Jon Walker reported this week that Governor Dennis Daugaard's ideological stinginess will squeeze many low-income South Dakotans out of the health insurance subsidies available under the Affordable Care Act.
Here's some small comfort for near-poverty workers laboring in the Daugaard-Medicaid gap: they at least won't be harassed by the IRS for not buying insurance. In June, the U.S. Department of Health and Human Services issued its final rule on exemptions from the individual insurance mandate. The PPACA thus has hardship exemptions for folks who really can't afford to buy health insurance. Hardship conditions include homelessness, eviction, utility shut-off, domestic violence, death in the family, fire or natural disaster, bankruptcy, huge uninsured medical bills, unexpected home care cost increases, and having a Republican governor who's playing politics with your family's physical and financial health.
The PPACA exempts several other groups from the insurance mandate, although Indians, devout theists, and others are still welcome to buy insurance on the exchanges:
- Individuals who cannot afford coverage;
- Individuals with household income below the filing threshold;
- Members of federally recognized Indian tribes;
- Individuals who experience a hardship;
- Individuals who experience a short coverage gap;
- Members of certain religious sects [though I'm telling you, praying for divine intervention is not as reliable as a good insurance policy];
- Members of a health care sharing ministry;
- Incarcerated individuals; and
- Individuals who are not lawfully present [a.k.a. illegal immigrants—fire away, Stace and friends!].
[Centers for Medicare and Medicaid Services, press release, 2013.06.26]
Contrary to popular Republican smokescreen point, members of Congress are not exempt. Actually, members of Congress and their staff are the only Americans required to buy their insurance on the PPACA exchanges. The only "exemption" is that their employer, Uncle Sam, can contribute toward their coverage on the exchange, just as the federal government will continue to contribute toward health premiums for all other federal employees.
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As the Affordable Care Act enhances the health and economic liberty of millions of Americans while protecting the working poor from undue burden, it also sends more federal dollars to South Dakota. We are receiving $1.2 million in federal grants to help South Dakota's tens of thousands of uninsured folks (not to mention thousands more like my family who will find the exchange a better deal than their current coverage) understand and sign up for the insurance exchanges. Local groups like Falls Community Health Center in Sioux Falls and Inter-Lakes Community Action Partnership in Madison will use those dollars to hire staff, pay for more work hours, and buy advertising and services that will help their neighbors and ancillarially juice the local economy.
Rep. Kristi Noem should love that.