In my research for this article, I decided to do a short “grassroots” poll of various friends and former co-workers to see what they thought of “ObamaCare.” They ranged from custodial staff to engineers and administrators.
Some immediately said that it was socialism, and the country didn’t need tax dollars supporting people for free. Others said it was a good idea, and the government should be helping take care of people. A couple of people simply said, ‘I honestly don’t know anything about it.’ The interesting thing was that of the 10 people that I informally polled, only one person knew a few specifics, but still actually didn’t have enough information to make an informed decision. The majority couldn’t give me a specific detail about what the Patient Protection and Affordable Care Act, also known as ObamaCare, actually consisted of, or why they specifically approved or disapproved of it.
In January of 2014, some important provisions will become available under ObamaCare, some of which need to be prepared for beginning in October of this year. So, it’s important to have a basic idea of some of those provisions and how they will affect those here in California.
The Patient Protection and Affordable Care Act—popularly called ObamaCare—signed into law by President Barack Obama three years ago on March 23, 2010, is a multi-year program that immediately began phasing in various mandates to provide not only more affordable and accessible medical coverage for Americans, but to also ensure better health for people through preventative wellness care.
It is not a welfare program. The program is for all people who have not had access to medical insurance in the past either because it was too expensive, or because their employer did not offer it.
It also sets certain prohibitions on insurance companies. Some of the more immediate results that became effective in 2010 were:
• Insurance companies could no longer impose lifetime dollar limits on hospital stays
• Dependent children could remain on their parents insurance until age 26
• New insurance plans had to cover preventative care and medical screenings
• The elderly who are affected by the Medicare Part D coverage gap, which caused high out-of-pocket prescription costs, would receive a rebate of $250, and the gap would be phased out by the year 2020.
• The Affordable Care Act also prohibits insurance companies from dropping policyholders when they become sick, as well as prohibits the exclusion of children under 19 years old with a pre-existing medical condition.
• In January of 2014, insurance companies will no longer be able to exclude adults over age 19 with a pre-existing condition.
“The Affordable Care Act has been a strong step in the right direction toward removing one of America’s greatest shames—which is the lack of access to quality affordable healthcare for far too many citizens,” said Congresswoman Karen Bass, (D-Calif.). “We recently celebrated the third anniversary of the Affordable Care Act and already people in my district are benefiting from many of the key provisions, including young adults being able to remain on their parent’s healthcare until age 26.
“The healthcare law includes benefits to make Medicare prescription drug coverage more affordable and since the law was enacted, California residents with Medicare have saved nearly $400 million on their prescription drugs. Insurance companies are no longer allowed to discriminate based on pre-existing conditions such as diabetes or high blood pressure. Next year, Californians will continue to reap the benefits of this law as healthcare exchanges become available. Our challenge will be cutting through the demagoguery and making sure people understand all of the benefits that become available to them as a result of healthcare reform.”
Each year more mandates have been phased in for insurance companies and patient wellness. In 2014, that will also include requiring that each state either set up a “marketplace” to offer health insurance or have the federal government set one up for the state.
California is the first state to create a health benefit exchange in response to the passage of the Affordable Care Act. Beginning in October of this year, this “marketplace exchange,” named Covered California (www.CoveredCA.com) will offer a place where both small businesses and individual buyers can comparatively shop for health coverage. Indivi-duals will be able to look at various insurance plans and compare them before making a choice.
Open enrollment will start this Oct. 1 for effective coverage in 2014. An estimated 2.6 million Califor-nians will qualify for federal financial assistance. An additional 2.7 million will benefit from the coverage offered through Covered California. Depending on their financial status, individual buyers also could be eligible for a tax credit to offset the cost of coverage.
Open enrollment closes March 31.
The health plans offered in Los Angeles County are: Anthem, Blue Shield, Health Net, Kaiser Permanente, LA Care Health Plan and Molina Health Care.
Individuals who do not purchase health coverage will be assessed a penalty of 1 percent of their annual income or $95 which ever is greater, and this penalty will increase each year.
Those whose employers don’t offer minimum essential coverage and whose household incomes are 133-400 percent of the federal poverty level will qualify for federal subsidies to help them pay their insurance premiums or cost sharing obligations (e.g., co-insurance or co-payments) under a plan they purchase through a state exchange.
Small business owners will also be able to purchase competitively priced health plans and offer their employees the ability to choose from different plans; they may also qualify for federal tax credits. Small businesses that do not offer health insurance to employees will be subject to fines.
For small businesses, there are two phases of tax credits. From 2010 through the 2013 tax year, there is a tax credit for businesses with 25 or fewer full-time equivalent employees whose total salaries amount to $50,000 a year or less. During this first phase, small businesses may be eligible to receive a 35 percent healthcare tax credit for coverage purchased.
If you have job-based health insurance you like, you can keep it. You’re considered covered. Any job-based health plan you currently have qualifies as minimum essential coverage. You may be able to change to marketplace coverage if you prefer, but there are several important things to consider:
• With most job-based health insurance plans, your employer pays a portion of your premiums. If you choose a marketplace plan instead, your employer does not need to make a contribution to your premiums. You should consider this carefully before comparing marketplace plans.
• If you decide to check out marketplace plans, be aware that you may not qualify for lower costs on your monthly premiums and out-of-pocket costs, even if your income would qualify you otherwise.
• Whether you qualify will depend on what kind of coverage your employer offers. If your job-based coverage is considered affordable and meets minimum value, you won’t be able to get lower costs on premiums or out-of-pocket costs in the marketplace. This is true no matter what your income and family size are.
• Your employer can tell you whether the insurance plan it offers meets minimum value and can provide you with information to determine if the plan is considered affordable to you.
• If you do not qualify for lower costs in the marketplace, and your employer does not pay part of your premiums on the marketplace, be sure you take these things into account before you consider choosing a plan other than your employer’s.
Starting in 2014, the tax credit increases to 50 percent and is available for two consecutive years. The Small Business Health Options Program (SHOP), also offers plans to small business owners, which can be purchased directly, or by using an insurance broker. (More information can be found at www.HealthCare.gov) Employers that have more than 200 employees must enroll new full-time employees in medical coverage.
An employer that has more than 50 employees and offers coverage that is unaffordable or doesn’t meet the minimum essential coverage and is found to have an employee who receives the premium assistance tax credit because their coverage is unaffordable or does not cover 60 percent of the total cost, then the employer will be fined the lesser of either $3,000 for each of the employees receiving a credit, or $750 for each of their full-time employees. Also, to qualify for any tax credit, an employer must pay at least 50 percent of the employee premium costs.
When the next phase of the program begins in 2014, and more people are able to sign up for and take advantage of better healthcare coverage, there is a concern that there could be a shortage of medical personnel, both doctors, and mid-level health professionals, such as nurse practitioners and physician’s assistants, to cover the increased number of patients.
According to Jim Mangia, president and CEO of St. John’s Well Child and Family Center in Los Angeles, “The big issue that we have to tackle is: how are we going to train and bring more primary-care providers to South Los Angeles? There is a shortage of providers and there is a concern that in 2014 it will be exacerbated by the increasing numbers of folks with pre-existing conditions who are eligible for health insurance.
“We are on an intensive recruitment; we are gearing up for ObamaCare. The issue is, are there enough providers out there? Certainly it’s a very competitive hiring environment. There really is nobody addressing the question of recruiting primary-care providers. There is a law being proposed by Sen. (Ed) Hernandez that would allow mid-level practitioners, such as nurse practitioners and physician assistants to provide more services.”
(Sen. Hernandez introduced a package of bills—SB 491-493—that passed the Senate and are currently in the Assembly Committee on Business, Professions and Consumer Protection in order to prepare for the increase of patients due to the coverage of pre-existing conditions. One bill is that nurse practitioners could be allowed to see patients if the doctors they worked for could not, and pharmacists could order blood tests to detect illnesses like diabetes.)
A modified federal student loan program meant to ease financial criteria for schools and students, is another provision under the Affordable Care Act. It is designed to draw more students into the healthcare profession. Loan repayment programs are being offered in exchange for working at least three years at a federal, state, local or tribal public health agency, as well as to health professionals employed at public health agencies or other settings that provide healthcare. Repayment programs have also been established for pediatric sub-specialists and providers of mental and behavioral health services for children and adolescents.
There are people who will not be eligible for this coverage. Undocumented immigrants, approximately 8 million people, will not be eligible to purchase insurance, nor will they be able to claim tax credits. People who have not enrolled in Medicaid (Medi-Cal is the name of the Medicaid program used in California) even though they may be eligible for it and people who have decided to take the option to pay the annual penalty rather than have the medical coverage would not be eligible.
For more information on the Patient Protection and Affordable Care Act, there are a number of helpful websites. The Department of Health and Human Services (www.hhs.org), Covered California (www.CoveredCA.com), www.ObamaCareFacts.com. For small businesses, there is www.healthcare.gov, and www.irs.gov.