot qualify for any subsidy.
This is the Medicaid Trap. The poor stand to get free health insurance in states that expand Medicaid, but if their state does not expand it, they get nothing. If your situation looks like this, you’re going to want to find a way to become a citizen of an expanding Medicaid state. Here’s a link to a map showing Medicaid expanding states and those states opting out of doing anything for their poor.
Another Legal Challenge
Four lawsuits are making their way through the legal system. Each is challenging the right of the IRS to issue tax credit subsidies to ACA subscribers in states that do not run their own exchanges. Regardless of the outcome, expedited appeals are expected through the Federal courts, possibly ending up before the US Supreme Court. If the subsidies are overruled in states that don’t operate exchanges, ACA insurance will be expensive in those states. Will this kill Obamacare, or will the taxpayers in No-Subsidy states rebel against the Republican governors blocking access to affordable healthcare? Will Obamacare thrive in states that run exchanges and expand Medicare? Will their success turn up the heat on non-participating states to get with the program?