Bette in Spokane has some genuine pain (probably. Or maybe not...see updates)

[multiple updates, through 2/3/14]

Yes, the brief "ACA victim" story that Rep. Kathy McMorris Rodgers (R-Wa) inserted in her response to the State of the Union address was cherry-picked and misleading. The pain that the ACA inflicted on the couple in question was exaggerated. But it was probably real. They are in the relatively small subset of Americans who may fare worse under the ACA than under the pre-ACA status quo.

Here is the tale that Rodgers told:

Not long ago I got a letter from Bette in Spokane, who hoped the President’s health care law would save her money – but found out instead that her premiums were going up nearly $700 a month.

Reporter David Wasson of the Spokesman-Review tracked Bette down and learned that she is hostile to the ACA ("I wouldn't go on that Obama website at all") and did not check out her options on the exchange. The $700 difference was between the plan she and her husband carried in 2013 and the plan their insurance company offered in replacement. Here are the basics:

Self-employed? That pre-ACA health insurance deduction is still there...

Self-employed and seeking health insurance? Call an accountant.

Everyone who's paying attention knows that shoppers on the ACA exchanges are eligible for premium subsidies if their income is under 400% of the Federal Poverty Level  (FPL) and the benchmark silver plan in their area would cost them more than 9.5% of their income (for young people in states with low premiums, subsidies may fade out somewhere under 300% FPL).

Equally important for those who qualify are additional subsidies to reduce deductibles and maximum yearly out-of-pocket costs. As I pointed out in a prior post, these subsidies have hard break points: they bump up at income levels of $17,235 and $22,980 and phase out at $28,775. Since self-employed "profit from business" is notably malleable, and since retirement contributions come off the Modified Adjusted Gross Income (MAGI) used to calculate subsidy eligibility, the low income self-employed are well advised to keep an eye on those break points.

There is in fact a third dip for the low-income self-employed -- and a longstanding major benefit for those with higher incomes. It's the self-employment health insurance deduction. If you're self-employed and buying insurance for yourself and/or your family on the individual market, you can deduct the full cost of the insurance from your MAGI. That is, if your self-employment income exceeds the cost of insurance after various other deductions: