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<DIV style="FONT: 10pt arial">----- Original Message -----
<DIV style="BACKGROUND: #e4e4e4; font-color: black"><B>From:</B> <A
title=dlj725@hughes.net href="mailto:dlj725@hughes.net">David Johnson</A> </DIV>
<DIV><B>To:</B> <A title=dlj725@hughes.net href="mailto:dlj725@hughes.net">david
johnson</A> </DIV>
<DIV><B>Sent:</B> Sunday, August 12, 2012 9:20 AM</DIV>
<DIV><B>Subject:</B> ACA - devil is in the details and fine print</DIV></DIV>
<DIV><BR></DIV>
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<H1 class=articleHeadline itemprop="headline"><NYT_HEADLINE version="1.0"
type=" ">Ambiguity in Health Law Could Make Family Coverage Too Costly for
Many</NYT_HEADLINE></H1><NYT_BYLINE>
<H6 class=byline>By <SPAN itemprop="creator" itemscope=""
itemtype="http://schema.org/Person"
itemid="http://topics.nytimes.com/top/reference/timestopics/people/p/robert_pear/index.html"><A
title="More Articles by ROBERT PEAR"
href="http://topics.nytimes.com/top/reference/timestopics/people/p/robert_pear/index.html"
rel=author itemprop="name">ROBERT PEAR</A></SPAN></H6></NYT_BYLINE>
<H6 class=dateline>Published: August 11, 2012 </H6>
<DIV
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data-title="Ambiguity in Health Law Could Make Family Coverage Too Costly for Many"
data-url="http://www.nytimes.com/2012/08/12/us/ambiguity-in-health-law-could-make-family-coverage-too-costly.html"
data-description="Rules proposed by the I.R.S. could leave millions of people in the lower middle class uninsured and frustrate the intent of Congress, which was to expand coverage.">
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itemid="http://www.nytimes.com"></DIV><NYT_TEXT><NYT_CORRECTION_TOP></NYT_CORRECTION_TOP>
<P itemprop="articleBody">WASHINGTON — The new <A class=meta-classifier
title="Recent and archival news about healthcare reform."
href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insurance_and_managed_care/health_care_reform/index.html?inline=nyt-classifier">health
care law</A> is known as the <A title="health law"
href="http://www.healthcare.gov/law/index.html">Affordable Care Act</A>. But
Democrats in Congress and advocates for low-income people say coverage may be
unaffordable for millions of Americans because of a cramped reading of the law
by the administration and by the <A class=meta-org
title="More articles about the Internal Revenue Service."
href="http://topics.nytimes.com/top/reference/timestopics/organizations/i/internal_revenue_service/index.html?inline=nyt-org">Internal
Revenue Service</A> in particular. </P></NYT_TEXT></DIV>
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<H6 class=credit>J. Scott Applewhite/Associated Press</H6>
<P class=caption>Representative Henry A. Waxman believes that an Internal
Revenue Service interpretation of the health care law is wrong. </P></DIV>
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<H3 class=sectionHeader>Related</H3>
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<H6><A
href="http://www.nytimes.com/2012/08/05/us/us-officials-brace-for-huge-task-of-running-health-exchanges.html?ref=us">U.S.
Officials Brace for Huge Task of Operating Health Exchanges</A> (August 5,
2012) </H6></LI></UL></DIV>
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<P itemprop="articleBody">Under rules proposed by the service, some
working-class families would be unable to afford family coverage offered by
their employers, and yet they would not qualify for subsidies provided by the
law. </P>
<P itemprop="articleBody">The fight revolves around how to define “affordable”
under provisions of the law that are ambiguous. The definition could have huge
practical consequences, affecting who gets help from the government in buying <A
class=meta-classifier title="More articles about health insurance."
href="http://topics.nytimes.com/your-money/insurance/health-insurance/index.html?inline=nyt-classifier">health
insurance</A>. </P>
<P itemprop="articleBody">Under the law, most Americans will be required to have
health insurance starting in 2014. Low- and middle-income people can get tax
credits and other subsidies to help pay their premiums, unless they have access
to affordable coverage from an employer. </P>
<P itemprop="articleBody">The law specifies that employer-sponsored <A
class=meta-classifier title="More articles about insurance."
href="http://topics.nytimes.com/your-money/insurance/index.html?inline=nyt-classifier">insurance</A>
is not affordable if a worker’s share of the premium is more than 9.5 percent of
the worker’s household income. The I.R.S. says this calculation should be based
solely on the cost of individual coverage for the employee, what the worker
would pay for “self-only coverage.” </P>
<P itemprop="articleBody">Critics say the administration should also take
account of the costs of covering a spouse and children because family coverage
typically costs much more. </P>
<P itemprop="articleBody">In 2011, according to an <A title=survey
href="http://ehbs.kff.org/">annual survey</A> by the Kaiser Family Foundation,
premiums for employer-sponsored health insurance averaged $5,430 a year for
single coverage and $15,070 for family coverage. The employee’s share of the
premium averaged $920 for individual coverage and more than four times as much,
$4,130, for family coverage. </P>
<P itemprop="articleBody">Under the I.R.S. proposal, such costs would be deemed
affordable for a family making $35,000 a year, even though the family would have
to spend 12 percent of its income for full coverage under the employer’s plan.
</P>
<P itemprop="articleBody">The debate over the meaning of affordable pits the
Obama administration against its usual allies. Many people who support the new
law said the proposed rules could leave millions of people in the lower middle
class uninsured and frustrate the intent of Congress, which was to expand
coverage. </P>
<P itemprop="articleBody">“The effect of this wrong interpretation of the law
will be that many families remain or potentially become uninsured,” said a
letter to the administration from Democrats who pushed the bill through the
House in 2009-10. The lawmakers include Representatives Henry A. Waxman of
California and Sander M. Levin of Michigan. </P>
<P itemprop="articleBody">Bruce Lesley, the president of First Focus, a child
advocacy group, said: “This is a serious glitch. Under the proposal, millions of
children and families would be unable to obtain affordable coverage in the
workplace, but ineligible for subsidies to buy private insurance in the
exchanges” to be established in each state. </P>
<P itemprop="articleBody">Businesses dislike the idea of insurance mandates and
penalties, but said the I.R.S. had correctly interpreted the law. </P>
<P itemprop="articleBody">“Employers who offer health coverage do so primarily
on behalf of their employees,” said Kathryn Wilber, a lawyer at the American
Benefits Council, which represents many Fortune 500 companies. “Although many
employers do provide family coverage to full-time employees, many do not.” </P>
<P itemprop="articleBody">The I.R.S. issued final rules for the health insurance
premium tax credit in May, but deferred its final decision on the affordability
of family coverage. </P>
<P itemprop="articleBody">Sabrina Siddiqui, a Treasury Department spokeswoman,
said, “We welcome comments from stakeholders and consumer groups and look
forward to continuing to work with them to implement these rules and to ensure
families get the affordable care they need.” </P>
<P itemprop="articleBody">The administration is trying to strike a balance. If
the rules allow more people to qualify for subsidies, it would increase costs to
the federal government. If the rules require employers to provide affordable
coverage to dependents as well as workers, it would increase costs for many
employers. </P>
<P itemprop="articleBody">Wayne Goodwin, a Democrat who is the insurance
commissioner of North Carolina, said the proposed federal policy would create a
hardship for many state employees. </P>
<P itemprop="articleBody">North Carolina pays all or nearly all of the premium
for health insurance covering state government employees, but it has never paid
the cost for their dependents, Mr. Goodwin said.
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