Tom Schrette and Alan Cash

Tom Schrette and Alan Cash

J.L. Sousa

Dear Tom and Alan:

I’m a regular working stiff with a health plan that is going up 32 percent at the beginning of 2017.

I don’t qualify for Medi-Cal or a tax break through Covered California, so it looks like I just take it.

Oh, and my boss doesn’t offer anything to the employees. My lousy health plan costs what I used to pay for rent!

If Trump repeals ‘Obamacare’, am I finally going to get some relief?


Tom: Hmmm, probably not.

The main thrust of the Affordable Care Act (ACA, ‘Obamacare’) was to expand Medicaid (Medi-Cal in California) and set up Exchanges in states to enroll people into health plans and, often, give them a monthly subsidy to pay their premiums.

As agents, we cannot enroll people into Medi-Cal, so we have to get certified each year to sign up enrollees for Covered California.

The rest of our business is for plans outside the Exchange. Many don’t realize that the plans are identical in or out of the Covered California Exchange. It’s all Bronze, Silver, Gold, or Platinum.

By the way, a Kaiser Family Foundation report says that 1.2 million people in California are receiving an average of $309 per month in federal subsidies.

Al: To me, the most startling result of the ACA is the expansion of Medicaid.

In the California Healthline of Nov. 23, Anna Gorman wrote:

“California grabbed the first opportunity to expand Medicaid and ran with it…”

“Thanks in part to billions of dollars in federal funding, a third of California’s residents…are insured by Medi-Cal, the state’s version of Medicaid.”

Tom: Eligibility for Medi-Cal has also expanded.

For up to 138 percent of the federal poverty level, an individual can qualify for Medi-Cal with an income below $16,243.

A family of four can earn up to $33,466 and qualify for benefits.

A surprising wrinkle for us in the recent past was when a husband and wife could get a health plan through Covered California, but their children were placed on Medi-Cal.

Al: For those like our reader, Swamped, who is not eligible for Medi-Cal or subsidies, it is advisable to have some health insurance because of the penalties built into the ACA.

The first year was only $95 if you weren’t covered. In 2016, it got a little more serious: the penalty was either 2.5 percent of the household adjusted gross income, or $695 per adult and $347.50 per child up to a maximum of $2,085.

For 2017 and beyond, the percentage will stay 2.5 percent, but the flat fee will be adjusted for inflation.

If you go for more than three full consecutive months without insurance, you owe a tax penalty for that year.

Again, for those who need to get cracking on this, the final day to apply is Jan. 31.

Submit questions or reach the Health Insurance Guys at Schrette Insurance, 1556 First St., Suite 105, Napa, 94559; 255-9511;; or