Eligibility for health insurance subsidies narrower than many consumer groups had hoped

Feb 1 2013

A final rule, released Wednesday, set out a strict definition of affordable health insurance that will prevent many families with modest incomes from obtaining federal financial assistance.

The New York Times: Federal Rule Limits Aid To Families Who Can't Afford Employers Health Coverage
The Obama administration adopted a strict definition of affordable health insurance on Wednesday that will deny federal financial assistance to millions of Americans with modest incomes who cannot afford family coverage offered by employers. In deciding whether an employer's health plan is affordable, the Internal Revenue Service said it would look at the cost of coverage only for an individual employee, not for a family (Pear, 1/30).

The Wall Street Journal: Workers' Children Won't Get Subsidies
The decision, announced by the Obama administration on Wednesday, means some low-income Americans whose employer-plan premiums are beyond their means won't be eligible for the main perk of the law. Several provisions are behind the wrinkle (Radnofsky, 1/30).

Kaiser Health News: Capsules: Some Families Will Be Ineligible For Insurance Subsidies Under Final Rule
But the rule defines the standard for affordability more narrowly than most consumer groups had hoped -; as an amount less than 9.5 percent of household income to cover just that employee's share of premium costs, not on what he or she must pay to cover their entire family, which is generally more expensive" (Appleby, 1/30).

The Associated Press: Some Families To Be Priced Out Of Health Overhaul
The Obama administration says its hands were tied by the way Congress wrote the law. Officials said the administration tried to mitigate the impact. Families that can't get coverage because of the glitch will not face a tax penalty for remaining uninsured, the IRS rules said (Alonso-Zaldivar, 1/30).

In addition -- 

Modern Healthcare: No Penalty For Medicaid-Eligible Uninsured, Proposed Rule Says
Two proposed rules from HHS and the IRS issued Wednesday describe how the government intends to apply the law's individual insurance mandate effective in 2014. Tax filers will need to begin verifying in 2015 that all of their dependents have qualifying coverage or pay tax penalties for them. The regulations describe a number of exemptions from the mandate, which requires most Americans to obtain qualifying health insurance or face tax penalties. About 2% of the population is expected to face those tax penalties despite the exemptions, according to the Congressional Budget Office (Daly, 1/30).

The Hill: Obama Administration Takes Steps To Implement Individual Mandate
The Obama administration took new steps Wednesday toward implementing the individual mandate in its signature healthcare law, downplaying the scope of the unpopular provision by stressing rules that allow exemptions from the requirement to purchase insurance. The Internal Revenue Service and the Health and Human Services Department emphasized exceptions to the mandate, which were detailed in new regulations that also laid out the process by which the IRS will calculate penalties for going uninsured (Baker, 1/30).

Kansas Health Institute: Feds Post Proposed Regulations For Health Insurance Mandate
Persons who go without health insurance after Jan. 1, would be spared a tax penalty if they can't afford health insurance, if they spend less than three consecutive months without coverage or if they qualify for other exemptions ranging from hardship to religious beliefs. The regulations also would exempt from penalty people whose income would qualify them for Medicaid coverage but live in states that choose not to expand eligibility (1/30).

Finally --

The Fiscal Times: Obamacare May Bring Heavier Workloads – And More Mistakes
When the Affordable Care Act is fully implemented, 32 million formerly-uninsured patients are expected to enter the health system. The influx has many experts worried about a physician shortage as doctors are not being added to the system at the same rate. While this could translate into doctors accepting fewer patients in offices, it could also mean crowded hospitals and overworked staff (Briody, 1/30).

San Francisco Chronicle: W-2 Forms Now Listing Health Care Costs
Employees have some new information on their W-2 forms for 2012 - the cost of their employer-provided health insurance. This amount shows up in box 12 with the code DD. It includes what the employer and employee paid in premiums last year. To find out what your employer paid, subtract what you paid (look at your last pay stub for 2012) from the DD amount. The amount in this box is not taxable (Pender, 1/30).