TOPICS > Health

Tax credit helps end one family’s search for health insurance

November 18, 2013 at 12:00 AM EDT
The Montez family of Colorado has been living without insurance, forcing them to avoid care and pay for medical expenses out of pocket. But now they are able to afford a health care plan under the Affordable Care Act. Julie Rovner of NPR joins Judy Woodruff to explain how tax subsidies are helping families get coverage.

JUDY WOODRUFF: The White House said today 20 percent of Americans will still not be able to buy health insurance on the federal exchange website by the end of the month. Instead, they will need to sign up by phone or in person, in many cases because of the complexity of their situation.

But, in advance of a congressional hearing, a senior Obama administration official was quoted as saying is improving, and said they are working on making it easier for people to understand whether they are eligible for subsidies. That’s been a problem for many up to now.

It brings us to our series on reactions to the Affordable Care Act. Tonight, we hear from a couple in Colorado who are finally able to buy coverage after years of being uninsured. They do with the help of a subsidy through the state’s exchange.

JOAQUIN MONTEZ, father: My name is Joaquin Dominges Montez III.

ROSALEE MONTEZ, mother: And my name is Rosalee Montez.

We will get you a smaller cup, OK?

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JOAQUIN MONTEZ: We live in Arvada, Colo., and we have three kids.

ROSALEE MONTEZ: Our oldest is a daughter, and she’s in college. And we have a middle, and he is a son and he’s 13, and he’s an eighth grader. And then our little one is 4 years old. We met in high school in the ninth grade, I think was. And we have been together 24 years?

JOAQUIN MONTEZ: Twenty-five.

ROSALEE MONTEZ: Twenty-five?

JOAQUIN MONTEZ: I work in a warehouse, and I do not get health benefits.

ROSALEE MONTEZ: I work in a warehouse as well doing commercial signage. And they don’t offer any benefits. It’s too small of a company.

JOAQUIN MONTEZ: We haven’t had insurance because it’s pretty expensive for us. You know, even though we have a two-income household, it gets really expensive.

ROSALEE MONTEZ: And then that’s the water.

JOAQUIN MONTEZ: We have looked into health insurance before, and it ranges from about $450 to $600, depending on who you go through and what kind of deductibles you have and stuff like that. So it’s kind of expensive for us, on top of a house payment, a car payment, as well as making sure our kids and fed and stuff like that.

So, normally, what we do when our kid does get really, really, really, really sick, we take them to urgent care, you know, because we can’t afford any hospital bills and stuff.
And it’s kind of a flat rate. You pay as you go. And…

ROSALEE MONTEZ: But it gets pretty pricey.

Our son was in football and he has broken his collarbone twice, one right after the other, same spot. We had to go to urgent care both times.

JOAQUIN MONTEZ: There was another time too where my oldest daughter had got real sick from something she had ate. And, you know, there was really nothing we could do to help her out. We tried to wait it out as much as we could, but she was really in pain. So we took her to the hospital. And it was pretty expensive.

ROSALEE MONTEZ: She got E. coli.

JOAQUIN MONTEZ: So I think that bill ended up being close to $17,000.

GIRL: How was your day today?

ROSALEE MONTEZ: I was always worried and anxious. I just — I try to do the best I can when they are sick here to remedy them at home. But there’s things you can’t do. It’s such a big load to carry because you’re just — on a daily basis, you’re wondering if your kids are healthy.

And then, when they’re not, you’re just trying to figure out different ways to get them healthy without the insurance.

JOAQUIN MONTEZ: We first heard about the Obamacare through Servicios de La Raza, which is a community outreach program.

One of the guys that I talked there, he kept mentioning to me about — that there was other people in his program that could help us out with Obamacare. So we called the lady that worked there. And she didn’t hesitate. I think, two days later, we actually met with her, got into her office. She sat us down. We filled out the applications, and that’s how we went about applying for it.

ROSALEE MONTEZ: We kind of got split up in our insurance. The kids are on CHP Plus, a government program that insures children. And they’re separate from what we qualified for. We qualified for basic insurance.

JOAQUIN MONTEZ: With the Obamacare, the main cost will be $450 per month. Obamacare, the tax credits will give us $287 a month to apply towards that bill, so our final bill will be $155 a month. Now that the tax credit is helping us out, we’re able to afford it.

Dear lord, we thank you for blessing us with another day, father.

ROSALEE MONTEZ: And knowing that we have that, and that we can qualify for something, because there’s been so many times we have been turned down to be qualified for anything, but to have somebody actually say, yes, you qualify for this and this is what you are able to get, it was just — we were like, we could actually breathe now, you know, actually say, we got insurance, you know? So, it was awesome.

JUDY WOODRUFF: As we have throughout, we try to fill out the bigger picture.

Tonight, Julie Rovner of NPR is back to help us out.

Julie, welcome back to the NewsHour.

JULIE ROVNER, National Public Radio: Thanks, Judy.

JUDY WOODRUFF: So, we just saw the story of the Montez family in Colorado. But, generally, who is eligible to apply for and get a subsidy like the one they got?

JULIE ROVNER: Well, it’s people between — who earn between 100 percent and 400 percent of poverty. People don’t realize there is actually a floor. If you earn under 100 percent of poverty, you are not eligible to purchase on the exchange. It was assumed that those people would be getting the expanded Medicaid. And in the half of states that are doing that, they will.

In the other half of the states, they could fall between the cracks, but if you earn up to 100 — excuse me — up to 400 percent of poverty — that is about $46,000 for an individual, up to about $94,000, so well into the middle class for a family of four — you will be eligible for some subsidy. Obviously, the subsidies are larger the lower your income is and smaller as your income gets higher.

JUDY WOODRUFF: But if you are not clear about it, when you go to the website and you start to put in information, that’s when you find out whether you are eligible.

JULIE ROVNER: That’s how it is supposed to work. And that’s been a lot of where the problem has been is trying to figure out exactly how big your subsidy is.

And there’s this data hub that you are supposed to put in your income and it’s supposed to go and look at your income from — through the IRS and figure out exactly what your subsidy is going to be and come back and tell you that. And then it’s supposed to show you these plans with your subsidy applied. So you are supposed to see how much it will cost you with that subsidy included.

JUDY WOODRUFF: So, when it works correctly — and I hear you saying it doesn’t always — it hasn’t always been working correctly — what is supposed to happen?

You go to the site or you’re on the phone, and what happens?

JULIE ROVNER: You go to the site or you’re on the phone. You’re supposed to qualify — you’re supposed to get qualified, basically, find out what kind of subsidy you are eligible for.

And then you go and choose a plan. And, basically that discount, it becomes a discount. And so you pay — as we just saw in the piece, the family is only going to pay the subsidized price. It’s not like you have to ask for the tax credit at tax time. That tax credit get applied on a month-to-month basis.

Then, at tax time, you reconcile. If you have underpaid, then you pay a little more. If you have overpaid, then you get a little bit of money back.

JUDY WOODRUFF: So, that was my question. This was in the form of — it’s not just that you pay a lower premium. It’s that this literally comes off your tax — your income taxes, right?

JULIE ROVNER: That’s right. It’s a tax credit. That’s essentially — but it is what we call an advanceable, refundable tax credit, so it gets applied to your monthly premium.

But then, when you file your taxes, you basically have to make sure that you got the right amount, based on your income.

JUDY WOODRUFF: And, again, it’s not this year, 2013. It will start to take effect in 2014, when they would start to pay the premium.

JULIE ROVNER: That’s right. And you would basically — so you will file it in April of 2015, when do your 2014 taxes.

JUDY WOODRUFF: So, as people have tried to sign on, what kinds of things have they run into as they have tried to apply for this?

JULIE ROVNER: Well, a lot of people have had trouble basically getting, you know, this estimate of what their subsidy will be.

That was the biggest difficult for a lot of people was finding out what that subsidy is. It’s also the biggest difficulty in people outside trying to sign up. A lot of outside groups, the insurance companies, some outside private exchanges like eHealthInsurance, have wanted to sign up what they call the subsidy-eligible people. And there are a lot of them.

And they haven’t been able to because the federal government hasn’t been able to find a way to take these people, find out what their — determine their subsidy and let them then go back to these outside places and sign up for these health insurance plans.

So they have been basically stuck in the federal website that doesn’t work that well.

JUDY WOODRUFF: And remind us, why did the Obama administration feel the need to do these subsidies in the first place?

JULIE ROVNER: Well, basically, the basic part of this was that the individual health insurance system didn’t work. It kept a lot of people with preexisting health conditions out.

So the first thing was to let everybody who wanted insurance to get in. But, of course, if you have sick people in this pool, now you want to have a lot more healthy people in the pool. In order to get healthy people in the pool, you basically had to require a lot of people in the pool. If you are going to require people in there, what were you going to do about people who couldn’t afford it?

Well, you were going to have to give them help. That is what the subsidies are for. They are to get people in who otherwise couldn’t afford it.

JUDY WOODRUFF: And do we know, just quickly, Julie, what percentage or how many people they believe are eligible for these subsidies?

JULIE ROVNER: Well, the estimates vary, but the Congressional Budget Office and others have estimated that somewhere between 18 and 20 million people total — this is over the next several years — will be eligible for some sort of financial help inside the exchanges.

JUDY WOODRUFF: And, just finally, broaden it out to the overall problems the administration has been having. They have been giving daily updates, reports on how it’s going. What — what are they saying right now?

JULIE ROVNER: Well, they keep saying it’s getting better, that the error rates are going down, that people are getting on faster, that they’re having an easier time, for instance, determining what kind of subsidy they’re eligible for.

They’re still working what they say on the back end of the exchange, which is getting people actually enrolled in plans and getting that information to the insurance plans. They still say they’re aiming to have this all working well at the end of the month. But they do keep redefining what working well at the end of the month actually means.

There’s going to be a big crunch because there’s a lot of people who are going to want to sign up, as they have been waiting for the end of the month, by December 15, the date you need to be signed up in order to have coverage start January 1.

JUDY WOODRUFF: Starting January 1. And that is just days away.

JULIE ROVNER: It certainly will be by the end of the month.


JUDY WOODRUFF: Julie Rovner of NPR, thank you.

JULIE ROVNER: You’re welcome.