After ACA this is no longer true in Medicaid expansion states.

There is no asset test, and there is no paying back benefits if you are under 65 when you took them.

Medicaid expansion is quite literally the best insurance that money can't buy.

In CA, for example, a family of 4 earning less than $33,500 gets MediCal [1]. If you just want free coverage for the kids, you can earn $64,600. [2]

[1] - http://www.dhcs.ca.gov/services/medi-cal/Pages/DoYouQualifyF...

[2] - http://hbex.coveredca.com/toolkit/renewal-toolkit/downloads/...

ACA is likely about to be repealed.

And maybe that's a good reason why it should be.

A progressive tax system should not be paired with a regressive subsidy as massive as ACA. It adds up to nearly a 100% tax on the first $60,000 of income for unhealthy / chronically ill families, and a 60% effective tax rate for healthy ones.

I'm actually quite aware of this (my partner used to do nursing home placements). But if you're going into a nursing home, the implication is that you will never need those assets again. While I don't agree with this process, it's difficult to argue it is without merit. I suppose if survivors wanted to inherit those assets, they could take on the care of their elderly family members.

It's also worth noting that, in most of the US, the alternative to medicaid was/is filial support laws, in which the nursing home could take the assets of the children of the patients in their care.

The point is that people on Medicaid don't really have health insurance. They have a line of credit with the government. They are accumulating debt. In most -not all- states the law requires the state to collect on the debt. Again, by law. They can and do place liens on your property, etc.

This is very, very far removed from the idea of health insurance. Your property becomes the property of the government. With real health insurance nobody places a lien on your home for medical services rendered.