As of today, my ACA discussion at DKos had 164 comments. It deserves that much here:

[truedelphi]

Are the ACA's "Subsidies" really subsidies? Or are they loans?


It is my understanding that many people who are not currently insured will be visiting the California exchange, and if their income is low enough, and they are not offered insurance through work, they will get insurance through MediCal.

I spent today cleaning out the closet. Among other items I came across was a brochure sent to this household some years ago (circa 2008-2009) when we qualified for MediCal.

Here is what it says in the brochure, sent by Health and Human Services:

"When a Medi-Cal beneficiary is 55 years of age or older at the time of death, the State will collect from his/her estate the cost of Medi-Cal services received including insurance premiums paid an d payments made to managed care on or after the 55th "birthday."

The brochure goes on to detail exclusions, such as if your spouse has survived your death, they won't go after the estate until the spouse has also died. And they exclude a household where a child survives a parent AND IS UNDER THE AGE of 21.

So is this still in place? And REMEMBER, in your state, (assuming you live outside California, MediCaid is the program that the poorer among us will be using . MediCaid is not only a program that serves those older persons seeking long term nursing care - it is the program that addresses the health insurance needs of poorer people.

For instance, in1995, 14 million people in the USA were dealing with health care matters through the auspices of MediCaid. And many of these people were single parents with children. MediCaid pays for doctor visits, and hospital ER visits, and hospital stays if needed. And of course, long care help inside a nursing care home.

Remember: the ACA is mandated - and once you sign up, if poor enough, you are shuffled onto MediCAid or MediCal. YOu probably get some type of notice in the mail after the sign up. (That's how our notice came.)

Again, this is not something I found out about by watching Fox news, or the RW Denouncers. It is right there inside the brochure issued by California Dept of Health and Human services.

[HereSince1628]

1. So, you feel entitled? Really?

OMG!

[truedelphi]

2. I'm not the one here since 1628.

And actually, everything about the subsidies being loans is not something that will affect me. I've moved into a higher income class.

see response my "Shrot and Sweeter, more concise" reply below.

[HereSince1628]

9. Ad hominem attack et al...I think I'll let you prosecute yourself

[roguevalley]

27. threads get what they earn

[HereSince1628]

31. Well, they get what the market provides.

That may not be exactly the same but it's usually pretty close

[truedelphi]

3. Here is the shorter and more concise version of the OP.

What's Unfair Is The ONLY People Who Have To pay back their medical insurance premium subsidy(ies) are those who get Obamacare via Medicaid.

Those who got a subsidy without going on Medicaid, don't have to pay back the subsidy.

And if you apply for health insurance, which we are all "supposed to," and you are poor, you are put into MediCal, (or MediCaid if you live in another state.) No choice about it.

[geek tragedy]

11. What part of "after death" did you not comprehend? nt

[truedelphi]

17. Uh hey there, distortionist -

As in one who distorts:

The OP is explicit in very clear language that this happens after death.

Read the middle section of the OP.

[geek tragedy]

20. So, you're just trolling then.

Your big whine here has been how Medical recipients are forced to pay back the money they get from Medical, calling it a 'loan.'

What's Unfair Is The ONLY People Who Have To pay back their medical insurance premium subsidy(ies) are those who get Obamacare via Medicaid.

Which is 100% false, since dead people don't pay anything back.

[truedelphi]

26. I sent the OP out to several people I know.

Here is one reply I got back from a guy who lives in Oregon:

MediCal and Medicaid are the same thing, just as Oregon Health Plan is Medicaid.

The states just give the programs their own labels.

All health insurance programs for the poor in this country fall under the umbrella of Medicaid.

When I signed up for the Oregon Health Plan last month, it says right there I agree to sign away my estate to recoup the expenses.

####

I never read the fine print so many here have read - and should I read that fine print I won't agree to it. To my way of thinking, "hearing no evil" "seeing no evil" "speaking no evil" is not an intelligent way to live, nor should it be required as part of being a Democrat. A program as extensive and important as the ACA needs to be discussed with all its flaws. If discussing it in that manner makes me a "troll" in your mind, so be it.

[geek tragedy]

28. Except this has nothing to do with the ACA. It's Medicaid, and for the past 20 years it's been

the rule that people can't retire early at 55 go on Medicaid and have the government pick up every dime of their treatment.

[truedelphi]

32. Except that now they are mandated to do that.

And the difference between someone being able to have the assurance that their estate will be passed to their children, or not passed on to their children, is a mere $ 95 a month.

Example (Based on Calif CA exchagne rates:

Example: Woman in early 60's, husband on MediCare - she pays some $ 95 out of pocket each month for her Calif. Silver ACA premium. The government subsidizes her premium each month to the tune of around $ 1,000. (Or $ 12,000 a year.) When she dies, nothing needs to be recouped by the government, as she is not officially on MediCaid.

Slightly more indigent person, same age. This person pays nothing each month. But when they die, their estate is lost, be that a modest home, trailer, the cars or whatever. because unlike the person above, who is not on MediCaid, they are.

[geek tragedy]

33. Same difference to them. Government doesn't get a penny of their money while they're

alive.

They can't take it with them.

[notadmblnd]

13. Do you really think that someone who qualifies for medicaid is going to have an estate

to pay back the state with after they die?

[PoliticAverse]

14. If they own a house, yes. n/t

[truedelphi]

19. Exactly. And the situation is very common -

Last edited Sat Nov 9, 2013, 04:34 PM - Edit history (1)

Many people who are in the older segment of society have only their homes left. Their "retirement savings" were wiped out with the economic crash of 2008.

And that home, be it a half million dollar modest ranch home in the San Francisco Bay area, or a $ 50,000 trailer here in Lake County is something they have worked hard to pay off the mortgage and to own outright, so that it can be passed onto their kids.

Many older people who have jobs are out there working. Some 14% of people past retirement age are working, many of them at jobs they have held for years and that they like. But for the rest of the older population, their jobs were outsourced to India or wherever. They don't have the ability to continue on in whatever profession they had previously, and they can't adapt to a younger person's job like waitressing or being a janitor, as the body is too infirm.

[kelly1mm]

15. Under ACA there are no longer asset tests for medicaid. Thus, you could have 1 million in the bank

and if your income was under 133% of FPL you would qualify for medicaid.

[snooper2]

4. Do threads on Dkos get threadjacked with posts about digital picture frames?

I was thinking about getting one for a Christmas present but DAMN they can get expensive!

[NightWatcher]

8. Hell yes they're expensive

And if you get a cheap one expect it to die w/in a year. My Christmas ones didnt make it into the summer

[Agschmid]

18. SPAM!

[NightWatcher]

5. I've seen requests for kicks and recs, but a specific number of replies?

Hope this one helps get you closer to your goal.

[Pretzel_Warrior]

7. I know. lol. As if DU gets NEAR the traffic of DKos.

[truedelphi]

24. Thanks.

It's important information to consider.

And most people are really clueless about the ACA's provisions.

I spent part of yesterday talking to a relative who let me know that one of my big concerns about ACA is irrelevant. That concern of mine is the manner of payment. I refuse to allow for paying for anything that automatically debits a bank account, as my income comes from a small business and some months money is in the bank, and sometime s money is not in the bank. (Anyone who has run a small business, that generates less than $ 50K in income, knows what I mean.)

I really don't want to have the ACA and required premiums result in NSF banking charges, which can amount to a lot of money during a bad month, even if only one "bad charge" is debited to the account.

So the relative tells me she understands all about the ACA, as she just had an insurance agent bill her for her new ACA account premiums. Good, I am glad it is helping her. Her situation with the ACA? She is replacing a really bad policy for a new policy whose cost to her is only $ 50 more each month, and her new ACA policy is not a total scam, as her last policy was. At least, she feels it will be excellent. Now she has had a steady income for years, not an extravagant income, but she can budget her money as it is a regularly occurring amount.

Anyway I had mentioned to her that there was the possibility of my receiving about 10K from a business venture beginning of next year. She immediately announces, "So as far as your paying out your premiums, just use that money to outright purchase the policy premiums for the whole year."

But the thing of it is, if I get the large amount of cash beginning of the year, I wouldn't know how much my policy premiums would be, because everything would need to be re-calculated.

I do know that 10K, if it is received, would probably end up knocking away many of the subsidy dollars, and so my "increase" in income would go to the ACA. But the relative couldn't make sense of that point. She just thinks, based on her income, that the ACA is very affordable. I also think based on the monthly premium amount she explained to me, that she has chosen the "Bronze" package, and if so, she is in for some very bad realities should she ever actually need to use her insurance.

[Pretzel_Warrior]

6. What are you on about?

maybe dig into your research before hitting SUBMIT on the post. You know...like answering your own question about whether MediCal takes your property after you die.

[geek tragedy]

10. ZOMG Obamacare socialist death tax!!!!!!

This thread will not go the way you wanted.

[PoliticAverse]

12. The Estate Recovery aspect of Medicaid for those over 55 has been discussed on DU...

You can learn more about it here...

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Estate-Recovery.html

http://aspe.hhs.gov/daltcp/reports/estaterec.htm

And here's a link to a dailykos thread specifically on this issue:
http://www.dailykos.com/story/2013/10/21/1249471/-Estate-Recovery-It-s-Worse-Than-You-Thought#

[frazzled]

16. You shouldn't have an estate if you're on Medicaid

To be eligible for Medicaid (say, when you are in a nursing home), all your assets have to be spent down. In other words, you've run out of money to pay for your nursing care. They don't count your home (if you're lucky enough to have one) when a spouse or close relative needs to live there: in that case it is considered a "home," not a "house" However, if you move permanently into a nursing home, or if you try to transfer that home to someone for less than market value, or if you die, then that home is considered a "house" and an asset, and Medicaid can use it to recoup the cost it has paid for your care.

When we had to put my mother-in-law in a nursing home, she was already living in assisted living and had sold her house. She was able to pay the care (a fortune) for two years, and then she had no money left. Medicaid then took over and paid the last six months of costs for her care (probably at least $50,000, plus medical bills from a ten-day hospitalization). When she died, there was no money left in her estate (I think they allow an amount to remain for burial costs). That was okay with us, because otherwise we would have had to come up with around $75,000 or so on our own to pay for her care. It was a blessing to us financially and mentally, because she was able to stay in her same room with her wonderful caretakers until the end.

You can't be sitting on trust funds for your kids and a house that is worth $300,000 and expect Medicaid to pay all your final bills. The program needs the money to help the truly needy. So yeah, they can theoretically get repaid if you leave a "home" or trust fund behind.

It's fair, and it's good.

This is not about collecting everything they paid to a person over their lifetimes (believe me, if you're poor enough to be on Medicaid, you don't have anything for them to come after anyway). This is about elderly people whose assets have been hidden in order to qualify for Medicaid to pay the expenses at the end of their lives.

[truedelphi]

21. You ae missing the point, which is this

What's Unfair Is THAT The ONLY People Who Have To pay back their medical insurance premium subsidy(ies) are those who get Obamacare via Medicaid. In other words, the poorest of the poor.

Those who got a subsidy without going on Medicaid, don't have to pay back the subsidy.

And if you apply for health insurance, which we are all "supposed to," and you are poor, you are put into MediCal, (or MediCaid if you live in another state.) So there is not even a choice about it.o choice about it.

[frazzled]

22. You're not understanding ...

If you're poor and have no money, you don't have to pay back a nickel.

Only if you rack up a couple hundred thousand in a nursing home and then expect to pass on your house worth $450,000 to children, will you have to pay it back.

Got it? Not yet? Read this:

http://aspe.hhs.gov/daltcp/reports/hometreat.htm

[truedelphi]

23. I have already stated this post is not in reference to

Situations concerning long term health care inside a nursing home.

JEESH!

[politicaljunkie41910]

35. Bud the law you cited from HHS specifically is aimed at long term nursing care type expenses.

Just as one mentioned in the post above, this provision was intended to prevent people who could otherwise afford to pay their own LTC expenses, or had other assets from placing their assets in trusts for their heirs to inherit upon their death, thereby avoiding paying there own expenses and attempting to later pass on their expenses to their heirs while benefiting from the state and federal governments footing the bills for their LTC, and rightfully so. The provision even reference how the many estate planning groups teach people how to do this. The HHS provision is trying to prevent this sort of scam to circumvent the eligibility rules for people who have the means albeit in illiquid assets. It doesn't apply to truly poor people who have no means to pay, and can be waived in the final analysis.

[jazzimov]

25. The subsidies are NOT MediCaid.

If you cannot afford the premiums, THEN you get free healthcare which is essentially MediCaid. But the subsidies for premiums are not MediCaid.

[truedelphi]

30. Actually, to what you are saying,

the answer is YES and NO!

If you don't have employer based insurance, or aren't self insured though your Business proprietor status, then you can apply for insurance on an Exchange (If you live in one of the states that has an exchange.)

If you are working and have enough income to afford some of the costs of the ACA-mandated insurance premiums, then you are not officially on MediCaid. (However, I feel that since the President has already talked up the idea of "expanding MediCaid," that could all come about with some type of legislative language attached to some other legislative action in Congress.)

So anyway, as it stands today, many people will be paying something toward the ACA premiums. Subsidies will be paid to handle the part of their premiums they cannot afford. But others don't have enough income to do that. So then they are automatically placed on MediCaid.

And that is part of my reason for writing this OP. Is it not unfair that those who cannot afford a single penny toward the ACA premiums must realize that the monies spent on them will be recouped by the government out of their estate, while those who can
afford a mere $ 95 a month will not be in that situation?

Example: Woman in early 60's, husband on MediCare - she pays some $ 95 out of pocket each month for her Calif. Silver ACA premium. The government subsidizes her premium each month to the tune of around $ 1,000. (Or $ 12,000 a year.) When she dies, nothing needs to be recouped by the government, as she is not officially on MediCaid.

Slightly more indigent person, same age. This person pays nothing each month. But when they die, their estate is lost, be that a modest home, trailer, the cars or whatever.

[Trillo]

29. I'm kicking it for you.

Don't have any intelligent comment to make, except it seems like there's been far too much inherited family wealth from every generation for a long time.

[truedelphi]

34. It seems to me that the same guidlelines that are in place for

Taxation with regards to inheriting an estate should be in place with regards to MediCaid recoups.

In other words, if the estate is less that some $ 600,000 (can't remember the exact amount you can inherit before you start paying a "death tax", but it is up there above half million bucks) it would not be recouped.