Affordable Care Act
Background
The entire nation is buzzing with debates and discussion about the controversial and groundbreaking policy that President Obama signed into law on March 23, 2010. In March 2012 the Supreme Court of theUnited Statesheard three days of testimonies from representatives from 26 states concerning the two year old Affordable Healthcare Plan. As the nation holds its collective breath while the Justices decide what parts of the current law stays and what parts go, let’s take a look at what is at stake.
The Patient Protection and Affordable Health Care Act: In Summary
Health-care Coverage for Individuals
An individual who makes up to $44,000 per year will be eligible to receive financial support to help with covering the cost of insurance. The coverage can either be obtained through an employer or an insurance company. Those who are under the age of 26 can opt to remain on their parent’s coverage even if they are married or not living at home. School enrollment status is also not an eligibility factor. This age limit was expanded through health-care reform to allow college students who are preparing to enter the workforce to maintain coverage while they are unable to afford their own coverage.
Health-care Coverage for Families
Families will be able to receive this same funding based upon the number of members in the household. National health-care reform has actually expanded coverage that has been in place through some state-wide health-care programs. Currently in some states, a family of four making up to $66,000 per year is eligible to receive subsidies from the state. With the passage of national health-care reform, that limitation is increased to $88,000. The larger the family is, the higher the eligible income limitation becomes for financial aid. This change will mean that more families will be eligible for government assistance, making insurance more affordable for many that are currently uninsured.
Determination of Subsidies
The exact amount of the subsidies will be determined through a graduating scale. Individuals and families with a lower income will be eligible for more assistance with their purchase of health-care insurance. Those that are on the higher end of the scale will need to pay more for the cost of insurance. Each individual and family can choose whether the subsidies will be paid through their employer plan or through their individual plan. This will allow each person to make the best health and financial decision for themselves or their family.
Other Potential Benefits
In addition to the government subsidies, individuals and families may also be able to find subsidization of the insurance cost through tax credits. Tax credits will help decrease the amount of income tax that needs to be paid to the government over the year. While this is not an upfront benefit to help with the cost of coverage, it should also be considered when making insurance coverage decisions.
With so many questions circulating about the legality of the current Affordable Care Act and the effects it is really going to have on our health when it fully takes effect, it can be hard to figure out the truth. So here it is: a quick summary of the current health care reform bill based on popular questions regarding the future of health care:
Frequently Asked Question:
Q: I already have insurance, do I need to purchase new health insurance?
- A. Probably not. If you already have insurance offered by your employer, or an individual plan that you really like, you can keep it.
Q: I am pretty healthy and never get sick. I don’t carry insurance. Do I have to buy this insurance?
A: If you don’t have insurance at all you will be required by law to purchase it by 2014 or pay a fine. You can purchase your health insurance from anywhere, but if you don’t you’ll be forced to pay either $750 dollars, or 2% of your income, whichever is greater.
Q: If I don’t have insurance now, will I be forced to buy it and will there be government help?
A: Those who are currently not insured will be required to purchase health-care insurance, but most people will be eligible for government help through subsidies. This help will be made available to individuals and families who qualify to assist in covering the cost of health-care insurance. The exact amount of assistance that will be available is dependent upon your specific situation.
Q: Will my current insurance change?
A: No. Currently established health insurance plans are “grandfathered-in” to the new market. This means if you want to keep your plan as it is, it won’t change. But new plans will be federally regulated to make sure that a minimum number of benefits are being offered. They will also include new consumer protections and an appeals process for individual health insurance consumers who need to dispute a decision or action their insurance company has made.
Q: Is there a public option?
A: No. However by 2014 each state will offer buyers the option of purchasing coverage from a health care insurance exchange. These health insurance exchanges will be not-for-profit businesses regulated by the federal government to ensure that a minimum level of coverage is offered, that no pre-existing conditions are used to deny buyers, and that consumer protection laws are followed.
Q: Will these exchanges sell insurance to anyone who needs it?
A: No. Undocumented immigrants cannot purchase health insurance from the exchanges, and neither can individuals who are currently covered by an employer-provided health care plan.
Q: What if I just can’t afford health insurance?
A: Individuals who make between 100% and 400% of the federal poverty level are eligible to receive credits that will assist them in buying individual health insurance from the exchanges. For the very poorest people the credits may cover all of their health care premiums.
Q: Will businesses be forced to offer employees insurance?
A: Some of them will. Businesses with more than 50 employees will be forced to offer health care, or pay a fee of $750 per employee. Businesses of less than 50 people are exempt from this law. Small businesses will receive a tax credit for up to 35% of the money they are paying to insure their employees. By the year 2014 that tax credit will go up to 50%, to help smaller businesses who don’t have the same bargaining power as big businesses.
Q: The company I work for is very small. My boss says that the new law is going force him out of business if he is forced to pay for insurance for us. What about that?
A: If your company employs less than fifty people, it is exempt from being forced to provide coverage. However, small businesses that do decide to offer coverage will get a tax credit for up to 35% of the money they spend on an employee plan. That tax credit will increase to 50% by 2014. Small businesses will be able to form groups to buy insurance for their employees. These groups can then negotiate better prices from the insurance providers just like the large companies.
Q: Who will get Medicaid?
A: By 2014 all individuals under the age of 65 who make less than 133% of the federal poverty level will be eligible for Medicaid. Right now the poverty level is at about $18,000 dollars per year for a family of three.
Q: Will this plan cover abortions?
A: No. These plans are funded by the federal government. Federal funds can not be used to pay for abortions or abortion-related services. President Obama signed an executive order specifically mandating that no federal dollars can be spent on this type of service unless it is connected to rape or incest.
Q: How will this all be paid for?
A: Taxes on health insurance companies, pharmaceuticals, and medical supply companies beginning in 2014 will provide between $6.3 billion and $14 billion over the next 10 years. Taxes on so-called “Cadillac” tax plans will also take effect in 2018. The majority of health care plans are not considered “Cadillac” plans. These plans are either offered by employers usually to upper management; or they are purchased by wealthy individuals. They often have no dollar or treatment limits, little to no deductibles and cover services that most other insurance plans do not cover. They cost around $8,500 per person, per year not including any deductibles or co-pays. Insurance plans that offer this plan level will have to pay 40% of the premiums they get for this level in taxes. Finally, cuts in Medicare, and reductions in Medicare fraud and waste are projected to save $100 billion in the first 10 years, and another $700 billion in the years after. These projections were reported by a non-partisan Congressional Budget Office.
ADDITIONAL LINKS
The single most comprehensive website for information on the Affordable Care Act is www.healthcare.gov
See a video of President Obama explaining how to use the website.
OVERVIEW LINKS
http://healthreform.kff.org/The-Animation.aspx This video is also available on YouTube.com
TIMELINE LINKS
ACA and People with Disabilities
http://www.healthcare.gov/news/brochures/people-with-disabilities-top5.pdf
ACA and Behavioral Health / Mental Health
http://www.thenationalcouncil.org/galleries/policy-file/FAQs%20on%20Medicaid%20expansion.pdf
ACA and Autism
http://childhealthdata.org/docs/drc/amchp-issue-brief—the-aca-and-cy-with-asd-dd-2012-february.pdf
http://www.autismvotes.org/site/c.frKNI3PCImE/b.5604501/k.8342/Washington_DC.htm