A lot of confusion surrounds the Patient Protection and Affordable Care Act (ACA), also known as Obamacare, and what exactly it has to offer. Legislators have tried their best to repeal or defund the Affordable Care Act through over 40 different failed bills proposed to the House. At over 40 attempts so far, the cost is estimated to have exceeded $60 million. Their latest attempt resulted, partly, in today’s government shutdown.
All of these attempts to undercut the law have failed, but many lawmakers have confused the nation about where the law stands and have wasted a lot of time and taxpayer money. It is important for people to utilize the new insurance option and show Congress that healthcare reform is here to stay. Don’t be mistaken: today’s government shutdown did not stop Obamacare enrollment, and seemingly nothing will.
As the next implementation step of the ACA, on October 1, 2013, uninsured individuals can visit Healthcare.gov to browse and sign up for insurance plans in their state-specific Marketplace.
States were given the option to create their own marketplace, also known as an exchange, which is essentially a supermall of insurance plans from different insurance providers and with a variety of coverage options. One study of 36 states found that on average, individuals will have a choice of over 50 qualified health plans from 8 health insurance providers. All marketplaces can be accessed through Healthcare.gov, no matter if the state is running their own or using one set up by the federal government.
Most uninsured individuals will now be able to purchase health insurance through the marketplace for $100 or less per month. This is because of federally funded subsidies applied directly to the insurance provider you choose in the form of tax credits. Individuals and families making 100% to 400% of the federal poverty level will be eligible for the tax credits – $11,490 and $45,950 for an individual and $31,322 and $94,200 for a household of four.
An optional Medicaid expansion offered by the Affordable Care Act now makes it possible for low-income adults under 65 to be eligible. The federal government is fully funding it for the first three years and gradually reducing to pay 90% by 2020. Twenty states are participating in the Medicaid expansion and more are moving toward participation. To find out if you quality for Medicaid in your state, go to Healthcare.gov.
All insurance providers in the marketplace have to provide plans that cover these 10 essentials benefits:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health & substance use disorder services (this includes behavioral health treatment)
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Prevention, wellness, and chronic disease management services
- Pediatric services including vision and dental care
- Dental and vision plans for adults will be available as separate plans in many healthcare marketplaces.
Seventeen states have passed legislation to prohibit abortion coverage by insurance plans in their states’ marketplaces. To find out which states have anti-choice legislation such as this, go here.
Previously, healthcare providers denied coverage based on pre-existing conditions, gender, and sexual orientation. The Affordable Care Act now ensures that insurance companies cannot raise premiums solely because of gender or sexual orientation. It has also strengthened the non-discrimination clause by specifying discrimination based on sex stereotyping and gender identity. The ACA also prevents companies from denying coverage or dropping someone from the plan because of a pre-existing condition.
Preventive care such as counseling for sexually transmitted infections, wellness visits, cervical cancer screening, depression screening and mental health counseling, immunizations, HPV and HIV screening, contraceptives, domestic violence screening and more must be provided with no co-pays no matter your insurance provider.
Insurance companies can no longer cap how much they will spend on health benefits in a year or lifetime, helping those with chronic diseases, cancer, or conditions such as HIV/AIDS when medical bills can be very high each year.
The Affordable Care Act requires all families and individuals who can afford to purchase healthcare to do so. In this way, healthcare costs remain low for everyone. Those who do not purchase insurance will pay a penalty starting in the 2014 tax year: the penalty is 1% of your income or $95 a year, whichever is higher, increasing to the maximum of 2.5% of your income or $695 a year, whichever is higher.
If you would like more information on the new marketplaces or have yet to enroll, don’t hesitate: visit Healthcare.gov and get covered! The Feminist Majority Foundation has updated resources about the Affordable Care Act available online as well.