What exactly is the ACA and how will it affect you? DAME breaks it down.
Feeling a little confused about healthcare this week? You’re not alone: The Patient Protection and Affordable Care Act—also called the Affordable Care Act (ACA) or Obamacare—is puzzling for many of us. In fact, more than 70 percent of Americans said they liked individual parts of the law, but only 37 percent said they liked the law itself. We can thank political spin for that one, but with the widely publicized healthcare exchanges opening this week (more on that later), it’s time to put the disinformation aside and focus on facts.
First, let’s dispel a few myths. The Affordable Care Act does NOT set up “death panels” to let the government decide who gets healthcare when they’re dying. And it does NOT give health care subsidies to undocumented immigrants. Anyone who tells you otherwise has their pants on fire. Also, the Affordable Care Act does NOT give people free health care (sorry).
First of all, it’s a law, passed by Congress, signed by the President in 2010, and reviewed by the Supreme Court last year. Its goal is to get more of the 60 million uninsured Americans covered by health insurance, and make health care cost less for everyone.
Half of all Americans already have private health insurance, mostly through their employers. Another third are covered through Medicare and Medicaid—government-administered insurance programs. The law expanded Medicaid to include most families earning less than $31,000 a year. But here’s the catch: The Supreme Court said it’s up to states to accept the expansion. So far, just 26 states are likely to opt in, even though the federal government’s covering most of the bill.
If you’re already covered, you likely won’t have to do anything, unless you want to make changes. But if you’re one of the 20 percent of Americans without private insurance or Medicaid eligibility, here’s where those healthcare exchanges come in that opened this week.
Think of the exchanges, or marketplaces, as an online healthcare mall at www.HealthCare.gov where you can comparison shop for plans. You can’t be refused, and the government provides subsidies to help you pay, depending on how much you make. The exchanges are open for enrollment from October 1 until March 31, 2014. (But the plans won’t take effect until January 1, 2014 if you enroll this year.)
The Affordable Care Act has an “individual mandate” requiring most Americans to have insurance by January 1, 2014, or pay a penalty of about $100. If you decide to rebel, the government won’t come knocking at your door—but Uncle Sam will take it out of your taxes. However, if you can’t find an affordable plan to purchase (by government standards), the penalty will be waived.
For all Americans, the law includes reforms to makes health care less expensive. Insurance companies can no longer put lifetime caps on your coverage, or kick you off your plan if you get sick. The law also limits annual out-of-pocket fees and guarantees your right to appeal if payment is denied.
You can also choose doctors from your primary network and get emergency care in hospitals outside your network. One of the biggest changes under the health law is that people with pre-existing conditions from asthma to cancer can’t be denied or charged more for healthcare.
Good news: Insurance companies can no longer charge you more for the same plan just because you’re female. Plans must include coverage for maternity benefits and breastfeeding support, as well as preventative care such as mammograms, colonoscopies, HPV testing, contraception, well-woman visits, and flu shots.
If you have kids, they can stay on your health plan until they’re 26. If you care for elderly parents, the law requires coverage of preventative health care services and gives prescription discounts for seniors on Medicare.
Beginning in 2015, businesses with over 50 employees will face penalties if they don’t provide insurance for full-time workers. Smaller employers don’t have to offer coverage, but may get tax credits if they do. The law also creates new small business health insurance marketplaces, also open this week.
The Affordable Care Act is funded in two ways: Taxes on health care industries such as hospitals, insurers, and medical device makers, and a tax on individuals who earn over $200,000.
House Republicans are making a last-ditch attempt to demand changes to the ACA as a condition of approving continued government funding. So far, the House has unsuccessfully voted to repeal the law more than 40 times. As we mention above, the ACA has been approved by all three branches of government, and once it starts delivering health insurance to millions of Americans, will be nearly impossible to repeal. Ironically, since funding for the Affordable Care Act is considered “mandatory” it’s not affected by the shut down.
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