Low-Income Taxpayers and the Affordable Care Act

What is the connection between taxes and health insurance? Why do advocates for low-income taxpayers need to know about the Affordable Care Act? The Patient Protection and Affordable Care Act1 (ACA) contains dozens of tax provisions.2 The ACA introduced a major new tax credit and a major new tax penalty for 2014. It also imported tax concepts into Medicaid. All told, the ACA will have a major impact on low-income taxpayers. Health care advocates are already in the thick of helping people get and maintain health insurance coverage. Tax advocates at Low-Income Taxpayer Clinics3 (LITCs) may not see ACA-related examinations and collection controversies until 2015, but now is the time many of our clients are making decisions that will seriously impact their lives and shape future tax controversies. Education, issue-spotting, and early guidance could make a positive difference. All advocates working with low-income taxpayers should educate their clients, particularly those in English as-a-second-language (ESL) communities, about their new rights and responsibilities. This article serves as an introduction and reference on the ACA for legal advocates and policymakers, with a focus on tax provisions affecting lower-income individuals.4 The article summarizes the major health care reform developments affecting low-income taxpayers from October 2013 through mid-2015, and introduces key ACA concepts. It then focuses in detail on the two ACA tax provisions that most concern low-income individuals: the Premium Tax Credit and the individual shared responsibility payment. This article also flags issues of concern for advocates and identifies areas to monitor for further development and advocacy. A comprehensive discussion of the ACA is beyond the scope of this article. Instead, this article focuses on the choices, deadlines, and difficulties likely to arise for low-income taxpayers in the relatively near future