Maybe it's because I'm a tax accountant, but the part about manipulating income to get credits seems like smart planning to me. However, I totally understand where you're coming from. My son has special needs and every time I changed insurance, we'd stay up at night worrying if our new plan would cover his many medical problems (I once had to leave a job because they wouldn't and our insurance is stupidly tied to employment).

Finally, he was approved to go on Medicaid, and I definitely had a bit of internal guilt for a bit, thinking that Medicaid was for "poor" people. It has really been a lifesaver, though. Potentially literally.