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How Poor Might Qualify For Obamacare Subsidies In States That Don't Expand Medicaid

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The reverse situation -- when someone underestimates their income to qualify for a larger subsidy -- would trigger requests for more documentation and in that case, the officials say they will rely on the electronic data.  If they did receive a larger subsidy than their income warranted, they would have to pay money back on their following year's taxes.

Several advocates who are involved in educating their communities about the new health insurance exchanges say they would not encourage people to do anything that might appear fraudulent.

"The population tends to worry more about getting in trouble with the IRS than worrying about not having health insurance," said Moriba Karamoko, director of the Louisiana Consumer Healthcare Coalition. Louisiana is not expanding Medicaid. "For me to suggest to anyone that they estimate to be higher when there is no reasonable expectation of that would be irresponsible, if not criminal."

Most said they were unaware that people below the poverty level who overestimate their income would not have to repay the subsidy if later found ineligible.

Cindy Zeldin, executive director of Georgians for a Healthy Future, said she will refer people who are ineligible for Medicaid and can't afford subsidies on the exchange to community health centers and other programs.

"We will do what we can to help people find coverage that they are eligible for and meets their needs," she said.

Harold Pollack, a University of Chicago professor of social services administration, said he is troubled that some people whom the law was intended to help get coverage may have to resort to overestimating their income to get assistance. "This is a perverse situation where people may have to break rules to get health care coverage that the law intended to provide them," he said.

Joe Antos, a health economist with the conservative American Enterprise Institute, said that while poor people won't know about the option, he worries that some groups may try to exploit it.

"The one factor that could make this more important," he said, "is the activity of community organizers and other people who have no official role, but who will be out there trying to pump up enrollment."

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

Thu, Aug 08 2013

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