In 2010, the Obama administration signed the Affordable Care Act (ACA), enacting several important health reforms. A key provision of the act is an individual mandate that will come into effect in 2014. The individual mandate is a law that would require all legal residents of the United States to have health insurance. Individuals who fail to secure coverage will be taxed a penalty that would depend on their income level, with exemptions for those experiencing financial hardship.
The individual mandate has been a very contentious part of the ACA; consequently, a majority of states collectively challenged the constitutionality of the act in federal court. On Thursday, June 28th, the Supreme Court upheld the ACA, with one significant caveat. The Supreme Court ruled that while the ACA was constitutional, the federal government could not penalize states by withholding Medicaid funds if they didn’t comply with the individual mandate provision of the law. With the penalty for non-compliance removed, individual states may decide whether or not they will respond to the numerous financial incentives provided by the Federal government to expand Medicaid coverage in their state.
It is important to note that the ACA contains numerous provisions, including linking Medicaid reimbursement rates to quality measures, prescription discounts for Medicare enrollees and providing generous incentives to providers for the adoption of electronic health records. However, each provision of the ACA warrants an article of its own, so for the purposes of this article, I will be limiting the discussion to the individual mandate.
In order to better understand the individual mandate, here is a brief overview of its provisions:
Medicaid Expansion: A central goal of the ACA is to make health insurance available and affordable to more people. This will be achieved, in part, by expanding Medicaid to include more low-income residents. However, many uninsured people will not qualify for public health insurance coverage and will be required to seek private health insurance.
Health Insurance Exchanges: Buying insurance as an individual is much more expensive than buying it as a group. For example, the rates offered to individuals are typically higher than the rates offered to organizations purchasing insurance for many employees. To help overcome this problem, states will create insurance exchanges, a ‘one-stop shop’, where individuals can compare health insurance rates for different companies and buy as a group for even better rates. In addition, enrollees will get tax credits for purchasing insurance through these exchanges.
Preexisting Conditions: Private insurers will not be able to reject people or limit benefits based on pre-existing conditions.
Employer assistance: Most large employers will be required to provide health insurance to their workers and smaller employers will receive financial incentives to encourage them to provide coverage to their employees.
A key aspect of the status quo that the ACA does not change is that Medicare and Medicaid will continue to be accessible only to those people who are either American citizens, or have been legal residents of the United States for the last 5 years.
It is clearly a transformative era in the healthcare world and healthcare advocates across the nation are elated about the potential that the ACA has to improve the healthcare delivery system. It is now up to the states to decide if and when they adopt the individual mandate provisions, and as such, implementation of the ACA is going to look very different from state to state.
As the ACA is likely to impact a significant proportion of US residents, it is important to understand its provisions. Providers can benefit greatly from taking part in the information technology incentive programs. Employers should find out about the incentives they can secure for providing coverage for their employees and be aware of penalties that may occur for having uninsured employees. Medicare recipients should find out about the enhancements to their coverage. Finally, those who are working with the uninsured or are themselves uninsured should familiarize themselves with the individual mandate and how it is being implemented in their state.
Khadija Gurnah, MPH has worked on Medicaid retention and enrollment for the last three years. Currently she works as a consultant who works primarily on developing IT infrastructure for public health organizations. She can be reached at kgurnah@zanoora.com or at www.zanoorablog.com.
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I have a friend who sure has been cghuat in this situation a high-income professional (in high tech industries in another state) who recently went back to work after a year and a half unemployed. This person’s spouse has been been out of work even longer and has chronic health problems that would put him in a high risk category in the individual insurance market, but he isn’t getting any kind of disability related health care. They had already run out of federal premium subsidy for COBRA (part of the one-time stimulus law) and were on the verge of running out of COBRA benefits when my friend finally landed contract work. They are now paying for an expensive individual policy. They can afford it because of the new income, but the job is only guaranteed to last a few months and it is not employment with benefits so it will not re-start the clock on COBRA. They are now repaying large debts to relatives that allowed them to keep up mortgage payments and pay for health coverage, but what would happen in a family where there are no relatives able to lend tens of thousands of dollars during this period, and what will happen if there’s another period of unemployment? This is a family where better options for health coverage outside the current crazy individual coverage market could make the difference between a long-time comfortable lifestyle and a fast, horrifying slide to no longer being in the middle class. This friend’s debt load would be much larger if she didn’t have a huge amount of organizational and negotiating skill. Her husband had a hospitalization while they WERE covered under the COBRA policy, but that policy was pretty slim and the uninsured costs were extremely high. She had the savvy to promptly, politely and assertively negotiate the remaining bill, inquire how it fit into the hospital’s charity care policy, and greatly reduce the amount owed. This was a real change for her because the idea of needing charity was an eye-opener. How many of us would have all those skills in the midst of lots of other economic and health threats? I wouldn’t want to be there.
The answer is that it doesn’t cost less ..if you don’t cenisdor what the employer is paying. That’s why so many people think COBRA is expensive. COBRA isn’t expensive, it’s just that when you continue your group plan under COBRA it’s the same plan, at the same cost (plus maybe 2% for admin), but it seems expensive because your employer is no longer contributing.Individual plans ARE CHEAPER than group because you can be turned down. In group plans nobody can be turned down, so the cost to cover all the health problems escalates.The biggest mistake people make is assuming that their work coverage is more competitive without shopping. It’s not uncommon, especially for young, health people, to be able to get cheaper plans on their own even when the employer is picking up half the cost.Finally, most small companies will just have their employees buy individual plans because it’s a fraction of the cost .though either way it’s always nicer when someone else is picking up the tab.
Weight loss pills aren’t generally coerndised standard treatment for weight loss and most of the time, they flat out don’t work. That’s why NO insurance will cover it.If you want to lose weight, the FREE method, is changing the types of food you eat, and the quantities, and increasing your physical activity levels.If you want to do something, but you want to do the EXPENSIVE version of it, that doesn’t work very well, AND you want someone else to PAY for it . . .then you really don’t want to do it very much.