Health Care

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Will you be affected by the new health care law?

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With open enrollment beginning Tuesday in the state health insurance marketplaces, there is still confusion about who is going to be affected.

IT’S LIKELY

The people more likely to be affected are the uninsured and those who are purchasing health insurance on their own or who have been denied coverage because of pre-existing conditions. In Georgia, there are about 350,000 purchasing health insurance on their own and many of them will be eligible for subsidies based on their income, which goes up to 400 percent of the federal poverty level or $94,000 a year for a family of four. There are an estimated 1.9 million uninsured in Georgia and many of those will also get help purchasing insurance. Advocacy groups have estimated that 800,000 will qualify for help. A prohibition against denying coverage because of pre-existing conditions also takes effect Jan. 1, which would make people in that category eligible for coverage.

IT’S LESS LIKELY

The people less likely to be directly affected include those who are getting health insurance through their employers. Those plans in existence when the law was passed in 2010 were grandfathered in, according to the Kaiser Family Foundation. They are still subject to some provisions of the law, such as extending coverage to dependents younger than 26 and eliminating lifetime limits on coverage or annual limits on coverage beginning in January, according to the foundation. They will not, however, have to provide the essential benefit package or cover preventive services for free that plans in the marketplace will, provided the plans do not make substantial changes, such as eliminating benefits or changing insurers, according to the foundation.

Those with employer-based insurance could still look to the marketplace for alternatives but would not qualify for premium help if their insurance plan is considered “affordable” and provides “minimum value,” according to healthcare.gov, the marketplace Web site where people will be able to find plan information and enroll.

Affordable is defined as a plan where the employee share of the annual premium for self-coverage is no more than 9.5 percent of annual household income, according to the Web site. A plan would be deemed to provide minimum value if it is designed to pay at least 60 percent of the total cost of medical services for a standard population. An employer should be able to tell employees if their plan meets those standards.

The Affordable Care Act at one time included that Medicaid expansion would be a part of the coverage offered but when the U.S. Supreme Court upheld the law it made Medicaid expansion optional for states.

Georgia and South Carolina have chosen not to expand Medicaid next year, which means adults who make less than the federal poverty level might not be able to find coverage because they are not eligible for subsidies under the law, according to the Kaiser foundation. However, they will also be exempt from the individual mandate so they will not be penalized if they do not have coverage.

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vegasbaby
178
Points
vegasbaby 09/30/13 - 07:12 pm
4
2
the question should be - How much more will you be affected?

Who came up with 9.5% of income as the premium limit? That is substantial and not what most families are budgeting for that item around the kitchen table. Also Healthcare providers are already feeling the double squeeze as employers and also the receivers of the lesser % from federal medicare reimbursement dollars. I have personally been impacted by this law in a negative way as an employee in healthcare, and worry about the unknowns that are still to come.

Little Lamb
49093
Points
Little Lamb 09/30/13 - 08:53 am
1
1
Dichotomy

In the second paragraph Mr. Corwin says that people who purchase individual insurance not through an employer are eligible for a subsidy if their income is less that 4 times the federal poverty level.

Then in the last paragraph he says that people whose income is less than the federal poverty level are not eligible for subsidies.

Don't those two statements seem contradictory?

Tom Corwin
10757
Points
Tom Corwin 09/30/13 - 11:29 am
1
0
Little Lamb

Both statements are true. The subsidies go up to 400 percent of the Federal Poverty Level, although there are reports that some subsidies for young people disappear before the 300 percent level in some exchanges. That is something I am attempting to check out. But subsidies are not allowed for those who earn less than the Federal Poverty Level. This was to prevent states from pushing their Medicaid population into the exchanges. When states elected not to expand Medicaid, as Georgia and South Carolina did, then those people are left without coverage and probably can't afford to buy coverage on their own. However, they are also exempted from the individual mandate so they are not penalized because they can't find coverage.

Marinerman1
5461
Points
Marinerman1 09/30/13 - 11:35 am
2
2
We ALL Will Be Affected By This Law/Tax

Small businesses that employ over the threshold of 50, will HAVE to do something. Large employers like Delta, have stated that Obamacare will cost them over $100 million next year. As 'vegasbaby' states, the healthcare providers (hospitals) will see major reductions in reimbursements. Two facilities, MCG (sorry) and University provide "unfunded" services to the uninsured and under insured. With reduced reimbursements, where will the funds come from, to provide these services? If you are State employees (includes all teachers and administrators), you have already found that your benefits have been reduced to a single payor next year. We will ALL be affected by this, and most of us will be affected negatively. This is a very bad, very PARTISAN piece of legislation. Just ask yourself one question -- if this is SO GOOD, why has there been a SINGLE exemption ??

Little Lamb
49093
Points
Little Lamb 09/30/13 - 11:44 am
0
1
Medicaid

Thanks for the explanation, Tom. So it sounds like the insurance subsidies are only for those above the federal poverty line up to 4 times the line (or maybe 3). Then for those below the federal poverty line, some are eligible for Medicaid and some are not. What a crazy system.

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