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        奧巴馬醫(yī)改對(duì)婚姻的隱性懲罰
        The hidden marriage penalty in Obamacare

        [ 2013-11-11 13:40] 來源:中國日?qǐng)?bào)網(wǎng)     字號(hào) [] [] []  
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        奧巴馬醫(yī)改對(duì)婚姻的隱性懲罰

        查看原文

        Childless couples and empty nesters pay more. Much more.

        The first time I heard Nona Willis Aronowitz talk about getting divorced to save money on health insurance I thought she couldn't really be serious. We were at Monte's, an old Italian place in South Brooklyn, having dinner with a group of New York women writers in late July.

        "Don't do it!" I urged her, certain, having watched my friends over the years, that no matter how casually she or her husband might treat the piece of paper that says they are married, getting unhitched would inevitably change their relationship as profoundly as getting hitched in the first place.

        But with the arrival of the Affordable Care Act's insurance exchanges, the question for Nona and her husband Aaron Cassara moved from the realm of casual conversation to a real financial conundrum. Aged 29 and 32, respectively, they were facing tough times for their professions, a wildly expensive city, and the scary prospect that both of them could shortly be uninsured. Right now Nona only has a COBRA plan—"which I can barely afford"—that ends January 1, she tells me. Her last staff job ended when the media outlet she was working for laid off its whole editorial team; she's been a full-time freelancer since. Aaron, a filmmaker who works part-time and also freelances, has been uninsured since her layoff, because it would be too expensive to have him on COBRA too.

        Any married couple that earns more than 400 percent of the federal poverty level—that is $62,040—for a family of two earns too much for subsidies under Obamacare. "If you're over 400 percent of poverty, you're never eligible for premium" support, explains Gary Claxton, director of the Health Care Marketplace Project at the Kaiser Family Foundation.

        But if that same couple lived together unmarried, they could earn up to $45,960 each—$91,920 total—and still be eligible for subsidies through the exchanges in New York state, where insurance is comparatively expensive and the state exchange was set up in such a way as to not provide lower rates for younger people. (Subsidy eligibility is calculated using a complicated formula involving income in relation to the poverty line, family size, and the price of plans offered through a state's marketplace.)

        Nona and Aaron's 2012 income was higher than the 400 percent mark, but not by much. In New York City, that still doesn't take you very far for two people. If their most recent months of income are in the same range, they will get no help at all with buying insurance through the exchanges if and when they apply, according to the Kaiser Family Foundation and eHealth subsidy calculators. Premiums for the two for silver-level plans came in at $9,248 for the year.

        But if they applied as unmarried individuals with something like their 2012 income, one of them would get at least $3,964 in subsidies toward the purchase of a plan, or possibly even be eligible for Medicaid, thanks to their uneven individual earnings that year. And if they fall below the 400 percent threshold, which Nona says they might this year, they could get substantial subsidies as a couple that are still worth less than what they'd be eligible for as individuals. These gaps are the marriage penalty.

        Married people who are uninsured make up just a small fraction of the uninsured, for obvious reasons: It is easier to be insured if you have two potential pathways of getting there. Only 15.4 percent of married people were uninsured 2012, according to research from the Kaiser Family Foundation; the uninsurance rate for "single adults living together" was more than twice as high—33.4 percent.

        That may be one reason the Obamacare subsides are more generous to single people and one- or two-parent families with children in the house than to couples who lack children. They were designed to help single moms and struggling middle-class families with children, not married creative-class millennials in pricey cities who have not yet settled into well-paid work, or barring that, work for a single employer.

        Health insurance isn't the only place where there's a marriage penalty. The federal income tax also hits married couples with similar earnings harder than couples with one main breadwinner.

        "In the tax code, you have a different set of tax rates for married couples that mitigates the marriage penalty to some degree," says Robert Rector, a senior research fellow at the Heritage Foundation who has been writing about the marriage penalty in health reform since 2010. Under Obamacare, however, there are "dramatic" penalties that are "substantial—particularly with couples in the upper age range," he says.

        "What you are doing is saying ... you have to pay a penalty of multiple hundreds of dollars—a substantial portion of your income—to stay married," Rector says. "It's saying society is basically hostile to the institution of marriage."

        Experts on the impact of marriage penalties were skeptical that many couples would consider divorce over insurance rates. Still, there is some data to suggest that marriage penalties embedded in government programs can discourage marriage among those who are benefiting from programs that favor the unmarried.

        "The received wisdom in public finance is that marriage per se can be financially discouraged if both members of a couple have decent earnings potential and would face a higher combined tax rate as a married couple than as a pair of singletons," explains Gary Burtless, a senior fellow at the Brookings Institution. "At the lower end of the income scale, if the combined earnings potential of the couple is not very promising, marriage might prevent the mom and kids from receiving as much government assistance as they can receive if the adult couple remains unmarried."

        There's no data yet on the potential size of the population potentially affected by such concerns under the Affordable Care Act, but Medicaid and other means-tested programs "already created that kind of potential marriage penalty," he notes. At least half of the newly insured under ACA will be insured under Medicaid.

        The great irony, Nona explains, is "we wouldn't be married if it weren't for a situation that happened in 2009 where he needed health insurance."

        Despite its administrative beginnings, their City Hall marriage has lasted so far. Aaron was on Nona's insurance at first; later, when their job arrangements changed, she was on his. Now Nona is looking to land a full-time staff job, in hopes of once again having an employer-based plan that Aaron, too, can join.

        "I guarantee you that in six months I will either be divorced or I will have a full-time job," she says.

        查看譯文

        無子女夫婦和空巢老人支付“罰款”更多,而且多得多。

        第一次聽到諾娜·威利斯·阿羅諾維茨談起要離婚來為健康險(xiǎn)存錢時(shí),我想她一定是在開玩笑。那時(shí)是六月下旬,我們正和一群紐約女作家在蒙特吃晚餐,那里位于南布魯克林區(qū)的一個(gè)意式地方。


        我當(dāng)然勸她千萬別這么做。這些年來我也曾目睹我的朋友們經(jīng)歷離婚。不管她或是她的丈夫覺得這張宣告他們結(jié)婚的紙張其實(shí)不重要,他們之間的關(guān)系都會(huì)隨著離婚而不可避免地產(chǎn)生很大變化,就像當(dāng)初他們結(jié)婚時(shí)一樣。


        然而隨著平價(jià)醫(yī)保法案保險(xiǎn)交易的實(shí)行,諾娜和她的丈夫亞倫·卡薩拉面臨的問題從休閑的談話境界轉(zhuǎn)移到一個(gè)真正的金融困境。他們今年分別是29歲和32歲,住在一個(gè)極度昂貴的城市又遇到了工作上的艱難時(shí)刻,更可怕的是他們的保險(xiǎn)即將到期。諾娜告訴我她現(xiàn)在只有一個(gè)到一月一號(hào)停止的統(tǒng)一預(yù)算協(xié)調(diào)法案規(guī)定的健康險(xiǎn),但她也幾乎無法負(fù)擔(dān)了。她的上一份員工工作結(jié)束了,因?yàn)槊襟w透露她在為一整支解雇了的編輯團(tuán)隊(duì)而工作。之后她就成了一名專職自由作家。亞倫是一名兼職電影制片人同時(shí)也是一位自由作家,自從妻子失業(yè)后,他就已經(jīng)不投保了,因?yàn)槟翘嘿F了。


        如果任何一個(gè)兩口之家的夫妻收入超過聯(lián)邦貧困線四倍即62040美元,根據(jù)奧巴馬醫(yī)改他們將得到很多補(bǔ)貼。凱薩家庭基金會(huì)的醫(yī)療保健市場(chǎng)項(xiàng)目負(fù)責(zé)人,加里·克拉克斯頓表示“如果你的收入在貧困線四倍以上,那么你就不符合高級(jí)支持的條件”。


        反之如果同樣的一對(duì)兒住在一起但不結(jié)婚,他們每人可以掙到45960美元,加起來也就是91920美元,但他們?nèi)匀挥匈Y格通過紐約州的保險(xiǎn)交易獲得補(bǔ)貼。要知道這里的保險(xiǎn)相對(duì)來說很昂貴,而且這個(gè)州的交易建立在不給年輕人提供更低利率的方式上。(補(bǔ)貼資格的計(jì)算用了一種很復(fù)雜的方法,涉及到收入水平與貧困線和家庭人數(shù)的比較,并且補(bǔ)貼通過這個(gè)州的市場(chǎng)發(fā)放。)


        諾娜和亞倫2012年的收入略高于四倍線。在紐約,這樣的收入水平仍然無法讓兩個(gè)人過得很好。根據(jù)凱薩家庭基金會(huì)和電子健康補(bǔ)貼的計(jì)算顯示,如果他們最近幾個(gè)月的收入在還同樣的范圍內(nèi),那對(duì)他們申請(qǐng)補(bǔ)貼毫無幫助。兩個(gè)人為白銀級(jí)別的保險(xiǎn)一年要支付9248美元。



        但如果他們以未婚的個(gè)人身份和一些別的條件類似于2012年收入來申請(qǐng)的話,一個(gè)人就能得到至少3964美元的購買保險(xiǎn)的補(bǔ)貼,或者甚至有可能有資格申請(qǐng)醫(yī)療補(bǔ)助,這都得歸功于這一年時(shí)好時(shí)壞的個(gè)人收入。若是他們的收入不足四倍線,諾娜說今年就有可能,那倆人能獲得大量的津貼,當(dāng)然作為個(gè)體申請(qǐng)依然比用夫妻身份申請(qǐng)得到補(bǔ)助的多。這些差距是對(duì)婚姻家庭的罰款。


        未投保的人中已婚的只占一小部分,理由顯而易見:如果你有兩條可行的路可走,投保會(huì)更容易。據(jù)凱薩家庭基金會(huì)的調(diào)查顯示,2012年已婚人士中只有15.4%未投保;“同居單身成年人”的未投保比例高達(dá)33.4%,是上一條的兩倍多。



        這可能是奧巴馬醫(yī)改補(bǔ)貼比起沒有孩子的家庭來說更有利于單親或雙親家庭的一個(gè)原因。醫(yī)改計(jì)劃的目標(biāo)人群有單親母親,有孩子且勉強(qiáng)維持生活的中產(chǎn)階級(jí)家庭,高消費(fèi)城市中未婚、沒有固定高薪工作或?yàn)閱我还椭鞴ぷ鞯膭?chuàng)意階層的千禧之子。



        不只是醫(yī)療保險(xiǎn)會(huì)讓婚姻家庭產(chǎn)生罰款,聯(lián)邦所得稅也會(huì)讓雙方收入均衡的已婚夫妻比只有一方養(yǎng)家的夫妻損失更多。


        美國傳統(tǒng)基金會(huì)資深研究員羅伯特·芮克特說:“在免稅代碼中,已婚夫妻有一套不同的稅率,這會(huì)使婚姻罰款減輕到一定程度。”從2010年以來,他就已經(jīng)開始寫有關(guān)于醫(yī)療改革中的婚姻罰款事由了。




        芮克特還表示,“你所做的事情表明你不得不支付一項(xiàng)數(shù)以千記美元的罰款來維持婚姻,這筆錢是你收入的很大一部分。也就是說社會(huì)根本就對(duì)婚姻制度懷有敵意”。



        研究婚姻罰款造成的影響方面的專家懷疑許多夫妻會(huì)考慮用離婚來改變保險(xiǎn)費(fèi)率。一些數(shù)據(jù)也表明這種政府項(xiàng)目所帶的婚姻罰款會(huì)鼓勵(lì)那些傾向不結(jié)婚又從這些項(xiàng)目中獲利的人們。



        布魯金斯協(xié)會(huì)的高級(jí)研究員加里?貝特里斯的解釋稱:“財(cái)政學(xué)中公認(rèn)的智慧是如果夫妻雙方有體面收入的潛力,則婚姻實(shí)質(zhì)上會(huì)使家庭財(cái)政狀況變壞,而且會(huì)讓他們面臨的綜合稅率比沒一對(duì)沒結(jié)婚的更高。在低收入群體中,如果夫妻的總收入前景不樂觀,婚姻或許會(huì)讓母子得到的政府補(bǔ)貼更少。”





        現(xiàn)在還沒有數(shù)據(jù)顯示平價(jià)醫(yī)療法案帶來的這種顧慮可能會(huì)影響的人口數(shù),但是加里指出醫(yī)療補(bǔ)助制度和其他發(fā)放救濟(jì)項(xiàng)目“已經(jīng)造成那種潛在的婚姻罰款”。至少一半新加入平價(jià)醫(yī)療保險(xiǎn)的人也會(huì)被納入醫(yī)療補(bǔ)助保險(xiǎn)中。



        諾娜說有巨大諷刺意味的是如果不是2009年時(shí)他正好需要健康險(xiǎn),他們就不會(huì)結(jié)婚了。


        盡管有個(gè)具有行政意味的開端,他們?cè)谑姓d辦理的婚姻依然持續(xù)到今日。亞倫一開始是在諾娜的保險(xiǎn)名下,后來,他們的工作安排改變了,情況又反過來了。現(xiàn)在諾娜正在找個(gè)全職的員工工作,希望能有個(gè)由雇主提供的醫(yī)療保險(xiǎn),那么亞倫也能加入了。

        她說:“我能向你保證,六個(gè)月內(nèi)我要么離婚,要么找個(gè)全職工作。”

        (譯者 Summer沒有星星 編輯 丹妮)

         
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