Obamacare: More Considerations

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?


Stay tuned.

4 thoughts on “Obamacare: More Considerations

  1. Thanks for the information on the lawsuits — these definitely bear watching as they will potentially affect millions of participants in the ACA plans.


    1. Litigation’s a double edged sword: if half the country has access to low cost medical care and the other half doesn’t, maybe those who don’t will wonder why. Maybe they can take it away from The Haves. Or maybe the Have Nots vote them out of power. And maybe these cases are frivolous — the intent of the law’s allowing the Feds to run the ACA in states that won’t would seem to authorize full access to the benefits of the ACA for all Americans who qualify, and not just those in states with caring governors.



  2. I just wanted to thank you for this, and your other posts on the ACA. Back in 2011, my husband and I set our retirement date to coincide with the full implementation of the ACA – I have pre-existing conditions which would make individual insurance impossible and, at 47, have too long to wait for Medicare.

    We are lucky in that we currently reside in the state of Maryland where health insurance has been regulated for years. The exchange here offers multi-state plans and, even without subsidies, the prices are extremely reasonable (less than 1/2 of what our COBRA would be). But my husband hates state taxes and wants to move our residency to South Dakota. Now I can show him why that would be a bad idea.

    I find your use of the Kentucky Exchange interesting. I’m wondering what the minimum qualifications would be to get insurance through a state in which you are not a resident. We won’t be receiving w-2s from any states for anything other than pensions. I’ll have to look into this. I look forward to your further posts.

    Thanks again!


    1. I have been unable to find any minimum qualifications for one’s insurance state IF no other state has a good claim on you. S Dakota has no income tax, so they won’t go after us for that. Our sticks and bricks home is rented out in NC, but since we lose money on the deal, NC has no claim on us either. We pass through 12 to 20 states each year, and if Kat did not work four months a year in KY, we might be able to claim some of them as home. Our situation looks like a tossup between SD and KY, and we already have to file a KY tax return since she works here.

      I suspect you need to establish enough links to a state to reasonably claim to be a resident there. If you plan to full-time RV, you could register your rig in Kentucky (or wherever you want health insurance), find a mail forwarding service with a street address in that state, and register to vote there. If there will be no W-2s, and you don’t buy a RV site somewhere else, that just might suffice, IMHO.

      Thanks for reading us,



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