To sign up for Obamacare, start filling out the forms now (and hire a good accountant)

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  • Want to apply for Obamacare this fall? Start the paperwork now @ScottGottliebMD

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  • Obamacare is a triumph of bureaucratic zeal. Now it has the paperwork to match its ambitions

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  • The task of applying for Obamacare will become akin to a second tax filing

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Want to apply for Obamacare this fall? Start the paperwork now.

The Obama Administration quietly released a draft copy of its “single streamlined application” for Obamacare. This is the form that the government will use to certify eligibility for the program’s subsidies. The on-line version of that form requires 60 printed pages to spell out all the queries. (A condensed paper version of the same application fills 21 pages).

And all this comes before you fill out your state paperwork to see if you’re eligible for Medicaid (and before you even begin to select a health plan). There’s also a separate form that you’ll have to give to your employer to complete for you.

What’s in the 60-page document? Most families of four will have to answer about 1,000 discrete queries by the time their done. Some of the information you won’t have ready access to.

Obamacare is a triumph of bureaucratic zeal. Now it has the paperwork to match its ambitions. "Obamacare is a triumph of bureaucratic zeal. Now it has the paperwork to match its ambitions." -- Scott Gottlieb

In order to make sure that consumers are eligible for government subsidies to buy coverage, the feds need to make sure that you meet certain income tests, and don’t have access to alternative health coverage through your workplace (or your spouses). So you’re going to need to answer a lot of questions about your income and employment status. Here’s a sampling of what you’ll need to know:

A lot of the information is personal: Is anyone in your house pregnant? Was anyone ever in foster care? Does anyone have a disability or need help with his or her activities of daily living. The feds want to know whether you might be eligible for stated-based Medicaid programs rather than the Obamacare exchanges.

A battery of questions deals with estimating your income and that of your spouse. How many hours do you work each week? How much money do you get from self-employment or a one-time windfall from capital gains or inheritance? How much do you get from “farming or fishing income?” Certain things, including child support, veteran’s benefits, and Supplemental Security Income (SSI) can be excluded.

Be aware: If the total income you’ve entered comes in too low relative to the government’s prior estimates of what you earn, there’s a battery of questions to ferret out where you might have made a (ahem) mistake. Has your wages or salary recently been cut? Is anyone in your household a seasonal worker?

To ferret out errors, the electronic form will also look for discrepancies between your application for Obamacare and your most recent tax return.

You’ll need a lot of information about your employer and any health plan it might offer. What is their EIN number? What are the name, number, and e-mail address for the person who handles health coverage at your place of work? You’ll also need the “name of the lowest cost self-only health plan” offered at your spouses workplace. But be careful here. “Only include plans that meet the minimum value standard set by the Affordable Care Act” (whatever that means).

Finished yet? Not even close. You’re only on page 37.

Members of your household could be asked to upload proof of income, proof of citizenship, and even proof of tribal membership. Have you smoked in the last 12 months? The government wants to know.

Is anyone in your household eligible to get health coverage from Medicare? Tricare? The Peace Corps? Any “Other state or federal health benefit program” that they may be able to tap for health coverage? You’ll need to figure this out in advance.

Now sign on the dotted line. Penalty of perjury applies.

Once you’re done with the application, at least three major federal agencies, including the Internal Revenue Service (IRS), will scrutinize your answers. If you apply on-line, that’s supposed to happen in real time. But the systems for sharing the information between federal agencies are still being developed.

A Kaiser Family Foundation poll conducted in early March 2013 found that 48 percent of those polled said they hadn’t heard anything the Obamacare exchanges. When folks turn their attention to the paperwork, many might wish they remained in the dark.

The Obama administration is subsidizing the hiring of thousands of guides to help people wade through the paperwork. But confusion won’t be the only issue.

The forms require applicants to declare lots of personal financial information to certify eligibility for Obamacare subsidies. This data will be checked against tax returns. Many people will be squeamish about running through that gauntlet.

The government estimates that the on-line application will take an hour to complete. No chance. Get a good accountant if you want to outsource the entire process. Or maybe Intuit [INTU:NASDAQ] will figure all this out with a new software product modeled after its popular TurboTax.

The looming tax season is an apt analogy to this entire ordeal. The task of applying for Obamacare will become akin to a second tax filing.

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About the Author


  • Scott Gottlieb, M.D., a practicing physician, has served in various capacities at the Food and Drug Administration, including senior adviser for medical technology; director of medical policy development; and, most recently, deputy commissioner for medical and scientific affairs. Dr. Gottlieb has also served as a senior policy adviser at the Centers for Medicare & Medicaid Services. 

    Click here to read Scott’s Medical Innovation blog.

    Follow Scott Gottlieb on Twitter.

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