A draft of the application for insurance asks people to project their 2014 income if their current income is not steady or if they expect it to change. The application runs 15 pages for a three-person family, but nowhere does it warn people that they may have to repay part of the subsidy if their income increases.
"I think this will be the hardest thing for members of the public to understand because it is a novel aspect of this tax credit," said Catherine Livingston, who recently served as health care counsel for the Internal Revenue Service. "I can't think of what else they do in the tax system currently that works that way." Livingston is now a partner in the Washington office of the law firm Jones Day.
There's another wrinkle: The vast majority of taxpayers won't actually receive the subsidies. Instead, the money will be paid directly to insurance companies and consumers will get the benefit in reduced premiums.
Health care providers and advocates for people who don't have insurance are planning public awareness campaigns to teach people about the health care law and its benefits.
Enroll America, a coalition of health care providers and advocates, is planning a multimillion-dollar campaign using social media, paid advertising and grass-roots organizing to encourage people who don't have insurance to sign up for it, said Anne Filipic, a former Obama White House official who is now president of the organization.
The Obama administration says it, too, is working to educate consumers.
"On Oct. 1, each state will have a marketplace up and running where consumers can choose a private health insurance plan that fits their health needs and budget," said Treasury spokeswoman Sabrina Siddiqui. "The premium tax credits will give middle-class Americans unprecedented tax benefits to make the purchase of health insurance affordable for everyone, and we will continue to work with consumers, community health organizations and other stakeholders to raise awareness and understanding of these tax benefits."