The House Ways and Means reconciliation draft is out. There are a lot of things that can be said, few kind. I want to highlight one section about the ACA that leapt off the page for me.
Sec. 112203. Eliminating limitation on recapture of advance payment of premium tax credit. Current Law: Under current law, there is a limit on the amount of excess premium tax credit certain individuals must repay if they misestimate their projected income and benefit from a more generous advance payment of the tax credit than they qualified for. Provision: This provision removes the repayment limits and requires affected individuals to reimburse the IRS for the full amount of excess tax credit received.
This is a wow of a provision. The consequence of this provision is that it will impose a massive uncertainty tax on low income enrollees who are likely legally eligible for coverage. Under current law, people who get too much in premium tax credits will have differential but capped exposure to paying some of it back. Low income enrollees whose actual income is below 100% FPL don’t have to pay anything back as long as the income estimate was made in good faith. This proposal would get rid of that safe harbor.
The ACA relies on projection of future income. In states without Medicaid Expansion, there is a hard cliff on assistance. If an individual earns over 100% Federal Poverty Level (FPL) they are entitled to premium tax credits to reduce their ACA premiums. If not, they are highly unlikely to be eligible for Medicaid, and would be expected to pay full premium for an ACA plan. That basically means a 50 to 80 FPL point gap in coverage for parents and 100 FPL point coverage gap for non-parent adults.
Right now, people make a projection of their income for the following year in November or December when they purchase insurance. 100% FPL for a single individual is $15,650 in the contiguous United States for 2025. That translates to full time work (2080 annual hours paid) at $7.52 an hour.
It is entirely reasonable for someone who is making $8 an hour and working full time (2000 hours/year) to project that they are going to make $16,000 (103% FPL) for the following year. This makes them eligible for substantial premium tax credits and cost-sharing reduction subsidies. In Columbia County, South Carolina, a single 40 year old would likely be eligible for roughly $5500-5800 in premium tax credits (in 2025, 5800, in 2026 with old subsidy schedule about 5500).
Great!
Now let’s imagine two scenarios.
They get a $1 an hour raise. Their income is now 115% FPL. They report it as required, and their premium tax credits either don’t change in 2025, or slightly decrease in 2026. This is FINE!
Now the other scenario is they are still making $8 an hour but the store decides on March 31st that the Tuesday morning shift is not needed, so they are only working 36 hours per week for the rest of the year. They work 1850 hours for the year. This is still full time work. They make $14,800 for the year. Under current law and policy, that is fine. It was a good faith estimate that was wrong and bad luck accrues to the government.
Under this proposal, that individual is now no longer eligible for premium tax credits and would need to pay back every dollar. They could incur a 30% to 40% of their income surprise tax bill due to bad luck.
Would you take this risk?
I wouldn’t.
I would, even if I can make a legitimate good faith estimate that my income will be over the 100% line by a bit, stay the hell away from shocks and surprises like this, especially if there are other provisions that deny me access to needed benefits if I am in tax debt to the IRS.
rikyrah
As always, they create things to hurt those who can least afford it. Thanks for the info.
RaflW
Since the topic is sh*tty things Republicans are putting in the Reconciliation Bill, there’s this turd:
The Ag Committee’s part of the Reconciliation Bill changes the SNAP definition of “dependent child” from under 18 years to under 7 years old to determine “Able-bodied adult without dependents.”
So if you are getting SNAP, and your kid celebrates their 7th birthday, congrats! S/he is an adult now in terms of fending for themselves in foraging for food. You too, lucky parent of an ‘adult’.
My takeaway: The GOP are dead serious about the return of child labor. Altho even cynical I didn’t think they’d go as low as seven. What age were bootblacks in Dickens’ time?
catclub
apparently Republicans in blue states want a much bigger state tax deductibility limit. It looks like it will go way up.
Tim C.
@catclub: Red states extract value and wealth from Blue states. Same as it ever was.
Sure Lurkalot
I’m certain that the US will remain an outlier for its lack of a universal healthcare system for the rest of my life. The current screeching about the USPS not generating a profit is indicative of our mindset since Reagan though the “skin in the game” ethos affected how Medicare was structured back in the 60’s.
Eduardo
Horrible, soulless people.
Also, spoken as a proud “neolib”: we need to do Medicaid for All under 65 and then add all the kludges and job and private plans and shit on top of that.
Matt
@RaflW:
The average GOP pol pays good money for the work output of seven-year-olds. Not in factories, tho – in the “studio”
Another Scott
Thanks for this. It’s infuriating what they’re doing.
Also too, … RollCall.com (from yesterday):
It’s always, a l w a y s, the Democrats’ fault with these oh so serious “party of personal responsibility” folks.
Grr…
Best wishes,
Scott.
Chris T.
I had our regular CPA do our taxes this year in the regular way, and was shocked to find that my ACA payments (which are enormous) qualified as a tax credit. They didn’t the previous year, but apparently that was because I had to take out a lot more retirement funds to cover major house repairs.
This whole Premium Tax Credit thing is so weird. If we just had an Australian-style system … ah well. Not that I’m objecting to getting a big lump of cash back, either, but it would make more sense not to have paid it out in the first place. Which, if I’d suspected PTC would apply, I could have risked, I guess?
Percysowner
And there’s this little addition to the bill ‘Buried in final pages’: GOP quietly slips plan to let Trump crush nonprofits into bill
Anonymous At Work
Three observations, one humorous:
First,
“The most daring attempt to solve Fermat’s Last Theorem using Quantum mechanics ever printed!”
Second, does this survive Parliamentarian review? (Related, does the Parliamentarian survive their own review?)
Third, how does this survive the laugh test at any hearing? Or will this avoid a hearing on the merits? Taking away a safe harbor like this would be equivalent to asking hearing witnesses to pre-estimate their capital gains for the next 12 months down to the exact dollars and cents.
Anonymous At Work
@Percysowner: Probably means that Republicans do not consider the possibility that they or Trump will ever allow another Democrat into the White House.
lowtechcyclist
TL;DR: how to kick a whole bunch of people off health insurance without saying you’re doing so. Ditto children’s nutritional benefits.
They really are the Party of Evil.
RevRick
@RaflW: @catclub: @Another Scott:
David Dayen, over at the American Prospect, argues that the GOP coalition is so riven with contradictory ideas that Trump’s Big Beautiful Bill may end up DOA. He speculates that Republicans May end up having to negotiate with Democrats by the end of the year just to get some of Trump’s tax cuts extended.
He points out the bill crosses so many red lines for so many parts of the caucus that it is difficult, if not impossible, to figure out how to get the numbers to work.
Just to give an example, the SALT caucus, which demands that the cap be lifted, is directly in conflict with Freedom Caucus, deficit hawks, who demand that the increase in the deficit to $2 trillion over the next decade. And that would require cuts in spending in programs like Medicaid and Inflation Reduction Act tax credits that make other Representatives, especially in swing districts, screaming.
Democrats should do all they can to magnify these impossible differences.
tobie
I’m about to call my awful Freedom Caucus member Rep about the Republican proposed budget. Can someone recall the CBO’s estimate of the number of people who will be kicked off Medicaid if this plan goes through? I can’t find the figure online. Thanks in advance for the help.
Baud
@RevRick:
Hopefully that’s the case. I’m assuming they’ll grab the ring while it’s in front of them.
Geminid
@RevRick: Republicans may have to negotiate with Democrats by August. That’s the time Treasury Secretary Bessant says the Debt Ceiling will need to be raised.
RevRick
@tobie: The member won’t care about that. Tell them the SALT caucus will blow up the deficit.
RevRick
@Baud: The thing is four nays sink the whole thing and they all want to grab different rings.
tobie
@RevRick: This is true. I left a message saying that you can’t cut your way to prosperity. Doing so will only cause the economy to contract. Having a sound industrial policy, sensitive to 21st century demands, would make a lot more sense and do more for balancing the budget than giving tax cuts to the wealthy. I added that an unhealthy, malnourished public doesn’t lead to worker productivity.
rikyrah
@RaflW:
just PHUCKING EVIL
RevRick
@rikyrah: And what may be the case is that one evil desire cancels another. Our task as Democrats should be to stir the pot of those warring desires.
Jay
@tobie:
CBO estimates 8.6 million.
Jay
@tobie:
Given that 90% of all productivity gains in the US Economy, since 2000, has gone to the 1%, why does your congress critter want to make multi-Billionaires haz a sad?
David Anderson
@Anonymous At Work: Parliamentarian only cares about the Senate bill…. this is the House doing its own thing in public and getting off on the cruelty.
Citizen Alan
@Percysowner: Does this mean that a future Dem President could start taxing the churches? Asking for a friend.
RevRick
@Citizen Alan: I don’t understand this fantasy that somehow churches are some sort of pot of gold. Given the economics of the vast majority of local churches that would get you $0.
When I was working full time as a pastor, I paid both federal taxes plus 15.3% for Social Security and Medicare (a weird quirk of federal tax law counts us as self-employed).
Doing away with the carried interest loophole for hedge funds would get you far more revenue.
Jay
@RevRick:
The target would be the Evangelical Megachurches, (hopefully) who’s Pastor’s amass great fortunes, jets and mansions, through grift, and sometimes build their own Universities, and use their influence on their “flock” to dictate politics.
scmp.com/magazines/style/entertainment/article/3260500/8-richest-pastors-and-televangelists-2024-net-worths-ranked-td-jakes-joel-osteen-and-kenneth
Another Scott
@RevRick: I’d like to think that dday is right, but I think most of this drama in the House RWNJ ranks is just the usual maximalist posturing before the deadline. They all know this is their last, best chance to destroy everything, so they’re going to take half a loaf if it comes down to the wire.
Now whether the House and Senate can get an agreement is more iffy, but I still think that odds are better than 50:50 that they will.
At least as things stand at the moment. Grr…
https://bsky.app/profile/fritschner.bsky.social
is keeping an eye on things (Rep Beyer is on the Ways and Means committee).
We’ll see.
No matter what happens, we have to keep fighting them every day because they will . not . give . up . We can’t either.
Best wishes,
Scott.
Percysowner
@Citizen Alan:Considering the Episcopal Church just pulled out of the refugee settlement business in protest of Trump’s making White South Afrikaners a priority for entering the U.S., I would not be surprised if Trump declares the Episcopal Church a terrorist organization. Evangelicals may shrug and not care because, right now THEY are the chosen religion.
Plus Texas used to periodically try to declare Unitarian/Universalist churches as not being “real” religion because they have no set creed and do not behave the way Texas thinks they should. I would be unsurprised if Trump didn’t start going after liberal churches.
JM
How does the clawback affect people in Medicaid expansion states? Does it just make the clawback happen for someone who estimated they’d be above 138% and they fall below? Or is it a different calculation altogether?
Gabe
Even if your income doesn’t change, you can drop below the poverty line because a change to your household size. For example:
A 52-year-old woman makes $20,030 (133% FPL) in 2025 working full time at a little under $10 per hour. Her daughter dies and the 52 year old woman takes in her two grandkids, increasing her household size from one to three. That causes her FPL to go from 133% FPL to 78% FPL.
She now has to repay the $9,082 of APTC she received.