<p>Tpg, these ins and outs are why you need local expert advice. All of our info is being found piecemeal and needs to be pulled together for your situation and for Texas, itself. Sounds like you have at least 5 issues going: SHOP, individual, lawful, possibly some unlawful family members, children- and add business practices. And accounting principles. Those covers ACA, immigration, and DoL. And IRS or Treasury definitions or expectations.</p>
<p>I think if only 2 of 4 adults are eligible, it may be the same as not covering an adult child who is self-supporting, has insurance. <em>Someone else will need to confirm.</em> In that case, I don’t think they are counted or any income included.</p>
<p>Then I see this:
ACA specifies that premium credits will be available to “applicable taxpayers” in a “coverage
month” beginning in 2014.14
An applicable taxpayer is an individual who
• is part of a tax-filing unit;
• is enrolled in an exchange plan; and
• has household income (defined as MAGI) between 100% and 400% of the federal
poverty level (with exception). 15
Footnote 15: An exception is made for lawfully present aliens with income below 100% FPL, who are ineligible for Medicaid. The income of these taxpayers will be considered to be exactly 100% FPL for premium credit purposes.</p>
<p>Even if we find something that sounds right, you will still need to confirm in Texas and for your assortment of issues. Maybe call the Natl Imm law Ctr or something like that in Texas. ACA is a big enough issue that immigrant advocates are on the alert. Good luck.</p>
<p>And unlawful status is supposed to be protected from being shared or accessed by immigration folks. Wish I had that quote for you.</p>
<p>OK, I’ll review the bidding to clarify things for myself:</p>
<p>Texaspg’s nonprofit wants to ensure that its employees, who are low income, have insurance coverage. Among the choices were these:</p>
<p>A) Go to the SHOP exchange. Get insurance. Get the subsidies, because small employers of low-wage employees can get subsidies for buying insurance.</p>
<p>B) Instead of buying insurance, give everyone a raise. The employees can go to the exchange, and buy insurance. They are all low-wage employees so they will be eligible for big subsidies. </p>
<hr>
<p>Texaspg is looking at choosing B, because both employer and employees will be better off.</p>
<p>The SHOP subsidies are supposed to be for small low-wage employers, and yet in this case, it turns out that the employer is better off letting employees go to the exchange. Under what conditions would an employer be better off with SHOP subsidies, assuming that the employer wanted their employees to have coverage?</p>
<p>The primary issues with SHOP that I see for us.</p>
<ol>
<li> Need to actually file a return to collect the money back which means we have to spend it first and wait a whole year;</li>
<li> The budgets belong to each board and we have fixed terms (we need the money during the year)</li>
<li> SHOP subsidy is only for two years at which point we have to move everyone out.<br></li>
</ol>
<p>So, I just gave my neighbor a ride to work at a high-end retail store and quizzed her to kill time. </p>
<p>There are about 15 employees including delivery people. She works in the office but is on Medicaid and has been since having her first child a few years ago. Husband works, but they are under the poverty line although they have 2 kids, 2 cars (one broken) and live in a vey nice house and are not hungry. Anyway, the boss has an HSA for some employees, but not all. Service people are part-time although they often do hit 40 hours. One older employee just went on Medicare and the boss is paying for that instead of paying for his previous HSA plan. It’s cheaper. Bosses wife and D are in the plan and labeled employees but the last thing the wife did was choose paint colors last year. Not sure about D, but she is in school 100 miles away and no-one has seen her recently. One weekend she was answering phones. The plan includes about 6 people and neighbor could have been included but she does better with Medicaid and it’s not a very good plan, apparently. He also charges them for it. </p>
<p>So, how can this be happening? From what I’m reading here it should be illegal although this particular boss is no dummy and has tax guys and accountants and has been running this place successfully for over 20 years. </p>
<p>I see. One problem then is that you have no revenues that these insurance premium expenses are offsetting. </p>
<p>But a for-profit business which bought on the exchange would not face that particular problem. They file quarterly tax payments, which would reflect the tax credits, so there wouldn’t be the issue of waiting all year to see the money.</p>
Honestly, given the two-year sunset of the SHOP tax credits, IMHO, the answer is NONE
Believe me, I stood on my head to figure out the best way for our tiny group. My agent said I had it exactly right. Now, if the NETWORK is narrower that my former employee group insurance, perhaps we will find we miss group.</p>
<p>For my H and I, who are not eligible for subsidy, we did have a slightly higher deductible per person (went from $1,000 to $1,400…but our premiums went from I think $1122 to $969 BUT the $1122 had also covered son, so it was a wash ). But we were also able to open an HSA to offset that and OOP max. Of course, drug costs are now included in meeting the deductible, whereas before it was always only a copay. Hospital copay has hiked to $250 from $100. We chose a PPO which all our practitioners seem to belong to (time will tell if there’s a billing issue or not). </p>
<p>Not “paying taxes” but how IRS and Treasury define some terms and cover some circumstances that provide a piece of the puzzle. </p>
<p><a href=“http://www.zanebenefits.com/resources/defined-contribution-health-plan”>http://www.zanebenefits.com/resources/defined-contribution-health-plan</a>
Apparently you can reimburse but this page describes the considerations. And: “Employers must limit their role to simply verifying that a qualified medical expense (such as an individual health insurance premium) was incurred, and then reimbursing such amount from the defined contribution.” That phrase, “such amount,” seems to imply you could set a max, then reimburse lower amounts, if that’s what is needed. I don’t know. That’s what I would look into next. </p>
<p>Each time, I was looking for something specific- if it were me, I might dig into whether a Defined Contribution Plan is efficient for this case.</p>
<p>Zane is informative. Afaiac.</p>
<p>Texaspg, we owe you for putting up with this thread. Glad it helped, but it still needs to be confirmed and to see if any other things take precedence, supersede or whatever (you know, same old as in life, taxes, finaid and all the other headaches.) This link includes a link to Texas- but from a quick glance, it looked pretty much the same. The other thing everyone says is see if your state has any special programs or provisions that fit unusual situations.</p>
Noncitizens who are ineligible for Medicaid because of their immigration status are subsidy-eligible even if their income is below poverty level. Their subsidy is calculated as if they were at exactly 100% of the FPL. There is a specific provision written into the law to allow this. </p>
<p>So in that sense, your visa-holding employees may be better off than a low-paid citizen employee – as the citizen might be denied a subsidy on the exchange because income is too low. </p>
I think the SHOP subsidies are intended to help small employers, but not necessarily low-wage employers Low-wage employees are going to be better off on the exchange for a number of reasons – not just because of the subsidies, but because that gives them a plan that they can keep if they like – and increases their options to seek other employment. </p>
<p>That in turn puts the employees in a better bargaining position with the non-subsidizing employer, who may have to raise their wages in order to keep them. If employer #1 is paying $9 an hour and no health benefit – and employer #2 pays $11 an hour, also no health benefit – it’s pretty much a no brainer to switch jobs. So employer #1 will have to raise wages to keep those employees. </p>
<p>Which goes back to the question of how does the small employer benefit by paying health insurance – they benefit if (and only if) their practices enable them to retain valuable employees. If they hire largely low skill workers, that might not matter. </p>
<p>So SHOP will probably benefit small employers who hire skilled workers and pay at least moderate wages to their workers. The ones who have a hard time replacing the $30K earner who may start looking elsewhere for employment.</p>
<p>As earnings rise and subsidy levels go down, employees are more likely to seek out employers that provide health insurance benefits. </p>
<p>“As a general surgeon with more than three decades in private clinical practice, I can safely say that Obamacare is the culmination of the changes that I’ve seen in the way doctors practice medicine.”</p>
<p>“This means less doctor choice for patients. Once free to be creative and innovative in their own practices, doctors are becoming more like assembly line workers, constrained by rules and regulations.”</p>
<p>A very sobering perspective by this surgeon on Obamacare.</p>
<p>"“Enrollment of new Medicaid beneficiaries continues in both expansion and non-expansion states,” said Jenna Stento, senior manager at Avalere Health. “Medicaid applications have increased 27 percent on average from October to January compared to application rates before ACA. Application rates in expansion states increased 41 percent over the same period.”</p>
<p>"A weeklong campaign to enroll thousands of community college students into health plans launched in Los Angeles on Monday to encourage young adults to sign up for Obamacare before March 31, or else face penalties under the federal law.</p>
<p>At least 50 percent of the 150,000 students who attend classes at the nine-campus Los Angeles Community College District are uninsured and would likely qualify for Medi-Cal or a lower tiered health plan, said Mike Eng, a member of the Los Angeles Community College District Board of Trustees."</p>
<p>I am a bit lost on the above quotes. I suspect they are wrong but I didn’t bother reading the law like some here did. :p</p>
<ol>
<li><p>Is there no income limit before “penalties” or fines kick in?</p></li>
<li><p>If someone is eligible for Medi-Cal, don’t they get to enroll anytime they please without the March 31st deadline?</p></li>
</ol>
<p>The person has to earn enough to be required to file taxes. If there is no tax return, there is no mechanism for the penalty to be assessed. </p>
<p>
</p>
<p>Yes, but it better to make that determination while they still have the option of going to the exchange, if their income is too high for Medi-Cal.</p>
<p>Students who expect to complete college this year or attend school part-time could potentially face penalties for being uninsured as a result of income earned later this year – so they could face penalties for not being insured for at least 9 months in 2014. </p>
Glad it helped, but it still needs to be confirmed and to see if any other things take precedence, supersede or whatever (you know, same old as in life, taxes, finaid and all the other headaches.) This link includes a link to Texas- but from a quick glance, it looked pretty much the same. The other thing everyone says is see if your state has any special programs or provisions that fit unusual situations.</p>