I’m a navigator for one of the state marketplaces.

I can see how this might not seem like a big deal if you’re thinking about someone like Anonymous Medical Biller who works a good paying regular job for regular hours and just needs to do a couple of minutes work with a calculator and then stop by HR and ask to have their withholdings adjusted.

I’d like you to think of all the people who are self employed with low income. The hard-working folks who earn maybe $17,000-$25,000 a year cleaning houses, mowing lawns, and doing other odd jobs. Right now they qualify for pretty significant advance premium tax credits. The problem with a refundable tax credit is that there’s no withholding to adjust. They’d have no choice but to pay the full premium up-front every month and that wouldn’t be possible so they’d end up going without health insurance. I think implementing this would also be disastrous for those who put together a living from multiple part-time/seasonal/temporary jobs because they’d have to constantly keep track of making sure each employer was properly adjusting their withholdings.