Something I pointed out months ago got a new life on Twitter yesterday. Here’s the idea: Imagine, in 2014, you are a person desiring health insurance and with <100% FPL income in a state that has not expanded Medicaid. It remains true that if your income were 100% FPL you could get subsidized coverage on the exchange. What to do?
The flip answer could be “get a job,” but let’s presume you’re trying to do that anyway. Another answer is to claim 100% FPL income, e.g., by saying you have some unreported cash income. Maybe you mowed some lawns and moved some furniture around the community. What entity is going to be able to successfully challenge this claim? It is hard to imagine the IRS auditing lots of poor people because they are claiming their incomes are too high.
Note, if it is possible to obtain subsidized coverage this way, it is so because of the SCOTUS decision on the ACA, which made Medicaid a state option. Call this the SCOTUS private option, if you like.
There’s a post up for grabs chasing down whether people could get away with this. I could do it, but I’m feeling generous and/or lazy. (Hint: Start with Tim Jost. See his recent Health Affairs post, which doesn’t quite get to this issue, but comes awfully close.)
Just to demonstrate I had the idea first (as far as I know), here are a few of my old tweets on this: