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Understanding the Affordable Care Act and the new insurance marketplaces.

July 25, 2013

There has been much said about the Affordable Care Act (or Obamacare), probably as much false as true.  Misconceptions are rampant, in no small part because of the misinformation spread by political opponents of the Obama administration.  In order to cut through the fog and find out what the ACA actually means to you, you can find a wealth of information on the federal government’s site, HealthCare.gov.  This site is also available in Spanish and resources are provided for speakers of many other languages such as Creole, Tagalog, Chinese, Polish, etc.  Press the “Start Now” button on the screen and answer a few questions and you will be taken to a screen that explains how to access the Marketplace in your state or the federal marketplace if you live in a state which has opted out from creating their own marketplace (such as my home state, Texas).  This screen will also feature questions and answers tailored to your demographic information.  You can even sign up to get email updates about the insurance marketplace here.

A link to a short animated video about ACA was posted on a health care related forum I read which I found to be a nice succinct explanation, though not detailed.  Regardless, it’s pretty cute and very easy to understand.

This video was written and produced by the Kaiser Family Foundation and narrated by Charlie Gibson, July 17, 2013.

Marilyn Tavenner, an administrator at Medicare and Medicaid Services, published a blog on the Health and Human Services (HHS) website this month entitled Myth vs. Fact: Health Insurance Marketplace on Track.  This article discusses details of the opening of the federal insurance marketplace and policy around it.

Misconceptions still abound as to the scope and effects of the Affordable Care Act.  I met a woman a few months ago who is Medicare age.  She was a full time RV’er and had been for several years.  She told me she had decided she needed to sell her RV and get a job because of Obamacare.  I did not pursue the conversation farther, but I’m assuming she believed care under Medicare was going to change drastically.  This type of misconception is widespread.  I have received dire warnings from some friends of a more conservative bent regarding my Medicare benifits set to start next year.  In reality, some services are going to be covered that were not covered before or at a higher rate, costing Medicare patients less.  The drug benefit, Medicare part D has already changed for the better, giving patients discounts on brand name drugs once they have reached the “donut hole”, thus reducing their costs.  The law also provides for closing the donut hole by 2021. For an explanation of the donut hole see my article, The mystery of the donut hole.

Many people fear they will not be able to afford insurance required by the “individual mandate.”  There will be government subsidies available to help lower income people with premiums.  See this page for income cutoffs for help with premiums.  In addition, insurance companies will not be able to deny coverage to people with pre-existing conditions or charge them higher rates.  Women will no longer be charged higher rates than men.  There may be some premium adjustments that occur because of these requirements, however one should keep in mind that employer provided coverage at big companies has been offered regardless of pre-existing conditions  for years.  My rates at some of the large corporations I worked for (such as HCA) was quite affordable.

The Medicaid expansion will raise the income allowed for people to obtain coverage to 133% of the federal poverty level for people under 65.  Of course if you live in a state that has opted out of the Medicaid expansion (such as Texas) this does not apply.  For more information on the Medicaid expansion, see the information provided on the  Medicaid.gov  eligibility page.

Overall, we should see more people getting better health care under the provisions of the ACA.  It’s not a perfect solution to the problems in our health care system, but it does something to help the millions of people who are unable to obtain needed care today.  Personally, I think it would be far cheaper and more efficient to offer Medicare coverage to everyone who wants it, but that’s not happening anytime soon.

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