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Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

What is the Penalty for No Health Insurance?

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Question: What is the penalty for not having any health insurance?

Answer: In 2016, the penalty is $695 per adult and $347 per child up to a family cap of $2,500 or 2.5% of household income, whichever is greater. In 2015, it was $325 for adults, with a $975 maximum or 2% of household income. Kaiser Family Foundation predicts that in 2016, average penalties will increase, on average, from $1,177 to $1,450 per household. According to Peter Lee of Covered California, “The bigger penalty could be showing up in the emergency room and walking out with a bill in the tens of thousands of dollars,”.


Max is exactly correct. I can verify this as I work for a County in California and we used process the ER room applications. It USED to be that the patient would be seen and treated, and the hospital would bring them the paperwork including the consent to apply for Medi-Cal (or the old CMSP program). It DID NOT have access to generate an aid code by inputting minimal information into the state MEDS system and get an INSTANT aid code they can bill to (and get the client a BIC card issued like Max mentioned).

There is zero accountability for what the hospitals are doing. They actively even lie or always put income as -zero- but that doesn’t matter. They are able to input and get “Emergency Services” temporary aid code and THEIR BILL gets paid out of Medi-Cal aid funds.

“According to Peter Lee of Covered California, ‘The bigger penalty could be showing up in the emergency room and walking out with a bill in the tens of thousands of dollars,’”

Peter V. Lee is wrong. What he describes is the status quo for uninsured persons. When they leave the ER, they either leave the bill behind — as a person with no insurance and no desire to pay insurance premiums — for the hospital and doctors to figure out how they’re going to be paid, or the bill is picked up by Medi-Cal and the person walks away with a BIC in the mail from the California DSS. Either way, taxpayers and insured persons (mostly the same + some dependents) foot the bill.

And our members of Congress declare that the PPACA has been a success. Who cares that half of the state-run Exchanges/Coops are not sustainable or have been closed?

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