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JAMA Forum

The Middle Class Tax Break Hardly Anyone Is Talking About

There has been no shortage of attention focused on the scheduled expiration of tax cuts for middle class and wealthy Americans at the end of this year. That’s likely to continue to be the case through the election and a potential lame duck session of Congress following it.

Yet there’s been surprisingly little discussion of the details of the substantial middle class tax break built into the Affordable Care Act (ACA).

To review, there are 2 primary ways that the ACA reduces the number of people who are uninsured. First, starting in 2014, people with income up to138% of the poverty level (now $31 809 a year for a family of 4) become eligible for Medicaid. (This provision became voluntary for states under the recent Supreme Court decision, as described in the JAMA Forum.)

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