Passage of the Affordable Health Care Act promised healthcare to millions of uninsured Americans who couldn’t afford it, were unable to obtain it, or didn’t qualify for other programs. The Act expanded Medicaid, called for the establishment of insurance exchanges and offered subsidies to assist families and low income wage earners purchase insurance.
Obamacare is a win-win situation for the majority of those who fall within those two groups, but according to the Congressional Budget Office (CBO), the Act still leaves an estimated 21 million without insurance.
Those individuals will continue to seek care at hospital emergency rooms and free clinics.
Essential Services and Coverage
The Act mandates that policies provide a variety of essential services, from medication and maternity benefits to mental health care. Office visits, preventative treatments, lab tests, newborn and pediatric care, hospitalization and emergency services will all be available under healthcare policies beginning in 2014.
Insurance companies can’t refuse insurance to individuals with preexisting conditions and adult children can remain on parental policies until they turn 26.
Families and the poor who meet income eligibility guidelines may be able to receive medical services through expanded state Medicaid programs. The Act assumed that individuals making $11,500 or less would automatically qualify for Medicaid
A ruling by the Supreme Court determined that participation in Medicaid expansion was optional. Many states chose to give up millions of dollars in federal incentives to expand Medicaid coverage.
Residents in states that don’t expand Medicaid coverage will have few choices – obtain insurance through an exchange or continue to do without medical coverage.
The Healthcare Marketplace And Subsidies
Also known as “marketplaces,” healthcare exchanges enable individuals to purchase their own healthcare coverage. Plan enrollment begins on Oct. 1, 2013, with policies going into effect on Jan. 1, 2014.
The marketplace for each state can be accessed online and buyers can choose from bronze, silver, gold and platinum coverage options, with varying premiums, deductibles and co-pays.
Some have mistakenly equated the term “affordable” with “cheap.” The Act doesn’t limit the amount that insurance companies can charge for their policies and many may discover coverage is still costly.
For those meeting federal financial guidelines, Obamacare provides subsidies to assist families and the poor purchase coverage through the exchanges.
Fines, Penalties And Stipulations
Obamacare extends healthcare to millions of new customers, but the Act also comes with built-in penalties and fines. Those who choose not to purchase insurance or can’t afford it, even with subsidies, will be assessed an income-based fine.
Those with employer-offered healthcare policies won’t be able to immediately ditch them in favor of more affordable options and subsidies through state marketplaces.
Individuals that choose to give up coverage through their employer will be required to wait a set amount of time before their marketplace policy becomes active and pays for services.
The Affordable Healthcare Act is a mix of coverage options, subsidies and penalties for families and the poor. It offers essential healthcare services through expanded Medicaid programs and state marketplaces, provides financial incentives to purchase through subsidies, and penalizes anyone who doesn’t have coverage.
Obamacare promises a nation where the majority of citizens have access to healthcare, paid for by those in more financially tenable positions.