ObamaCare Rollout: Kaiser Explains to Poor People in Non-Medicaid Expansion States How to Game the System by Lying

By Lambert Strether. Originally published at Corrente.

Kaiser Health News:

Some of the millions of poor people expected to lose out on Obamacare coverage next year because their states are not expanding Medicaid might have a way to get help, but the strategy carries risk.

Experts say the key is for them to project their 2014[*] income to at least the federal poverty level, about $11,500 per person or $23,500 for a family of four.

We explained how those income calculation works — and the ethical problems with it — here.

That would entitle them to federal subsidies that would cover nearly all the cost of private coverage sold on new online insurance marketplaces set up by the federal health law. The subsidies are available on a sliding scale to people making between the poverty level and four times that amount.

Everyone applying for subsidies must estimate their 2014 income. For the poor, the difference between qualifying — or not — could be $1,000 or less a year. Since many rely on hourly or seasonal work, their incomes often fluctuate by a few thousand dollars each year. That’s one reason why people often lose eligibility for Medicaid, the state federal insurance program for the poor.

While there are steep fines for knowingly lying on a government application for financial assistance, if someone merely miscalculates their income above the poverty level in 2014, and is later found to have made less than the poverty level, they won’t have to pay any money back, according to the Treasury Department.

“There’s little risk because under the rules you don’t have to pay anything back,” said Richard Trembowicz, vice president for Celtic Insurance Co., a subsidiary of Centene Corp. which is offering plans on several exchanges, including Mississippi.

So, Kaiser is recommending that poor people “merely miscalculate” their income. Just on the high side.

Maybe I’m just old-fashioned, but that sounds to me a lot recommending that people lie. (And never mind that you fill out the ObamaCare form under penalty of perjury.) Will Kaiser also recommend that people “merely miscalculate” to avoid being forced into Medicaid? How about if they “merely miscalculate” a few dollars low to get into the Exchanges at 400% the poverty level, minus a dollar? Would that be OK? Why or why not?

To me, this has the smell of devolution, and is yet another example of how Obama corrupts whatever he touches. What’s happened to Kaiser Health News — as reputable an organization as we can find on the health beat these days — that they’re now going “nudge nudge wink wink” to poor people about how they can game the system?

And how about the Navigators? How about the HHS help line? How about healthcare.gov chat? Will they, too, be recommending that people “merely miscalculate”?

Of course, and as usual, with single payer Medicare for All, none of this lying and gaming would be necessary: Everybody in, nobody out.

NOTE * Yes, you have to project your income to claim your subsidy. That’s a whole ‘nother can of worms.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.

69 comments

  1. Phil Perspective

    What’s happened to Kaiser Health News — as reputable an organization as we can find on the health beat these days — that they’re now going “nudge nudge wink wink” to poor people about how they can game the system?

    Lambert:
    What would you do given the hand we’ve(meaning the U.S.) been dealt? Can you really blame Kaiser? I can’t. Is the government going to prosecute thousands and thousands of people if they all lie to get coverage?

    1. KnotRP

      So banks can mark to market and robosign and foreclose
      and whale trade (while issuing FDIC backed CDs) for profit & bonuses, but poor people better not punch the wrong calculator button when **guessing about the future**,
      which is an imprecise PROJECTION by definition, or they
      are going to jail for perjury (and prisoners have medical
      coverage)?

      The irony…it burns.

    2. LAS

      Moreover, is it really lying? Don’t we all aim to exceed the poverty level? Wouldn’t being in better health make it more feasible to achieve?

      Lying is covering up the past and present, not aiming for the future.

      1. Lambert Strether Post author

        Oh, I don’t know about that. If I tell somebody I’m going to give them an apple tomorrow, knowing I’m going to give them a fig, surely that’s lying, even though it’s about the future. Not a very important lie, to be sure.

  2. cripes

    And while the cheerleaders the Administration has rounded up around the country–especially “progressive” and community and social service organizations–keep telling their subjects to get on the bandwagon, that “everything thing will be better with Obamacare,” buying insurance will be like buying airline tickets on Orbitz, you have so much choice, ad nauseum, the wreckage will pile up.

    The people bounced in and out of shitty coverage silos, owing back taxes, changing doctors and pharmacies, and not getting care. Hell, the usual toll of bankrupcies, catastophic illness and death.

    Don’t start me on the actual shitty bronze plans–just go to the Massachusetts Insurance Exchange and read the horror. Huge dedcutibles and co-pays, separate doctor and pharmaceutical payouts, and the evil “co-insurance” scam where many procedures demand 35% from indigent workers. Got 35% on your next MRI? Knee surgery? Didn’t think so. Do without.

    But hey, they’re ENROLLED.

    How in god’s name does an individual living on 16,000 or a family on 23,000 pay 2,000-5,000 before he sees a nickel of coverage and then keeps making huge payouts after the shitburger insurance actually kicks in?

    He won’t.

    What’s so odious about the crappy upper-middle-class diversity creeps telling po’ folks how great Obamacare will be is that they don’t plan on getting stuck in the exchanges, having gold plans at their stupid foundation jobs flacking for the medical-insurance-industrial complex. Evil bastards.

    1. John

      That’s the Obamacare plan.

      Take money in premiums that never translate into care. Get richer.

      Just another reason to despise the Democrats as much as the Republicans.

  3. middle seaman

    This progressive doesn’t believe that Obamacare is Oxiclean, not even close. Yet, in this post the Republicans war on America is a big culprit. True, health care reform, even its Obama minuscule version, shouldn’t have been that convoluted and decidedly not poor people friendly.

    1. Lambert Strether Post author

      Last I checked, ObamaCare was named for Obama, a Democratic President, written by Democrats, passed by Democrats, implemented by Democrats. If you want to shift the blame to the Republicans, you’ll have to do better than this.

    2. Crazy Horse

      The American Health Care system in three easy lessons, courtesy of Reggie Middleton:

      1-Retail mark-up on a kilo of cocaine, NYC 2013:— 200%
      2-Retail mark-up on an Apple I-Pod made in China:— 336%
      3-Retai mark-up on the Glidescope, a typical medical imaging device. With a little price support help from standard US medical system purchasing practices encouraged by the private insurance industry and now backstopped by Obamacare.
      4,361%!

      http://boombustblog.com/blog/item/9134-what-a-i-doing-with-glass?-hint-healthcare-companies-enjoy-margins-many-multiples-of-that-of-cocaine-dealers

  4. ambrit

    Lambert;
    Aren’t you blaming the victims of this crime here? Sure, this is Greshams Dynamic working, but, these poor people, and I include myself in that cohort, are given nothing but bad choices. This isn’t the ‘slippery slope’ but the pit at the bottom of said slope we’re floundering around in. Yes, I agree that Medicare for All is the optimal solution. To get to that happy state, we need to retake our government from the corrupt forces that have stolen it. Short of such an outcome, we’re stuck with the Heritage Foundation Care mess. Kaiser is being pragmatic. Peoples’ lives are at stake, mine included.

      1. ambrit

        Lambert;
        Not to over simplify it, but isn’t this just what the elites do all the time? I envision it as Enron style accounting for All. Some true herd behaviour at work here. All clump together and sacrifice an outlier or two to preserve the group. (The perjury thing.) As for the ethical side of it; we’ve run, not wandered, into Relativism, as far as our politics and finance are concerned. Goose, meet Gander. Anyway, what’s the use of encouraging people to aspire to elite status if you don’t let them lie, cheat, and steal with impunity?
        As for my point about real human beings at risk, well, there it is. Unless you’re suggesting the Reincarnation crowd has it right, length and quality of life can hold equal weight with the ethical and moral dimensions. I suspect that this fallable human being is just as conflicted as any. Ain’t life grand?

  5. cripes

    Amvrit–How is he blaming the victims?

    I think his point here is the dilemma created by this convoluted plan leads outfits like Kaiser to recommend enrollees tweak their earnings to “qualify” in states that didn’t adopt the Medicaid provision–thanks to the supreme court and those republican-libertarian governors in places like Texas and Florida.

    Of course, in another horror-filled iteration of this POS, those same people could be charged with perjury or fraud, and have some terrible penalties imposed on them in addition to poverty.

    “We must do more to reduce the privileges of the underprivileged.”

  6. Disgruntled

    They lie because they are in a society that demands it to survive.

    The US government wasn’t established to represent the interests of the people or to be fair or equitable. A cursory review of the founding fathers and the interests they represented should be enough to convince people that nothing has changed.

    The State is merely the existence of a monopoly of violence. It exists solely as coercive force to ensure that the interests of the ruling class remain secured. Everyone else as far as its concerned can die.

    1. diptherio

      In a society where everyone knows that the tycoons, presidents and CEOs lie continually, with little or no repercussion, it shouldn’t be that surprising that poor folks and the people trying to help them out might not consider a little flubbing of the truth that big of a deal. Why should they? The rich and powerful game our governmental and legal systems all the time for their benefit, why shouldn’t we? The cynicism that started at the top has trickled down to the rest of us. Fish rots from the head, but the body isn’t far behind and, like it or not, we’re all a part of this fish.

      I’ve had more that one instance in my life when, while interacting with some governmental bureaucracy, a compassionate peon sitting behind a desk has clued me in to how to “game the system.” Ex. I was told by the clerk when replacing the title for my car that I should claim that I paid no more than $500 for it. If I told the truth ($1000), I would be required to procure a surety bond which would be more time and money I didn’t have. “Just put $500,” she told me, and I did. I didn’t feel one bit bad about it, and I doubt she did either.

      1. petridish

        And yet lying seems to be the default position only of the monied sociopaths, those who are certain they will never feel the sting of punishment.

        The morts have to be encouraged or “advised” to lie–by the mortgage broker, the insurance company or the government drone.

        And when the sh** hits the fan, these manufactured chumps take the blame. Again.

    2. Cynthia

      I live in one of the twenty or so states that is NOT going to expand Medicaid. So this may explain why none of the top administrators at the large safety-net hospital where I work seem the least bit concerned that extra Medicaid dollars won’t be flowing their way to cover the costs of their huge uninsured population, many of who are definitely poor enough to qualify for the Medicaid expansion program. Just like the folks at Kaiser Health News, they too will encourage poor patients to fraudulently overstate their income in order to qualify for federal subsidies on the ObamaCare insurance exchanges.

      I know for a fact that those who work in financial aid, in social services, as well as in care management all look the other way whenever uninsured patients fraudulently understate their income in order qualify for charity care — which, by the way, is funded through Medicare. My guess is that they do this because it’s a lot easier to get free money from Medicare’s multibillion-dollar charity care program than it is to hire a collection agency to get money out of uninsured patients who are definitely NOT poor enough to qualify for charity care. So it wouldn’t surprise me at all that they too will look the other way as poor patients fraudulently overstate their income, qualifying them for federal subsidies insurance.

      What’s the take-home message here? If you are a super-size corporate entity, whether you are in banking, defense or even healthcare, defrauding the government is the easiest and most effective way to boost your bottom line.

      1. katiebird

        I still wonder what happens at tax time when/if their MAGI (and do we have to fill out new forms in April 2015 to determine it?) is less than the permitted income?

        Do these poor recipients of Medicaid and Medical Attention have to pay back the subsidy and cost of the care they received? Will they be hit with penalties?

        Does anyone know the answer to this?

        1. Lambert Strether Post author

          File under: “What a tangled web we weave.”

          I’m seeing some what I can only call bluster on this thread about how people should lie to protect their families — but I think they should also consider the consequences down the line.

          Subsidies that are subsequently deemed too great can be clawed back.

          Not only the IRS will be checking your income, but the credit reporting agencies, too.

          And the ObamaCare form is signed on penalty of perjury.

          If I were cynical and paranoid — and to be fair about Kaier, I don’t think the sort of demon spawn that would plan this — I’d view the recommendation to lie as a form of entrapment, so the bones of the poor who only wanted health care for their children could be picked clean at leisure.

          1. diptherio

            Maybe it’s entrapment, maybe it’s just a sign of the times. For the poor in America, it’s lie or die. Kaiser is just telling it how it is. Your honor or your health care, you can only have one…

          2. AnonII

            This is critically important. It was the “penalty of perjury” clause that forced me to honestly answer to every question they asked about my health on the Individual Application for Kaiser Health Insurance. I didn’t want to “go to jail” or “pay through the nose” should I get sick, need extensive care, and have the costs of illness care, after paying premiums to Kaiser for years, suddenly not covered as a result of these Application answers.

            As a result of “telling the truth” to Kaiser? I was denied Kaiser Health Insurance in 2004 for “pre-existing conditions.”

  7. taunger

    Lambert, I’m afraid you are missing the forest for the trees. The problems you describe above plague every major welfare program; section 8, food stamps, medicaid. Obama may be artfully deceiving the public, but he’s doing so in a well accepted legal and administrative manner. It would be nice if you commented on the relationship if these issues to those in existing programs.

      1. cripes

        Lambert:

        *taunger* points out the entire system of benefits is constructed to put “poor folks” (Obama’s locution) into the same white lie conundrum by design. And you don’t make the connection.

        And you answer “Why? This is a post about ObamaCare.”

        Well, you don’t have to, but he’s correct, and it’s relevant.

        It’s a pillar of the entire “welfare queen” meme used by the right for forty years to disparage poor people and it will be used here. I’ve watched the pompous, grasping overpaid exective director of a social service agency pontificate about indigent clients “gaming the system” when they try to get few extra bus passes to get to work. This from a leech that sucks $250,000 into her pocket from poverty programs.

        So, yeah, creating buckets of losers by income brackets is part of the design, and it’s something anyone who’s been forced to navigate the benefits system knows from experience.

    1. anon y'mouse

      at least with SNAP (food stamps) you have to sign a similar statement about misrepresenting your situation in order to obtain benefits, and are made quite aware that you will be paying anything that you were given back if later “found out”.

      but then, they also verify all of your income every 6 months, and make you requalify (basically, go through the same signup process as the initial one) every year.

      for all I know, they are also checking with IRS et al on your income.

      1. Peter Pan

        I learned the hard way, way back in 1985, that the IRS will share your income information with any government entity that requests it (federal, state, county, municipal).

        If you qualify for SNAP benefits and then overestimate your projected income to qualify for ACA Obamacare, I wouldn’t be surprised to find out that this overestimation of income would be shared with the Department of Agriculture or your state’s DHHS and disqualify you from SNAP benefits.

        If you’re poor and you’re going to game the system you must think through the potential consequences.

        BTW, Lambert, this is a great series on ACA. Please keep plowing through it for us. Thanks!

  8. petridish

    Enrolling low income people in Obamacare plans was never meant to assure access to medical care for those uninsured people. It was written by the insurance companies.

    The plan was intended to create individual conduits of taxpayer money to the insurance companies with a token, “affordable” contribution by the individual to make things look legit. Remember, there are no controls on the premium costs, but there are definite limits on “affordability.”

    Of course Kaiser would encourage people to “mis-estimate.” They get the benefit of of the taxpayer-funded income stream while the individual commits the fraud, er, makes the mistake. (And takes the blame.) Every enrollee is money in the bank–however it got there. It’s a perfect plan.

    And there’s not much chance of the insurance company having to provide any actual medical care. The plans are designed to be unusable.

    It reminds me of the mortgage industry’s liar’s loans. What does Bill Black call it? CRIMINOGENIC?

    1. katiebird

      Kaiser actually DOES provide healthcare. I was born in a Kaiser Hospital, delivered by Kaiser staff doctors. When I went to a doctor as a child it was to a Kaiser Clinic. Our prescriptions came from Kaiser pharmacies.

      Their business model is very different than the other “bill paying services” provided by most Health Insurance companies.

      1. LAS

        That’s right. Kaiser has vertical integration, operating its own hospitals and its own physician practices. Kaiser hospitals are paid for by the Kaiser health plan. Conversely its hospitals are private and primarily meant serve those in the health plan. It is integrated and monogamous. This risk model may better promote good patient care than fee-for-service.

        Elsewhere we have HMOs (insurers) and hospitals that are not monogamous and have to constantly re-negotiate contracts.

        1. Jim Haygood

          ‘It is integrated and monogamous.’

          Yeah … safe but dull.

          I kinda prefer the edgier nurse-swapping hospitals myself.

      2. petridish

        Although Kaiser does provide the majority of care to its subscribers through providers it employs at facilities it owns, it is still an insurance company. It is an HMO, a huge one.

        Kaiser sells policies with varying levels of coverage, eligibility conditions, waiting periods and requirements as do all insurance companies. Kaiser collects premiums commensurate with the level of services on offer in a particular policy. All services are not necessarily available to all policy holders.

        I do not know whether Kaiser intends to participate in the exchanges. It is my understanding that no insurance company is compelled to do so. Since they are giving advice on income reporting to maximize the government subsidy, I would assume they are. But make no mistake, the basic set-up is the same. If you buy an Obamacare policy from Kaiser, you will pay a specific premium for a specific set of covered services. You will just be restricted as to where and by whom those services can be delivered.

      3. anon y'mouse

        no doubt, Kaiser is better than nothing. when I had them, they took care of things that were urgent-seeming (and later turned out to be manageable or negligible) very quickly.

        but if you had a disfiguring and uncomfortable skin rash, getting to see a dermatologist took 4 months. which is probably typical for any non-urgent specialist care. when it happened to me and I showed up rash-free on the appointment date, the dermo thought he was being funny when he quipped “well, the first thing we try to do to cure you is to make you wait.”

        later, the rash came back.

        but yes, you probably won’t die from lack of service AND you do get the annual preventative checkups plus ability to schedule with your regular doctor for anything troublesome (but he still pulls the same approach as any other insurance/admin. harassed doctor, which is to deny action on anything that isn’t serious). it’s probably very good if you have something low-grade and chronic that requires regular medication. I imagine that it is a lot like what’ I’ve heard about the NHS in England.

        my grandmother is with Kaiser still.

        1. Denise B

          Kaiser’s refusal to provide me with the mental health services it claimed to offer in its marketing materials was pretty much outright fraud.

          Slightly off topic but I never like to miss an opportunity to warn people about this. After charging me $896/month for individual coverage in 2009, despite claiming to offer individual psychotherapy, they informed me that they would offer me none, and handed me a list of outside therapists I could entirely pay for myself. And then warned me that if I saw their psychiatrist for medication I had better not try to talk about anything except medication.

          They were eventually fined by the state for this but of course I’ll never get back the thousands of dollars it cost me. Although now that I’m in better shape I wonder if I could still sue them.

          1. d cortex

            of course Kaiser is the company that told Richard Nixon to announce universal health care for Americans – because this new plan meant less care from Kaiser while awarding the company more government subsidy! (see Sicko the movie)

  9. Jagger

    —-The plan was intended to create individual conduits of taxpayer money to the insurance companies with a token, “affordable” contribution by the individual to make things look legit.—-

    You nailed it.

  10. fajensen

    To me, this has the smell of devolution, and is yet another example of how Obama corrupts whatever he touches.
    Why should poor folks be excluded from Increasing Shareholder value at the health industry?

    Seems to me that shareholder value is the only yardstick for what is Right, Proper and American these days.

    Projected Earnings must be a form of Free Speech. Exactly like the credit ratings, that we pay experts millions to provide and by law force investors to buy.

    I would estimate wrong too.

  11. katiebird

    Here’s a thought-experiement: What happens if you over-estimate your income (let’s say it happens with pure conviction that your estimate is true) and you actually earn LESS than the minimum required to participate in the exchange.

    Must you repay your premium subsidy and benefits? WHAT a nightmare.

    1. run75441

      katie:

      Just do a 1099 for the difference.

      “While most people are aware they must include wages, salaries, interest, dividends, tips and commissions as income on their tax returns, many don’t realize that they must also report most other income, such as:
      •cash earned from side jobs,
      •barter exchanges of goods or services,
      •awards, prizes, contest winnings and
      •gambling proceeds.”

      and pay the increased taxes if it is greater the subs exceed the claimed income. This isn’t rocket science by any stretch of the imagination.

  12. Jim Haygood

    ‘How about the Navigators?’

    Well, if you’ve got a 2013 model with chromed spinner wheels, you probably shouldn’t drive it to the Medicaid office.

    Oh, wait, you meant the gestoras! The first lie they gonna tell is to get their own subsidized coverage. People helping people, it’s the American way!

  13. denim

    Try a licensed tax expert before heading down a slippery slope recommended by someone with a political agenda or alledged heart of gold. Our tax system is “pay as you go.” The W4 has to be filled out correctly or an estimated tax payment must sent in to the IRS. A starting place may be http://www.irs.gov/uac/Tax-Law-Questions

    IRS pub 505 and IRS pub 910 may be understandable to some… but free help is supposed to be available to those in need of it.

    1. katiebird

      I am VERY curious about whether there will be Tax forms available to help people calculate their MAGI (which is different in some mysterious way from the traditional AGA used on the 1040 forms)

      The Healthcare.gov site makes it seem like a breeze — just calculate this, add this, subtract that, adapt those and there it is! Well. How many people think doing their taxes is that easy?

      Are we supposed to think that estimating will be any easier?

  14. curlydan

    People will learn the system and adjust. If there’s no penalty to those under the poverty line, why not “miscalculate”? Unfortunately, the CBO probably didn’t count on this, and the fraud will begin to inflate the deficit. The slimy Repub governors won’t care much either since the subsidies will come from the feds.

  15. PeonInChief

    Single mothers with kids have been claiming higher incomes than they, in fact, have for years. That’s how you got your kids into Healthy Families and kept them out of Medicaid. What we should be looking at is not why they do that, but why Medicaid provides such lousy benefits for the people it’s supposed to protect.

    1. Lambert Strether Post author

      A Jobs Guarantee would do that, properly implemented. However, since such a reasonable, centrist position hasn’t gotten any traction, I’m upping my demand to a guaranteed annual income.

    2. L

      “True compassion is more than flinging a coin to a beggar. It comes to see that an edifice which produces beggars needs restructuring.” -Martin Luther King, Beyond Vietnam

  16. Gareth

    If providing my family with healthcare mean that I had to over estimate my income, I would do it without hesitation. Banks and corporations rob us blind, while the government lies to us and spies on us. Is it really up to our poorest citizens to sacrifice their healthcare in order to prop-up the sinking ethical standards of the Homeland?

  17. Lambert Strether Post author

    People can do what they want to get health care — including lying. People who read the post will see I make no critique of the poor.

    Rather — and I find it odd that nobody here has yet thought to do this — blame the policy makers who put people in the position of lying to get what should be theirs by right. However, I read this as a sign of how desperate peope are — a desperation the powers that be are clearly playing on.

    Let’s change the use case. Suppose it wasn’t lying that got you into the program, but a bribe. Just small one. Would that be OK?

    Pretty degrading political economy, if you ask me. And that is, of course, the forest here, and not the trees.

    BOTE People are also missing the policy implications. What should the Navigators recommend?

    1. ambrit

      Lambert;
      That train has already left the station. Bribery is not only a usual ‘expense’ of doing business in America, but it has come out of the closet somewhat. Citizens United codified it into law, at least for the corporations. All we poor folks are asking for is that the Feds enforce “Equal Protection.”
      Looks to me like that dreaded ‘slippery slope’ meanders all the way to the National Mall.

  18. deconstructingpoliticalspin

    The key point in the Kaiser piece is:

    For the poor, the difference between qualifying — or not — could be $1,000 or less a year. Since many rely on hourly or seasonal work, their incomes often fluctuate by a few thousand dollars each year. That’s one reason why people often lose eligibility for Medicaid, the state federal insurance program for the poor.

    And the fact of the matter is that the “poorest of the poor” often have a different set of circumstances from most of the populace, which are much more unpredictable.

    This income cohort often bounces from job to job. And I don’t say that “as a slight.”

    When one has no transportation (or no “reliable” transportation), no dependable child care (and it’s the very poor that the DA’s love to prosecute for child neglect), environments that lend themselves to asthma and other chronic illnesses which must go untreated–one tends not to hold a “steady job.”

    So again, I do not mean to “belittle” any individuals in this circumstance.

    Au contraire, having spent over three decades advocating for individuals in this income cohort, I am still amazed at the courage and resilience that many of the desperately poor demonstrated on a daily basis.

    And I often wondered, if faced with their daunting and distressing circumstances, would I have had the wherewithal to have even “been able to get out of bed” every morning.

    The answer was always, “I’m not so sure.”

    Hence, it IS difficult for many very low income individuals to make an accurate income projection.

    I believe that the Kaiser piece simply acknowledges this fact.

    And that they are implying that if you really don’t know, why not make a projection that is (hopefully) to your advantage.

    IMHO, it is inexcusable that “the poor” were treated differently by The Affordable Care Act than the rest of the citizenry, in the first place.

    To put the lowest income Americans into Medicaid, which basically allows the government to eventually strip them of their measly assets (if they are age 55 or older) through the MERP mechanism, is simply unconscionable.

    1. deconstructingpoliticalspin

      From all that I’ve read, I don’t believe that “navigators” are in a fudiciary position.

      And, it sounds as though they strictly will give out (probably reading from script) on health care “plans.”

      Could be wrong, but I would think that navigators would completely stay away from any “advice.” (of the nature of the Kaiser piece)

      I can hardly wait (since I’m not likely to be talking to any of them) to hear “how” the navigators operate.

      I would be terrified to have to buy an Exchange insurance product.

      As far as I can tell, when one contracts for an insurance product, if one “signs up for” a health plan that it too expensive, this would not be an acceptable excuse for cancellation.

      I do not expect navigators to “venture off script.” I would think that “community non-profits” might have a bit more leeway, but who knows?

      In the end, I imagine that most navigators will be useless.

      1. Lambert Strether Post author

        The navigators are not fiducaries. They can show you how to understand your choices, but not select a plan. In other words, they’re in exactly the position to do “nudge nudge wink wink” with enrollees.

        * * *

        It’s another way that ObamaCare creates first and second-class citizens. Suppose policy (as implemented in scripts) is that Navigators should never recommend that you overstate your income. So people who go to them as trusted source of information don’t do that. But people who do not go to Navigators “merely miscalculate” on the high side, and so these two populations end up getting different levels of insurance and, one would assume, care.

        How is that an equitable outcome?

        1. deconstructingpoliticalspin

          Sorry, I didn’t mean to imply that the PPACA is “equitable” in any way.

          If I had my way, The Affordable Care Act would be repealed by sundown, LOL!

          I did try to briefly articulate a couple of obstacles that the very poor face, when it comes to “holding jobs.”

          And that this distinction will make it considerably more difficult from many of them to make an accurate income projection.

          I’m no tax expert, by any means, but I’ve always been under the impression that many (if not most) Medicaid receipients were too poor to be required to pay federal income taxes. Which would probably mean that they may not have any 1040’s to “pull,” and therefore no really accurate idea of what their previous years’ income was. (with which to project future income)

          Therefore, IMHO, the question becomes,

          “If you are forced to make a very uncertain projection (with no reliable backup info to assist you–if you are so poor that you are exempt from filing income taxes), do you do so in a manner that would help you, or harm you?”

          And again, many of these individuals, for reasons beyond their control, are in and out of jobs. They often hold several jobs a year (and I don’t mean piecing together several parttime jobs–I’m saying “one job at a time” several).

          I guess the bottom line is, most middle class, or for that matter working class individuals, do not share the same degee of “job disuption” and uncertainty, that the poorest cohort usually must deal with.

          Therefore, it could be more difficult for Medicaid (or near-Medicaid) receipients to do this calculation accurately.

          But I’ve not read any study on this specific issue, as it relates to The Affordable Care Act. It’s just my opinion from years of dealing with this cohort. I could be wrong. OTOH, from what I’ve observed, most of them don’t have a “home filing system” from which they can retrieve this information. ;-) (That’s meant to put levity into this depressing topic–not snark.)

          From my observation, so many of the Medicaid recipients that I worked with literally were worried “where their next meal was coming from.” So, IMO, the Government’s expectation that they would have the “tools or resources” to provide this information, is a little bit unrealistic.

          Hey, I abhor The Affordable Care Act as much as you do. And I’m think we’re pretty much “on the same page” regarding most of the issues related to the implementation of the ACA.

          I would like to elaborate just a bit more, but must come back later to do so.

          1. deconstructingpoliticalspin

            Oh, to answer your question directly:

            How is that an equitable outcome?

            It clearly wouldn’t be.

            But when all is said and done, I imagine that the worst inequities will be suffered by the poorest Americans.

            It seems they always are . . .

          2. deconstructingpoliticalspin

            “Here Comes The Sun,” Nina Simone

            This is only a “Test Video”–won’t be making a practice of posting music videos. Would like to post a YouTube video pertinent to one of the blog posts, but not certain how to embed here at NC.

            This is a pretty nice rendition of this George Harrison tune–so hope this works!

            ;-)

    2. Ms G

      Well, it seems that ObamaCare has caused (part) of the American citizenry to look more carefully at what exactly Medicaid is.

      The few facts that have come to light (for those of us who have not (yet) had any direct involvement with the program) — claw backs, skeletal services, “payment sharing” creep, gutted physician and hospital networks — it seems another plank on the platform for Medicare for All should be the abolition of Medicaid as a cruel charade masquerading as a “health care safety net for the poor.”

      (And, by the way, Medicare itself is fast being gutted so a very strong push against this process must proceed in tandem with the demand for Medicare for All. Otherwise we’ll just be asking for a Medicaid-style program (with far heftier “cost-sharing”) than even Medicaid (or the ObamaCare Products, which seem to be based on Medicaid for all (or nothing) they provide for the money.)

      1. Lambert Strether Post author

        And if you’re over 55, your Medicaid coverage gets clawed back from your estate. So if you’ve managed to hang onto your house and you want to pass it on to your kids, think about that. Especially given that ObamaCare forces you into Medicaid if your income is less than 138% of poverty level.

        1. Ms G

          Precisely why Medicaid as it exists (as we are learning) must be abolished — it is apparently a system to abuse the most vulnerable and financially low: just like ObamaCare (or RomneyCare).

  19. JEHR

    But, you see, this is all-of-a-piece: Weren’t the prospective homeowners encouraged to lie about their income in order to get a higher mortgage so that the mortgage companies could get bigger fees, so that the lenders could make more toxic subprime securities, so that the banks could make bigger profits so that the executives could make big bonuses and so that, finally, the whole edifice of cards could fall down and said banks could be bailed out?? Yup–all-of-a-piece!

      1. cripes

        Lambert:

        You are not clear why you object to analogies–suggestive or regular or otherwise–between Obamacare and a long history of federal benefits legislation that’s rigged to incentivize beneficiaries to tweak reported qualifications, and how this puts them at risk of sanctions or penalties, or just plain old getting screwed and blamed for “gubmint spending” while the corporations run off with the money.

        Isn’t that your point earlier, and isn’t that what’s being done with SNAP debit cards, and housing subsidies, and prescription benefits and more? Doesn’t ObamaCae fit into this long and honorble tradition of screwing and blaming the poor? Or is it some unique creation?

        What’s your objection?

  20. Exchange Envoy

    Political affiliations and Tax burdens aside…The other less talked about aspect of Obamacare is the fact that depending on your income, the cost of health insurance as a percent of income smacks the middle class right in the face. A good infographic that illustrates this is here http://j.mp/14KXiBz

    You can really see how making $1 more than the FPL will end up costing people thousands.

    1. cripes

      “Smacks the middle class right in the face”

      Well, yeah, income benefit limits tend to do that, another reason to have universal benefits, with eligibility not determined by income. But, are the $95,000-$150,000 crowd your idea of middle class?
      Do you know what the median income really is?
      According to the 2010 census, it WAS $27,344, it’s lower now. Before taxes.
      So, what the hell is the “middle class” if it’s not in the middle of the earning scale?

      Middle of what, the top 10%?

      1. PeonInChief

        The phrase “middle class” is one of the most abused in the English language. There are lots of definitions, but the term tends to slither all over the place, and its use depends much on what the author is trying to show. The government used to do a series of budgets–poverty, lower budget, moderate income and middle income–all of which had market baskets of goods that indicated income status. The government quit doing these budgets a few years ago, likely because the cost of the “middle income” basket was rising far above the median income.

  21. 7Towers

    How is it that the poverty level for a single is 11,500 and for 4 people as family it’s 23,500? Does this make any sense to anyone here?

    Also these guidelines never refelct the reality of current dollar value with guideline figures being 3 decades behind present currency value . Why do they use the gross figure that includes money that is deducted and no longer yours decreasing actual real income.
    Its all such a sick joke

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