Subtitle C - individual affordability credits (sections 241-246)

what a nice little term 'affordability credits' - sounds so pleasant doesn't it? Another fun one 'credit eligible individuals' - doesn't this sound like someone who has done a good job with their finances and can secure a loan? No, it's almost the exact opposite, it's someone who needs help paying their insurance premiums.

The commissioner (HCA) will have a form that people can fill out to apply for credits (a reduction to their premium). There will of course be a process to determine whether the individual is eligible; the HCA can use the state's Medicaid determination in the process, and in so doing, the HCA will be nice enough to reimburse the state's Medicaid for their time and effort.

In years 1 and 2, credits will only apply to people on a 'basic' plan. In year 3 and after, there will be an option to apply a credit to an 'enhanced' or 'premium' plan.

The credit is specifically not a cash rebate.

So, who would be able to apply for a credit?

- an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act).
in the last section (246), it specifically states that no credits shall be available to persons not lawfully present in the US.
- someone not on an employer-sponsored insurance plan
- family income below 400% of the Federal poverty level for their size of family
- not Medicaid eligible
- after year 2, a family on an employer-sponsored plan but the cost of the plan is > 11% of the family's income

When defining income, we're talking about 'modified adjusted gross income'.

Credits will not be treated like a benefit from the employer (for tax purposes).

The premium credit is applied on a sliding scale based on family income. Essentially, if you are the poorest of the poor, you need to pay about 3% of the premium (if I'm understanding it correctly).

There is also the concept of credits for cost-sharing affordability. If I'm reading this correctly, it applies to HCA paying the insurance companies their % of the premiums.