At first, Prins was pleased at the prospect of free coverage.
But the more she thought about the fine print, the more upset she got. Why was this provision only for people age 55 and older? Why should those insured by Medicaid have to pay back health expenses from their estates when people with just a bit more income who get federal subsidies don’t? Why didn’t she and Balhorn know about this before getting to the application stage?
As Prins began searching for answers, she found that even those trained to help people sign up for insurance under the ACA weren’t aware of this provision, nor were some government officials.
Around the country, the issue has sizzled away in blogs and commentaries from both right and left. The National Women’s Law Center noted the ACA and its regulations prohibit age discrimination in programs such as Medicare and Medicaid.
Dr. Jane Orient, executive director of the politically conservative Association of American Physicians and Surgeons, writing in The Washington Times, called the recovery provision “a cash cow for states to milk the poor and the middle class.”
“People will think this is wonderful, this is free insurance,” Orient said in an interview. “They don’t realize it’s really a loan, and is secured by any property they have.”
Even states that are now limiting estate recovery, she warned, can change the rules again if budget problems become more intense.
One reason this snafu has become so troublesome is that ACA rules appear to give those who qualify for Medicaid little choice but to accept the coverage.
People cannot receive a tax credit to subsidize their purchase of a private health plan if their income qualifies them for Medicaid, said Bethany Frey, spokeswoman for the Washington Health Benefit Exchange.