Here’s a post at Ace’s, written by someone named Warden, describing his experience with employment-based health insurance premiums this year. Here’s what happened to him:
My own horror show arrived in the mail today. I’ll spare you the gory details. Here’s the short version: A 25% increase in premiums for the same health coverage I carried last year. For someone on a family plan, that translates into a $1,200 yearly increase.
So congratulations. If you make somewhere around $50,000 a year, then more than your entire after tax annual raise just went to pay for Obamacare. Doesn’t that feel FANTASTIC? You’re bringing home less this year than you did last year.
And you’re one of the lucky ones. See, you have a job. And you got a raise. You’re one of life’s lottery winners. A one percenter.
He might be even more upset if he took a look at what would happen if he were to go on the exchanges. At an income of $50,000 a year and with a family of four, and if $1,200 represents a 25% increase, he appears to be about to start paying premiums of about $6K a year up from $4.8K last year (he also reports having to pay an additional $600 as a smoker’s penalty, but let’s leave that out and just figure the basics).
As a person who’s buying insurance though work, he is eligible to go on the exchanges and shop around. Using this handy calculator (which is not exactly accurate for all states but which seems to give a good idea of what to expect in many), it turns out that, if Warden and his wife are both 35 and have two minor children, a silver plan (the standard used) would cost $9748 a year, with fairly high deductibles and co-pays that would amount to the consumer having to pay about 30% of the family’s medical expenses as well.
So that’s not a good deal for him at all. There’s no reason to go to the exchanges—and even if that age estimate is too low, if his age were higher than that the cost to him would be even higher.
So forget the exchanges. Right?
But what about subsidies? A person getting employment-based insurance can use the exchanges instead and get subsidies as well if his premiums for insurance through work—if he were single—would amount to over 9.5% of his income. That’s a bit hard to understand, but it means that for Warden, whose income is $50K, although he’s actually being asked to pay a whopping 12.5% of his income for work-based premiums on a family plan, he’s not eligible for a subsidy on the exchanges because if he were single he’d probably be paying a lot less than 9.5% of his income for his work-based premiums. I don’t know the exact figure he’d be paying at his company if he were single, but unless it were above $4750 a year (highly unlikely, if a family plan is $6000), then he would not be eligible for a subsidy on the exchanges no matter how high his actual work-based premiums are.
But surely, then, he’s better off than if he were self-employed, making $50K a year, the same age with the same family, and on the exchanges? Or at least he’s not worse off?
In fact, he’s a lot worse off. Here’s the scoop (you need to go to the calculator again to get the figures). If he is 35 years old with a wife of 35 and two minor children, self-employed (or employed by a company that does not offer insurance), his insurance premiums would be $9744 a year on the exchanges for a silver plan, as previously stated. But that’s not what he would actually pay, because at $50K a year his income figures in at 212% of poverty level for a family of 4. That caps his contribution to premiums at $3360 a year.
That’s all he has to pay no matter how high his premiums actually go; the government picks up the tab for the rest. In the case of a 35-year old with a family of 4, that means that the government would pay $6384 to his $3360, about two-thirds of the cost. If he and his wife were 40 years old, his premium contribution would stay the same but the government subsidy would go up to $6672 because the premiums rise with age and the government makes up the difference. And if both he and his wife are 45 the government contribution rises to $7548 while his contribution stays put. What’s more, because his income is under 250% of poverty level, he also gets hefty breaks on deductibles and co-pays.
It used to be that employment-based insurance was less expensive than individual, in part because of employer contributions. Now it seems that in many cases the tables have been turned for middle-income people (those with incomes under 400% of the poverty level, that is, which includes a significant percentage of the US population), with government subsidies giving a huge advantage to the self-employed and those without employer-based insurance for any reason. Haves and have-nots, indeed.
[NOTE: I’m assuming that Warden is quoting his premium payment amount after the employer share of premiums has already been paid.
If I’ve made any computational errors, let me know. After all, I did this on a Saturday night, while watching the World Series, which the Red Sox seem poised to lose.
One more thing—the online calculator I used to do the computations was the best I could find, but of course it could be giving me incorrect information. Like the Obamacare website itself.]