ACA Title 1, Sec. 1411. Procedures for determining eligibility for exchange participation, premium tax credits and reduced cost-sharing, and individual responsibility exemptions: “Bad” – Way too easy to exploit. This section provides the basic rules for the procedures to determine eligibility, level of premium tax credits, level of reduced cost sharing and waiver of individual responsibility provisions. All these features seem to be set up to make it easy for the average person to claim eligibility for reduced cost sharing, premium credits and becoming exempt for individual responsibility provisions. For example, as long as someone vouches that the individual involved is a citizen and/or present in the U.S. legally he or she is considered as covered under these provisions. In addition any employee can claim that the employers’ health plan coverage is “unaffordable” and the employer can not access the employees’ tax return to validate their claim, but must pay the applicable tax for not providing “affordable” health plan coverage to every employee. The rules seem very skewed in the favor of the employee and not very balanced for the interests of the employer. Another example of bad policy that is very likely to lead to abuse and higher cost for employers and the system at large. This section also includes an explicit blanket prohibition against the Justice Department from filing any liens against employee offenders that try to “game” these requirements. Another example of bad government policy.

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