MONEY Health Care

Americans with Obamacare Are Still Afraid of Big Medical Bills

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Walker and Walker—Getty Images

A new survey finds most Americans are satisfied with their Obamacare plans, but they're still worried about one thing.

Americans gave Obamacare plans high marks in a survey out today from the Kaiser Family Foundation. Three-quarters of those enrolled in health plans through the marketplace say they’re satisfied with the choice of primary care doctors, 73% express satisfaction with their doctor’s visit copays, and 65% say they’re satisfied with their premiums. Overall, 40% say they’ve mostly benefitted from the Affordable Care Act, while only a third say they’ve mostly been negatively affected.

But there’s one nagging problem. Even though Americans are generally happy with Obamacare plans, a large minority—38% of marketplace enrollees—say they still “feel vulnerable to high medical bills.” (A similar proportion of people in non-Obamacare plans agree.)

Most alarmingly, Americans enrolled in plans that meet ACA requirements are more likely to struggle with medical bills than Americans enrolled in plans that do not meet ACA requirements. Americans in ACA-compliant plans are also more likely to report skipping care because of cost. Even though the Affordable Care Act outlawed annual and lifetime coverage maximums—the health insurance provisions that saddled the insured with hundreds of thousands of dollars in medical debt and doomed the sick to bankruptcy—more than half of Americans enrolled in ACA-compliant plans say they’re worried they won’t be able to afford the health care services they’ll need in the future.

One culprit may be high deductibles. In a previous survey, the Kaiser Family Foundation found that Obamacare silver plan enrollees have an average $3,453 deductible, meaning they need to pay more than $3,000 out-of-pocket before insurance would cover part of the cost. On average, Americans enrolled in bronze plans need to pay more than $5,372 out-of-pocket before insurance kicks in.

Unsurprisingly, people with high-deductible plans, whether ACA-compliant or not, feel more financially vulnerable. Only 7% of Americans on high-deductible plans say their health insurance is an “excellent” value for the cost, compared with 19% of Americans on lower deductible plans. And fewer than a third of Americans on high-deductible plans say they could pay a $1,500 medical bill without borrowing money—which is a problem, because a $1,500 bill is a real possibility with a $3,000-plus deductible.

How to save on medical care:

MONEY Health Care

Now You Can Really Get Free Birth Control Under Obamacare

assortment of birth control pills
Ted Morrison—Getty Images

The Obama administration just tightened the law that says insurance companies must cover all types of contraceptives.

Following recent reports that many women still pay for birth control methods that should be covered by insurers under the Affordable Care Act, the government just released a new document clarifying and tightening the law.

“Insurance companies have been breaking the law and today the Obama administration underscored that it will not tolerate these violations,” Gretchen Borchelt, National Women’s Law Center vice president for health and reproductive rights, said in a statement. “It is past time for insurers to adhere to the law and stop telling women that their chosen method isn’t covered or that they must pay for it.”

Whereas previous government FAQs about Obamacare were not as clear about the types of birth control covered under the law, the new guidance includes an explicit list—printed below—of all the contraceptive methods insurers must cover.

Until now many women, including one MONEY staffer, have found that insurers have been able to skirt the law by lumping together certain categories of contraceptives and charging expensive co-pays on all but a small number of methods. Since the previous language was vague, insurance companies have been able to deny coverage of brand name contraceptives—even when an equivalent generic is not available.

In particular, the new rules are especially good news for those who use IUDs, patches, and vaginal rings, since those are the birth control methods that women have had the most trouble getting covered, according to a recent study by the NWLC.

If your insurer is still making you pay out of pocket for your preferred method of birth control—and a generic substitute is not available to or appropriate for you because of, say, side effects—you should fight back by first talking to your doctor, who could advocate for you to your insurer.

This should be especially effective since the rules make it clear that doctors get the final say over whether a particular birth control method is medically necessary.

According to the new statement: “If an individual’s attending provider recommends a particular service or FDA-approved item based on … medical necessity … the plan or issuer must cover that service or item without cost sharing. The plan or issuer must defer to the determination of the attending provider. Medical necessity may include considerations such as severity of side effects, differences in permanence and reversibility of contraceptives, and ability to adhere to the appropriate use of the item or service.”

If that doesn’t work, consider resources like the National Women’s Law Center: Its website has templates for appeal letters and a free hotline (866-745-5487) you can use to get further help.

Here is the list of contraceptive methods that are now fully covered. Insurers must cover at least one type of birth control in each of these 18 categories:

(1) sterilization surgery for women
(2) surgical sterilization implant for women
(3) implantable rod
(4) IUD copper
(5) IUD with progestin
(6) shot/injection
(7) oral contraceptives (combined pill)
(8) oral contraceptives (progestin only)
(9) oral contraceptives extended/continuous use
(10) patch
(11) vaginal contraceptive ring
(12) diaphragm
(13) sponge
(14) cervical cap
(15) female condom
(16) spermicide
(17) emergency contraception (Plan B/Plan B One Step/Next Choice)
(18) emergency contraception (Ella)

The new government statement also clarifies that insurers must cover preventive services for transgender people when such services are medically appropriate, anesthesia services during preventive colonoscopies, and preventive screening for mutations in the BRCA-1 or BRCA-2 gene.

TIME Innovation

The Epic Scale of Lobbying Cash

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

These are today's best ideas

1. Corporations now spend more lobbying Congress than taxpayers spend funding Congress.

By Ezra Klein in Vox

2. Customer satisfaction and quality health care aren’t the same.

By Alexandra Robbins in the Atlantic

3. Here’s how manufacturers can cut costs and carbon emissions.

By Ken Silverstein in Forbes

4. Why is the U.S. condemned to have second-rate train service?

By Simon van Zuylen-Wood in National Journal

5. Scientists want to use lasers to shoot down space junk.

By Marissa Fessenden at Smithsonian magazine

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

MONEY Health Care

You May Still Have Time To Avoid the Health Law’s Tax Penalties

The tax-filing deadline may have passed, but it's not necessarily too late to get around the penalty for going without health insurance last year.

Even though the April 15 tax filing deadline has passed, you might be eligible for some health law-related changes that may save you money down the road.

•If you owed a penalty for not having health insurance last year and didn’t buy a plan for 2015, you may still be able to sign up for a marketplace plan, even though the open enrollment period ended Feb. 15. Many people who didn’t have insurance and didn’t realize that coverage is required under the law are eligible for a special enrollment period to buy a plan by April 30. If you sign up now, you’ll have coverage and avoid the 2015 penalty, which will be the greater of $325 or 2% of your household income.

•If you paid the penalty for not having insurance for some or all of last year and didn’t carefully check to see if you might have qualified for an exemption, it’s not too late. You can still apply for an exemption from the requirement by amending your 2014 tax return. It’s worth looking into since the list of exemptions is a long one. For example, if your 2014 income is below the filing threshold of $10,150—or $20,300 for a married couple—you don’t owe a penalty for not having coverage. Likewise if insurance would cost more than 8% of your income or if you’ve suffered financial hardships like eviction or bankruptcy.

•In February, the Centers for Medicare & Medicaid Services announced that 800,000 tax filers who received a federal subsidy to help pay their insurance premium and used the federal health insurance marketplace received incorrect 1095-A tax forms. These forms reported details about the advance premium tax credit amounts that were paid to insurers based on the consumers’ estimates of income. They were then used to reconcile those payments against how much consumers should have received.

If you filed your taxes based on information that was incorrectly reported by the government on the form, you generally don’t have to file an amended tax return even IF you would owe more tax. But you may want to at least recalculate your return, says Tara Straw, a health policy analyst at the Center on Budget and Policy Priorities.

“You have the option to amend if it helps you,” she says. Unfortunately, the only way to figure that out may be to do the math on the tax form 8962 that you use to reconcile your income.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

MONEY Health Care

Why Young Millennials Are Turning Down Health Coverage at Work

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Getty Images—Getty Images I don't need health insurance, boss. I've got my mom's plan.

Thanks to Obamacare, they can probably get cheaper health insurance from mom and dad.

New college grads want a job, but they can take or leave the health insurance benefits that come with it. Less than half of all eligible employees under age 26 enrolled in an employer-provided health plan in 2015, according to a new report out today from the ADP Research Institute.

But don’t worry about the rest. Under the Affordable Care Act, young adults are allowed to stay on their parents’ health insurance plan until they turn 26. And that’s probably what many are doing, says Chris Ryan, vice president of strategic advisory services at ADP. “There are lot of people who do value health coverage very much, but they want to stay on their parents’ plan as long as possible,” Ryan says.

Why Young Workers Have More Options

The provision that lets young adults keep their parents’ health insurance until age 26 has been one of the most popular parts of Obamacare. It was also one of the first provisions to go into effect. Between September 2010 and December 2011, more than 3 million adults aged 19 to 25 got private health insurance largely thanks to the ACA, according to the Department of Health and Human Services.

A lot has changed since 2011. More millennials have entered the workforce, and a greater number have become eligible for health benefits. Today, 83% of employees under 26 are eligible for health insurance at work, up 8.5% from five years ago. Still, fewer millennials have actually enrolled in their employers’ plans. In 2011, almost 57% of young millennials who were eligible for employer-subsidized health coverage took it; this year, only 44% did.

One sign that many of these young adults are ditching their employer’s plans for their family’s plan: Once employees are too old to stay their parents’ plans, they’re much more likely to sign up for employer coverage. Three-quarters of eligible employees aged 26 to 39 enrolled in an employer health plan, the survey found.

Happily, after widespread concerns that young people would not sign up for health insurance, the vast majority are now covered one way or another. Nationally, 83.2% of Americans aged 18 to 25 now have health insurance, up from 76.5% in the last quarter of 2014, according to a recent Gallup poll. Today, there are 4.5 million more insured young adults who would not otherwise had coverage, according to the White House.

When Mom and Dad’s Plan Has the Edge

For millennials just starting out, however, health insurance premiums can still eat up a large part of their meager incomes. ADP found that employees earning $15,000 to $20,000 spent 9.5% of their annual income on premiums. Employees earning $45,000 to $50,000 devoted 5.8% of their income to premiums, while employees earning more than $120,000 spent just 2.3% of their income on premiums.

So even if young millennials have jobs with health benefits, the family plan is often the better deal. “Most millennials in their early 20s have entry-level salaries, so it’s attractive for our generation to get on a parent’s comprehensive plan for health and financial security,” writes Erin Hemlin, health care campaign director of Young Invincibles, a millennial research and advocacy group.

ADP found that individual premiums cost $486 a month, on average. But add two or more dependents to the plan, and premiums cost an average of $1,377 a month—which, split three or four ways, is less than an individual plan.

“There’s no question—it is usually cheaper for someone to be an additional dependent rather than pay for single coverage,” Ryan says. And then there are the tax benefits. “Because the premiums are on a pre-tax basis and parents are usually in a higher income bracket than their children, the parents are getting a better tax break, and the insurance overall is cheaper,” Ryan says.

Still, there are downsides to staying on a parent’s plan. If you don’t live near your parents, make sure you can find local doctors that are in your parents’ insurance network before you turn down health benefits at work. And consider if you want your bills and explanation of benefit statements mailed to your parents. Not sure what to do? Here’s more on how to decide— or shop for an individual plan on your own if you’re not getting coverage at work.

TIME Chris Christie

How Obamacare Makes Chris Christie’s Medicare Plan Possible

Chris Christie
Mel Evans—AP In this April 8, 2015 file photo, New Jersey Gov. Chris Christie addresses a gathering as he announces a $202 million flood control project for Union Beach, N.J.

New Jersey Gov. Chris Christie would like to raise the age to qualify for Medicare, part of a bold plan to reform entitlements that he released Tuesday morning.

The proposal was greeted with cheers from many conservatives, but there’s a twist. The main reason that slowly raising the retirement age from 65 to 69 is politically feasible is a law that many conservatives hate: Obamacare.

That’s because working-class Americans who lose health insurance at work when they retire at, say, age 65, would instead be eligible to receive modest subsidies on insurance exchanges set up by the Affordable Care Act. (Very low-income seniors could also sign up for Medicaid in some states or receive larger subsidies for coverage on the exchanges.)

“Obamacare soaks up the people who would otherwise be displaced by raising the eligibility age for Medicare,” said Avik Roy, a prominent Republican expert in health care policy who has argued that conservatives should use Obamacare to promote their own policies rather than repeal the law. “In the old days, if you raised the eligibility age for Medicare, then someone who is low-income at 65, but not eligible for Medicaid, are stuck in this gap, so what do you do?”

“But with [Obamacare], that safety net is there, so it’s much easier to raise the Medicare age,” added Roy.

But if retirees who, at 65, would have qualified for Medicare, which is relatively cheap, shift en masse to private insurance, which is relatively expensive, does Christie’s plan of raising the eligibility age actually save any money?

That answer has been hotly debated for years, since the cost of providing health care to 65-69 year-olds wouldn’t just disappear, it would shift to another part of the federal budget.

Some argue that it would save money, since the subsidies under the Affordable Care Act get smaller as seniors’ income rises, while Medicare serves seniors of all incomes the same.

“In general, raising the eligibility age for Medicare will save money for the federal government because seniors with relatively higher incomes wouldn’t be eligible for any other federal subsidies,” said Michael E. Chernew, a professor of health care policy at Harvard Medical School. “That’s the simple analysis.”

A 2011 Kaiser Family Foundation study estimated that raising the eligibility age for Medicare from 65 to 67 would save the federal government as much as $5.7 billion in the short term. But it could also cost 65- and 66-year-olds $3.7 billion in out-of-pocket expenses, and employers $4.5 billion in retiree health-care costs. (And that’s to say nothing of how the policy could negatively affect the cost of Medicaid and Medicare Part B premiums, according to the Kaiser study.)

Chernew added that raising the Medicare age comes with other, more complex ramifications, including the type and quality of care available, and whether such a policy would encourage more older Americans to remain in the workforce for longer. Another part of Christie’s plan directly incentivizes Americans to keep working past the age of 65 by eliminating the payroll tax for workers 62 and older.

But the broader question is whether conservatives want to make use of the Affordable Care Act to make their own changes to the health care system or whether they want to repeal the law and start from scratch.

Roy, who has advocated for “transcending Obamacare,” argues that that Christie’s policy proposal is a smart political play. “He’s staking out ground as a credible, bipartisan entitlement reformer,” he said.

MONEY Taxes

Last-Minute Tax Filers: Beware of This Obamacare Scam

pill bottles with money in them
Adrianna Williams—Getty Images

If you don’t have health coverage, you pay a penalty to the government. And scammers are ready to take advantage of that.

For all stripe of rip-off artist, tax season might as well be called open season. Scams are legion, and navigating a solution after the fact can be somewhere between maddening and negotiating an Iran deal that everyone likes. Last month the IRS issued a warning that received scant attention from the media, but nonetheless could impact millions of taxpayers this year — particularly targeting low-income, elderly and Spanish-speaking taxpayers.

The scam takes advantage of the Individual Shared Responsibility Provision of the Affordable Care Act. It’s a penalty, but one with many exemptions. Because it is somewhat complicated, the new provision has become the object of many fraudsters’ affections, especially during tax season.

This is the first year that taxpayers must confront this new liability. In the simplest of terms, if you don’t have health coverage, you pay a penalty to the government.

The provision is intended to induce people to get coverage, since individual shared responsibility is all about increasing the number of Americans enrolled in health insurance plans in order to enlarge the pool to spread risks and reduce costs. Regardless of what you think of that theory, that’s the informing principle.

So what is the penalty? While at first blush it doesn’t sound like a huge amount of money, it’s not nothing either — especially to a family who is forced to live paycheck to paycheck. It can be 1% of a family’s annual income (minus the tax return filing threshold for your filing status), with a maximum penalty being the national average cost of a bronze plan, or it can be calculated as $95 per adult and $47.50 per child under the age of eighteen, capping out at $285 for a family. The amount per adult will increase each year. In 2016, it will be $695 per adult and $347.50 per child, capping at $2,085 per family.

For an unscrupulous tax preparer the Shared Responsibility penalties can add up to quite a caper. How so? Because the scam involves A) taking advantage of the inherent complexity of the exemptions and B) pocketing the penalties. Sometimes the scammer claims he or she can reduce the cost of the penalty because they have created a pool for leverage, or they simply claim that paying them directly instead of the government is “how it’s done.”

The only thing you need to know is: That’s not how it’s done. The easiest way to avoid this scam is to remember one rule: Only pay the IRS. Period.

There is some good news. While you are required to report whether or not you have health care coverage on your tax return, the majority of filers will not have an issue here. It has been estimated that only four million of the estimated 30 million uninsured will have to pay the Shared Responsibility Provision in 2016. But here is where fraudsters see their honey pot, using complexity to fleece honest taxpaying citizens while exposing them to penalties when the IRS circles back to get money that was stolen from them.

Are you off the hook for paying the penalty? Here’s the list of exemptions to see if they might apply to you (consult your tax preparer as this column is not meant to serve as a substitute for professional tax advice):

  • There were no “affordable” options for you, because available annual premiums were in excess of 8% your household income.
  • You had a gap in coverage less than three consecutive months.
  • Your household income was below the return-filing threshold ($10,150 for an individual on a 2014 tax return).
  • You are not a U.S. citizen, a U.S. national, nor an alien lawfully present in the United States.
  • You belong to a health care sharing ministry.
  • You belong to a federally-recognized Native American tribe.
  • You are in a jail, prison or another qualifying institution — such as a psychiatric hospital, etc.
  • You belong to a qualifying religion existing prior to December 31, 1950, recognized by the Social Security Administration (SSA).
  • You qualify for a hardship exemption.

Hopefully it’s not news that you need to choose a tax preparer wisely. There are many fly-by-night operations that are literally gone in the blink of an eye the minute April 16th rolls around.

That said, most tax preparers work hard to get you the best possible refund (or the lowest possible amount due) while remaining scrupulous and sticking to the letter of the law—and that is no easy task given the complexity of the Internal Revenue Code of 1986. If you are unsure about a tax preparer, you should ask for references or, even better, consult the IRS’s searchable database of tax preparers that are recognized by the agency.

This story is an Op/Ed contribution to Credit.com and does not necessarily represent the views of the company or its partners.

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TIME Health Care

Obama on the Affordable Care Act’s Fifth Anniversary: ‘It’s Working’

White House Student Film Festival
Martin H. Simon—Pool/Corbis President Barack Obama hosts the second-annual White House Student Film Festival in the East Room of the White House, in Washington on March 20, 2015.

He challenged Republican critics who are campaigning on repealing the law.

President Obama had a simple message on the fifth anniversary of the Affordable Care Act: It’s working.

Speaking in the Executive Office Building next to the White House, Obama argued that his signature health care law was “working better than many of us — including me — anticipated” at increasing health insurance rates and improving the quality of care.

“The bottom line is this for the American people: this law is saving money for families and for businesses,” he said. “This law is also saving lives, lives that touch all of us. It’s working despite countless attempts to repeal, undermine, defund and defame this law.”

In particular, Obama highlighted a government report that showed that fewer mistakes in hospitals saved the lives of 50,000 people between 2011 and 2013, which the White House partly attributed to initiatives to reduce accidental overdoses, bedsores and patient falls.

The remarks came just two days after Texas Sen. Ted Cruz promised to repeal “every word of Obamacare” in a speech launching his presidential campaign, the first Republican to join the 2016 race.

Obama took the opportunity to take a few shots at Republican critics of the law, joking that “death panels, doom, [and] a serious alternative from Republicans in Congress” have all failed to materialize and challenging candidates campaigning for repeal to explain how “kicking millions of families off their insurance” will strengthen the country.

“Making sure that the Affordable Care Act works as intended to not only deliver access to care but to improve the quality of care and the cost of care, thats something that requires us all to work together,” he said.

MONEY Taxes

Why Obamacare Has Made Tax Filing an Even Bigger Headache This Year

piggy bank with band-aid on head
Getty Images

This is the first year that health reform crops up on your tax return. And a new study finds that many Americans who got help with health insurance premiums in 2014 now owe the IRS money.

This tax season, for the first time since the health law passed five years ago, consumers are facing its financial consequences. Whether they owe a penalty for not having health insurance or have to reconcile how much they got in premium tax credits against their incomes, many people have to contend with new tax forms and calculations. Experts say the worst may be yet to come.

When Christa Avampato, 39, bought a silver plan on the New York health insurance exchange last year, she was surprised and pleased to learn that she qualified for a $177 premium tax credit that is available to people with incomes between 100% and 400% of the federal poverty level. The tax credit, which was sent directly to her insurer every month, reduced the monthly payment for her $400 plan to $223.

A big check from a client at the end of last year pushed the self-employed consultant and content creator’s income higher than she had estimated. When she filed her income taxes earlier this month she got the bad news: She must repay $750 of the tax credit she’d received.

Avampato paid the bill out of her savings. Since her higher income meant she also owed more money on her federal and state income taxes, repaying the tax credit was “just rubbing salt in the wound,” Avampato says. But she’s not complaining. The tax credit made her coverage much more affordable. Going forward, she says she’ll just keep in mind that repayment is a possibility.

It’s hard to hit the income estimate on the nose, and changes in family status can also throw off the annual household income estimate on which the premium tax credit amount is based.

Like Avampato, half of people who received premium tax credits would have to repay some portion of the amount, according to estimates by The Kaiser Family Foundation. Forty-five percent would get a refund, according to the KFF analysis. The average repayment and the average refund would both be a little under $800. (KHN is an editorially independent program of the foundation.)

Tax preparer H&R Block has also looked at the issue. It reported that 52% of people who enrolled in coverage on the exchanges had to repay an average of $530 in premium tax credits, according to an analysis of the first six weeks of returns filed through tax preparer. About a third of marketplace enrollees got a tax credit refund of $365 on average, according to H&R Block.

The amount that people have to repay is capped based on their income. Still, someone earning 200% of the poverty level ($22,980) could owe several hundred dollars, says Karen Pollitz, a senior fellow at the Kaiser Family Foundation. People whose income tops 400% of poverty ($45,960 for an individual) have to pay the entire premium tax credit back.

Experts say the message for taxpayers is clear: if your income or family status changes, go back to the marketplace now and as necessary throughout the year to adjust them so you can minimize repayment issues when your 2015 taxes are due.

Many people are learning about what the health law requires and how it affects them for the first time when they come in to file their taxes, says Tara Straw, a health policy analyst at the Center on Budget and Policy Priorities. For the past 10 years, Straw has managed a Volunteer Income Tax Assistance site in the District of Columbia as part of an Internal Revenue Service program that provides free tax preparation services for lower income people.

Some of the recently initiated owe a penalty for not having health insurance. For 2014, the penalty is the greater of $95 or 1% of income. The H&R Block analysis found that the average penalty people paid for not having insurance was $172. Consumers who learn they owe a penalty when they file their 2014 taxes can qualify for a special enrollment period to buy 2015 coverage if they haven’t already done so. That would protect them against a penalty on their next return.

People may be able to avoid the penalty by qualifying for an exemption. Tax preparers rely on software to help them complete people’s returns, including the forms used to reconcile premium tax credits and pay the penalty for not having insurance or apply for an exemption from the requirement. For the most part, the software is up to the task, Straw says, but it comes up short with some of the more complicated calculations.

Case in point: applying for the exemption from the health insurance requirement because coverage is unaffordable. Under the health law, if the minimum amount people would have to pay for employer coverage or a bronze level health plan is more than 8% of household income they don’t have to buy insurance. That situation is likely to be one of the most common reasons for claiming an exemption.

But to figure out whether someone qualifies, the software would have to incorporate details such as the cost of the second lowest cost silver plan (to calculate how much someone could receive in premium tax credits) and the lowest cost bronze plan in someone’s area. The software can’t do that, so tax preparers must complete the information by hand.

“That one in particular has been vexing,” says Straw.

The gnarliest filing challenges may yet come from people with complicated situations, such as those who had errors in the IRS form 1095A that reported how much they received in premium tax credits, experts say.

Take the example of a couple with a 20-year-old son living at home who bought a family policy on the exchange. If midway through the year the son gets a job and is no longer his parents’ dependent, the family’s premium tax credit calculation will be off. The family needs to work together to figure out the optimal way to divide the credit already received between the two tax returns. The goal is to maximize the benefit to the family and minimize any tax credit repayment they may face.

“A lot of tax software is just not designed for that kind of trial and error,” says Straw.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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