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Yeah, but if you qualify for Medicaid now based on your current income then you should enroll, as it's expansion (increasing the income levels) was part of the ACA too, assuming you're in a sane state. At the point in which your income goes above the Medicaid cut-off you should still be eligible for some subsidies up to a certain point. After that, depending on what state you're in your monthly premiums on an exchange plan will be very very reasonable. Anywhere from $50 - $300 for Silver plans, again based on your state, and if you qualify for a subsidy then obviously that's reduced.

Don't quite understand why you think it doesn't work for entreprenuers. I myself left a cushy job around 10 months ago to do a new start-up and I signed up on the NY exchanges nicely, with a monthly outlay of a very reasonable $150.

Especially compared with the prior situation which was that as a freelancer, if you were lucky you could get individual coverage for around $500+... assuming no pre-existing conditions.

I had individual coverage as a freelancer for $130 per month.

I got coverage under the ACA as a freelancer for myself and my wife at $420 a month.

In NY, it was illegal to discriminate based on pre-existing conditions, which meant it was higher there than other states in which it was legal. I used to live in NYC and was under Freelancers Union insurance, which ran about $400 a month with a $10k deductible and 30% coinsurance. Moved to Nashville and was able to get better insurance for about $200 a month. (I'm insured through an employer now, so I have no idea what it looks like post-ACA).

> Yeah, but if you qualify for Medicaid now based on your current income then you should enroll, as it's expansion (increasing the income levels) was part of the ACA too, assuming you're in a sane state

Do they care why your income is low? For instance, if I lose my job, and decide to take a year off before looking for another job, could I go on Medicaid for a year? Or is it like unemployment benefits, where they get testy and stingy if you aren't trying to get a job?

So... sign up for Medicaid. When you become ineligible for that, you can sign up for a non-Medicaid plan. I fail to see the problem.

Yeah I fail to see the problem. When I left my salaried job to start my own business I applied for our state provided healthcare (MA) as my income was almost non existent. As my income increased I got bumped from plan to plan adding cost along the way. If you actually have $0 in income, Medicaid or the like sounds appropriate.

To be fair to Skolos...

it does depend on what state he was in.

But I agree... entrepreneurs should not be living in certain states. They are just bad places to be launching a startup.

Didn't the Affordable Health Care Act essentially roll out nationally a model similar to the successful state models (like Massachusetts) making this a universal method? I claim ignorance here but was under the impression the systems worked similar.

Nope... states can opt out. So you really need to check the rules in your own state. Like any other thing when starting a business.

I think I was not clear - there is no problem with signing up with Medicaid. The problem is - I don't see how ACA adds anything to entrepreneurs.

When I quit my job, we signed up for private insurance (family of 4 - $500 a month with decent coverage). That was pre ACA time. All I've got from ACA - my insurance got bumped to $680, which is OK and still much cheaper than any comparable plan on the marketplace.

So my complaint is not about lack of options for entrepreneurs, my complaint is that ACA actually made my life marginally worse, not better.

Also don't forget that jumping from plan to plan includes filling tons of forms, which takes quite a bit of time and frustration, which I would rather spend building my business.

I doubt you really got "decent coverage" at that price, and I expect even at $680 the coverage will magically evaporate if shit hits the fan.

That said, you've taken your own unusually strong position, observed that the ACA didn't change it, and extrapolated to all entrepreneurs. What does "entrepreneur" mean to you, exactly? Is "healthy and financially secure" a prerequisite in your view?

I also don't know what "tons of forms" you're talking about, since that hasn't been the case in any situation I've personally observed since the beginning of the year, but you've now said you're in Texas, which is actively trying to thwart the ACA, so is even less likely to be representative.

Whether or not $680 is "decent coverage" for a family of 4 depends on age and perhaps the state you live in. Assuming that the family is young, that would buy one of the better pre-ACA plans in my state (Washington). I have no idea how old the parent is.

Of course, that won't buy a comparable post-ACA plan. The ACA rather dramatically increased the costs of insurance even for plans that were unchanged by the ACA (~35% more at my current startup for the same plan). Other startups I know faced similar cost increases, which makes the argument that the ACA helps startups dubious.

So you're saying that having a lower change of shit hitting the fan make for a better case of buying plans that disappear when shit hits the fan? Mindblowing.

> I think I was not clear - there is no problem with signing up with Medicaid. The problem is - I don't see how ACA adds anything to entrepreneurs.

What is provides is better access to heath insurance plans. My employer's offering (UnitedHealthCare) is atrocious for $460/month for myself and my wife, so I went and got BCBS Illinois for $490/month, with much better coverage.

I could not do this prior to the ACA. Sorry if it makes your life marginally worse, but it makes people's lives marginally better when they could not get insurance before, or were paying large sums for pathetic levels of coverage.

Switching plans means: filling out forms, making calls, spending time on hold. Waiting for your mail to arrive to make sure everything is on track. Following up when something goes wrong. First with the insurance companies, then with every medical provider you deal with.

If you're healthy and insurance isn't strictly necessary, maybe this isn't so bad.

If you're like me, have a pre-existing condition and your well-being actually depends on receiving quality coverage, switching plans is scary. A few years ago I switched plans, and due to a bureaucratic mistake with a pharmacy relating to the transition, I ended up having to pay for a months supply of medication out of pocket, which cost me something like $4000 IIRC.

So excuse me if I don't want to switch plans every time I change income brackets.

By the way, as someone with a pre-existing condition, I strongly support the ACA. I think it's great. Understandably though, it isn't perfect.

I am in the same boat as you. I am the founder of a small startup. My business income is highly variable. Most months I am below the medicaid cutoff, others above.

Signing up through the exchanges under this scenario sounded like a nightmare where if my income goes up, I have to change from one plan (medicaid) to another (private plan) and possibly back again if my income drops.

Instead of that nightmare, I opted to skip the exchanges entirely and sign up direct with a private plan. This disqualifies me for any subsidy, but as a person in his early 30s, my plan is only about $300/mo which I consider very affordable for the level of coverage I am getting.

On a separate note, I am very thankful that ACA exists, because I have a pre-existing condition with very costly needs. Being able to have any insurance at all, without discrimination and at a reasonable price, is a godsend. I hope they can create some more sane options for entrepreneurs, but even if they don't, I am very grateful that the ACA exists.

I was grumbling today about my new job and having to pay $30 a month for our Medicare levy. I can't even fathom how expensive your health insurance is, you poor bastards.

And yet despite that, startups are few and far between, despite our government happy to help us when it comes to our health, etc. Go figure on that one.