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Comment by wil421 | Hacker News Reader

If she’s only making $9.50 an hour she qualifies for some pretty cheap if not free healthcare. When I was in college working in a restaurant it was between $30-40 a month for healthcare I was making approx $20-25k a year.

Healthcare is mentioned exactly one time in the article.

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Yes, it's mentioned once, in the context of her not having affordable insurance options.

> At 29, Brown works approximately 40 hours a week, splitting her time between a McDonald’s in Durham, North Carolina, and a food-service gig a local hospital. “It’s still not enough,” she said. Both jobs are part-time, and she doesn’t receive health insurance through either employer. She can’t afford insurance on her own, either. That’s a problem since Brown is diabetic, and she has to pay for her medical expenses out of pocket. She’s trying to do all she can on her own—she receives no food stamps or other assistance, she notes—but it rarely feels like she’s doing enough.

I just put her stats into the healthcare.gov calculator. She can get a bronze plan for $370/month, and she qualifies for a $370/month premium tax credit - meaning she can get a bronze level plan for $0/month.

Seems affordable. What am I missing here?

She doesn’t have the extra $370/mo in her budget to pay out in anticipation of a $4440 refund next year.

The government knows that this is a common state for people, and would allow her to pay her estimated tax credit monthly directly to the insurance company.

So that isn't it. Any other guesses?

https://www.irs.gov/affordable-care-act/individuals-and-fami...

You and I are capable of finding, reading and understanding that document. I don't know if it is realistic to expect that from someone who spends all of their time and energy on mere subsistence.

How do the tax credits work? As in, you get the money back on your tax refund? This woman makes about $500 a month. And those plans are typically $8000+ deductible, basically shit plans. In most states, people qualify for Medicaid when they make less than $1,200 a month. Which is completely free care.

You can take the tax credit and apply it to your taxes at EOY, or you can have advanced payment where the tax credits are paid out monthly to your insurance company to help cover your premiums. Using the latter method, she basically just gets free health care - she doesn't need to wait a full year to recoup her $370*12

I suspect that for most people making, say, less than $60,000 a year, paying cash for insurance and then expecting to be reimbursed by filing incomprehensible tax forms is not an option. This person simply can't afford it. Tax credits are useless when you are living paycheck to paycheck from two crappy jobs. She is probably eligible for Medicaid.

The ACA specifically supports paying your estimated tax credit directly to the insurance company on a month to month basis, meaning you don't need to front the cash before you get it back as a tax credit.

> Seems affordable. What am I missing here?

40 * 4 * 9.50 = $1520

370/1520 = 25% of your GROSS income to stay alive. She doesn't pay $370 a month in taxes, and the tax credit doesn't come out of Social Security tax, which is her largest tax.

She isn't paying $370 out of pocket though. She could be paying $0 out of pocket using the advanced payments to pay for her premium. And tax credits can make it so you are owed money by the government - it doesn't matter if she pays $370/mo in taxes or not.

As other posters have said, bronze doesn't buy you much - but I can't understand why she can't afford it if it is $0 out of pocket.

Well maybe you should fly out there and explain to exhausted mickey-d's worker how she could magically get free health insurance. Seriously; it would be an epic good deed assuming you're actually right.

I know people who have been in this position: just because you read something on a website doesn't make it necessarily true.

Why would I need to fly out there? Open enrollment is happening right now, and I just plugged her stats into the form on healthcare.gov. It literally took me less than 90 seconds.

Obamacare bronze is useless for someone super poor. Even the HMO Obamacare plans like kaiser charge $100 dollar copays for a doctors visit, which is clearly out of reach for someone like this.

Sadly, I think the most cost effective approach is often not to use insurance at all but instead go to the free / community clinics which could provide a subset of care at a lower price.

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