The goal of the Affordable Care Act was to help several large classes of people who had been excluded from the insurance market because of rising prices and previous insurance practices. Those consisted mainly of people who could not afford to pay for insurance, and people who could not buy insurance at any price because of present or past health problems.
But most Americans already had insurance. According to a recent NBC News report, 32 percent of Americans get government-sponsored insurance such as Medicare or Medicaid. Among those too young for Medicare, 58 percent get health insurance through an employer.
Employer-provided insurance typically offers more choices and better coverage options than policies available on the individual market. The ACA was never intended to disrupt or undermine that market, so the ACA specifically excludes individuals who are eligible for employer-provided insurance from subsidy eligibility.
There is one exception: if the cost to the employee of the employer-provided subsidy is more than 9.5% of the employee’s income, then that person can shop on the exchange instead and receive a subsidy if the income is low enough. Continue reading