7 Obamacare Secrets for Residents of Florida’s 6th Congressional District and 2 Campaign Promises

Here are 7 facts about The Patient Protection and Affordable Care Act, or Obamacare as it is colloquially known, that you may not have heard of. As your Congressman, I will support education, outreach, and expansion of Obamacare as well as state expansion of Medicaid in Florida and 13 other states who have still refused to accept a federally funded expansion allowing households with income of up to 138% of the federal poverty line to receive Medicaid.

DISCLAIMER: This article does not, and is not intended to, provide legal, tax or accounting advice, and readers should consult their tax advisors concerning the application of tax laws to their particular situations.

1. Obamacare is still functioning, despite rumors to the contrary.

Even without the individual mandate that previously would penalize you on your federal income tax return for not having insurance, Obamacare hasn’t gone away, as codified in United States Code, Title 42: The Public Health and Welfare, Chapter 157: Quality, Affordable Health Care for All Americans. You can still sign up on HealthCare.gov and large federal subsidies are still offered. About 25% of Americans erroneously believe Obamacare was repealed in 2018, and the vast majority do not know basic facts about it, despite the Trump administration’s baseless claim that their recent 90% cut to educational/outreach efforts is warranted due to everyone knowing about Obamacare now (completely false!).

2. You may be able to enroll at any time of the year.

Although the “open enrollment” period is now quite short: November 1 to December 15, you can actually enroll at any time of the year if you qualify for a “special enrollment period.” The criteria are quite broad, and include:

• Got married in past 60 days
• Had a baby, adopted, or placed a child in foster care in past 60 days
• Got divorced or legally separated and consequently lost health insurance in past 60 days
• Someone on your plan died causing you to become ineligible in past 60 days
• You moved between counties or ZIP codes or for work or school and had qualifying coverage for at least 1 of 60 days prior to the move
• You became a U.S. citizen in past 60 days
• You left jail or prison in past 60 days
• You began or ended service in an AmeriCorps program
• Anyone in your household lost qualifying coverage in the past 60 days or expects to lose it in the next 60 days
• You became a member of a federally recognized Native American tribe
• On occasion, victims of natural disasters such as Hurricane Maria in Puerto Rico are declared eligible for a special enrollment period
• You filed an amended IRS tax return (Form 1040-X on paper by mail) to update a prior tax return to add Form 8962 due to failure to reconcile subsidies reported on Form 1095-A, 1095-B, or 1095-C

3. Your job cannot offer “good” health insurance.

In order to receive a federal subsidy for Obamacare, your employer must NOT offer insurance that is “quality” and “affordable.” Many employers do not offer any health insurance to part-time employees, which means you are eligible for an Obamacare subsidy if you meet the other criteria such as being ineligible for Medicaid, Medicare, VA healthcare, and so forth. If health insurance is offered to you as an employee, it must:

1. Meet the actuarial bronze level of quality (“minimum value standard”), meaning it “pays at least 60% of the total cost of medical services for a standard population and offers substantial coverage of hospital and doctor services.”

2. Be “affordable,” meaning that the lowest bronze plan for YOU only (not including your family) from your employer costs LESS than 9.78% (in premiums paid by you via payroll deductions) of your entire HOUSEHOLD’s income.

If BOTH of the above two criteria are met by your employer health insurance plan, you are NOT eligible for a federal Obamacare subsidy (i.e., Premium Tax Credit). If both of the above criteria are met, you ARE generally eligible if your household income is between 100% and 400% of the federal poverty line and you are ineligible for Medicaid or other coverage. The rationale is that taxpayers should just pay for the genuinely needy, so if you have a good employer plan available you should not be allowed to receive a subsidy.

4. The Advance Premium Tax Credit (APTC) may mean your cost is absolutely zero.

Even though premiums keep going up, up, and away year after year, so does the premium subsidy—that is, the amount you can receive from the federal government as a free grant toward your health insurance. Basically, as long as your income is above 100% and under 400% of the federal poverty line (FPL) you can receive a sizable subsidy—often $1,500 per month or even more for a family. For a family of 3 in 2020, that means your household must earn between $21,720 and $86,880. You have to fill out an application on HealthCare.gov and guesstimate your household income for the tax year you are applying for (that is, you must guess what you will earn in all of 2020). The subsidy remains quite large up to 400% of the FPL and then falls off a cliff to exactly $0 per month above this income level. If your chosen plan is cheaper than your maximum monthly subsidy, you own nothing per month as the money is paid directly from the U.S. Treasury to your health insurance company via what is called an Advance Premium Tax Credit (APTC).

On your tax return you must reconcile premiums and tax credits based on Form 1095 that you receive from your insurance company using IRS Form 8962, which is included in all major tax software such as TurboTax. If you underestimate your income you may be required to pay back a maximum of $1,300 of subsidies received during the year if your household income is under 400% of the FPL, or the entirety of all subsidies received if it is above 400%.

The Trump administration is making it harder for people with volatile incomes (e.g., gig economy) to receive the APTC due to requiring documented proof of income, and they are discouraging a practice of overestimating one’s projected income at 100% of the FPL for those living in poverty (below 100% of FPL) in order to receive the APTC in a state that has rejected Medicaid expansion in order to cut costs, as well as failing to educate Americans—an estimated 10 million are eligible for Obamacare subsidies but not taking advantage.

In Florida’s 6th Congressional district, some of the major insurers offering plans on HealthCare.gov are Florida Health Care Plans, Florida Blue (BlueCross BlueShield FL), and Oscar Insurance Company of Florida. You apply and enroll on HealthCare.gov and then you’ll receive your plan information, insurance ID cards, payment instructions (if you are not fully funded by the APTC), and log-in instructions for the insurer’s website later, typically by U.S. Mail.

5. If you are a big saver, you can manipulate your income using retirement accounts to stay under 400% of the FPL and qualify for a subsidy.

To receive an Obamacare subsidy, besides being ineligible for other insurance such as Medicaid or an employer plan, your household income must also fall between 100% and 400% of the federal poverty line (FPL). For a family of 3 in 2020, that means your household must earn between $21,720 and $86,880 (modified adjusted gross income including wages, interest, dividends, capital gains, etc.).

Earning over $86,880 would be particularly unfortunate for an APTC-receiving household of 3 as they would have to pay back ALL subsidies received, which could easily be over $10,000 in a year. However, if you happen to be a big saver, like many followers of Mr. Money Mustache, you can put up to $19,500 in your employer’s 401(k) or 403(b) plan via payroll deductions per person in 2020 (and your spouse can do this too). Contributions must be “traditional” or “pre-tax,” NOT Roth or “tax-exempt” or “post-tax.” Pre-tax contributions reduce your modified adjusted gross income (MAGI) reported to the IRS, which can qualify you for Obamacare subsidies if your household income goes down.

Even if you didn’t receive an APTC, you can get the money back as a tax refund during the following year (as a “regular” PTC or Premium Tax Credit). Note that many tax-filing software programs do NOT correctly handle a situation where a taxpayer is receiving their subsidy as an IRS refund.

Beyond this, you can put money in a pre-tax (traditional) individual retirement arrangement or IRA to reduce your MAGI and qualify for Obamacare. The limits are $6,000 per person, so that’s up to $12,000 between you and your spouse if married, and a non-working spouse qualifies to contribute as long as you are married filing jointly (MJF).

Note that for those Age 50 and older, the limits are higher: $7,000 for IRA and $26,000 for 401(k) or 403(b) in 2020. This is a great way to reduce your income if you have a high savings rate, and you can invest your retirement money in stocks or bonds so it can grow until you are eligible to make withdrawals at Age 59.5 or older. For IRAs, you can even contribute up to the tax filing deadline of the subsequent year, which is April 15, 2020 for contributions designated to 2019, or April 15, 2021 for contributions designated to 2020. Make sure to check if you are eligible for the IRS Retirement Savings Contributions Credit via Form 8880 due to your retirement contributions.

If you designate a traditional IRA contribution for the prior tax year after having already filed your tax return, you can still get your Obamacare subsidies restored if this contribution puts you below 400% of the FPL, and get your Saver’s credit if eligible, but it won’t be easy: you must file an amended IRS tax return on paper by mail using Form 1040-X and it will be manually processed by an IRS agent and can take up to 16 weeks. You can do this for up to 3 years after the initial filing (e.g, up to March 14, 2023 if you file for 2019 on March 14, 2020). The U.S. Treasury will end up issuing you a check, with interest, for the additional amount owed from the government to you due to your amended return.

6. Florida has a Medicaid–Obamacare coverage gap.

Florida’s Rick Scott, who made off with $300 million from Columbia/HCA from defrauding Medicare (the company admitted to 14 felonies) and used it to become governor, then REFUSED to accept federal Medicaid dollars that would help over 800,000 low-income Floridians and would most likely actually save money for the state.

Because of Republican refusal to accept a federally funded expansion of Medicaid authorized under the Affordable Care Act (commonly known as Obamacare), Florida has a Medicaid–Obamacare coverage gap. This means that there is a hole in between where many Floridians are ineligible for Medicaid due to making too much money (the limits are very low) and ineligible for Obamacare due to making too little money. Many adults are required to earn less than 29% of the FPL to receive Medicaid in Florida, which is only $6,299 for a family of 3, but can’t receive an Obamacare subsidy unless they earn 100% or more of the FPL, which is $21,720. Therefore, families, such as families of 3 who earn between $6,299 and $21,720 in 2020, are in the coverage gap being ineligible for both Medicaid and Obamacare subsidies. Families with small children may still be eligible for Medicaid, but “able-bodied adults” receive the worst treatment under this regime.

7. Be prepared with proof of immigration status or citizenship.

Under the Trump administration there has been a push to disqualify recipients of Obamacare subsidies who cannot prove their immigration or citizenship status. You may receive a digital or U.S. Mail notice from the HealthCare.gov marketplace requesting a copy of your passport or other documents, and they will cancel your subsidy payments if you do not comply by uploading digital files or mailing in photocopies. This can happen even if they should already know you are a citizen based on documents you submitted in a prior year or based on other information available to the government. Make sure to watch your mail closely, or preferably, sign up for emails and digital alerts to avoid the possibility of such notices being lost in the mail.

Two Campaign Promises

If I am elected to the United States House of Representatives for Florida’s 6th Congressional district, I’m going to make expanding Medicaid and Obamacare a priority, but I’m also going to make it a priority to help constituents get educated and enrolled. As long as it’s still functioning, we’ll be signing up constituents for Obamacare left and right*, or helping them understand the program and their plan. (I will comply fully with the Privacy Act of 1974 which requires written consent from constituents in order to assist.)

Note: On February 21, 2020 I endorsed universal healthcare for all Americans (Medicare for All). However, I will fight for whatever I can get accomplished as your Congressman. We need to aim high, in my opinion.

To facilitate access to my staff and I for minorities and disadvantaged populations, I will open a constituent office in mid-town Daytona Beach and possibly Deltona as well, or alternately a traveling mobile office as it can be hard to find office space in Deltona. I will also hire at least one Spanish-speaking staffer.

Using my knowledge from my Ph.D. in instructional design, I will design training materials for my employees and the public to help with Obamacare. The incumbent, Republican Michael Waltz, has an office at Port Orange City Hall, but I think mid-town Daytona Beach is a far more underserved area and many Port Orange residents have motor vehicles. Waltz’s website does not even mention helping people with Obamacare, possibly due to the GOP’s whole “down-with-Obamacare” shtick.

* As of present I have not verified the legality of this but it is clear that Congressional representatives can and do help constituents deal with federal agencies.

Congressional representatives receive a budget from the U.S. Treasury of approximately $1.3 million per year to rent offices and employ staff to help with Congressional work and constituent services.

DISCLAIMER: This article does not, and is not intended to, provide legal, tax or accounting advice, and readers should consult their tax advisors concerning the application of tax laws to their particular situations.

I need your help. Please donate if you want to see real change for Florida’s 6th district in Congress.

Donate to Richard Thripp's Campaign

Leave a Reply

Your email address will not be published. Required fields are marked *