So what’s the takeaway for anyone wanting to use the subsidy? Yes, the government will pay about two-thirds of your COBRA premiums, and for most people that might make the cost of insurance bearable for the nine months the subsidy lasts. But what happens after that? The Labor Department FAQ makes it clear:

If you plan to continue your COBRA coverage after the premium reduction period, you will have to pay the full amount of the premium. Failure to do so may result in your loss of COBRA coverage.

“If a new job with health insurance doesn’t materialize, a person would have to continue to pay all the premiums for the next nine months, and then go to the individual market,” explains Kofman. “That’s the only way to guarantee your right to a policy in most states.” So maintaining coverage beyond the initial nine months is important to most people with health conditions, even minor ones.

While these rules may seem draconian to consumers, they protect insurers by making certain that too many sick people don’t come into their mix of policyholders. If these people showed up, carriers would have to pay out gobs of money in claims, which could affect their bottom lines. Welcome to health insurance—American style.

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.