One answer for people in states like Florida and Texas who make too little to qualify for subsidies on the health insurance exchange, but too much to qualify for Medicaid (and in Texas that's
easy to do) is to take on enough extra work to get the subsidy. As written, Obamacare intended to expand coverage nearly universally, by covering the working poor with a Medicaid expansion. The U.S. Supreme Court, however, ruled in 2012 that states could refuse the expansion money, leading to millions falling into the gap. One of those people is Alma Ramos, profiled in
this piece from
The New York Times. Her solution was to take on as much extra work as she could.
Encouraged by counselors at a storefront enrollment center here, she took on more work, busing tables at night and, more recently, cooking tamales to sell out of her tiny apartment. By raising her annual income to about $24,000, Ms. Ramos, 39, qualified for a subsidy that enabled her to buy insurance for just $20 a month.
"I want to be covered for my kids," she said. "I'll do whatever I need to do."
It's a solution enrollment counselors say they use regularly with the people they're advising, seeing if adding additional work is a solution. That could mean adding more hours at a part-time job, if they can get them, or taking on an additional job, or if they are self-employed at something like housecleaning, taking on more clients. It ends up that low-income parents have the hardest time, and need to take on the most extra work, because the poverty level is set higher for people with larger families. They have to get above the 100 percent of poverty to qualify for subsidies, and for many that's just not possible. For others, it means accepting trade-offs like having to find—and pay for—additional childcare in order to work the extra hours needed for the extra income to be able to get insurance.
It also puts people in the position of potentially overestimating their income for the coming year when they apply. If they estimate they'll make more than 10 percent over what they did in the previous tax year, they have to provide documentation. While the law won't require that people who fall below the poverty level in a year they receive subsidies pay back the subsidy, it still puts people on the cusp in an uncertain position and the uncomfortable position—for many—of swearing and attesting to the government that they'll have an income that they're not at all sure of.
All because Chief Justice John Roberts had to prove his conservative credentials when he decided against striking down Obamacare as a whole—he decided to gut just the Medicaid expansion instead. Imagine the ramifications if he decides in the current challenge before the court to take subsidies away from millions of people.