Image by Kevin Simmons via Flickr Creative Commons. Stock Photo from Mayberry Health and Home: www.mayberryhealthandhome.com

Patient Protection and Affordable Care Act

By Dan Yaseen

What Is Obamacare?

The Patient Protection and Affordable Care Act, also known as Obamacare and the Affordable Care Act (ACA), was signed into law by President Barack Obama on March 23, 2010. It represents the most significant overhaul of the country’s healthcare system since the passage of Medicare and Medicaid in 1965.

Although the Affordable Care Act was signed into law in 2010, the healthcare reforms it enacts roll out year by year starting in 2014 with the final stage in 2022.

There are more than 50 million Americans who currently have no health insurance; in California, the number is more than 7 million. One of the objectives of Obamacare is to help these individuals get health insurance by expanding Medi-Cal and offering tax assistance to people who cannot afford health insurance.

Health plans will be offered through health insurance exchanges. California’s exchange is Covered California (www.coveredca.com) and offers ACA plans in the state. There is a wealth of information at its Web site.

Covered California will offer 13 health plans across the state, but only three companies—Anthem Blue Cross, Blue Shield and Kaiser—will offer plans in Fresno, Kings and Madera counties. In Mariposa, Merced, San Joaquin, Stanislaus and Tulare counties, Health Net will also be available. Each company will offer health plans with four different tiers: bronze (60% coverage), silver (70%), gold (80%) and platinum (90%).

The following benefits must be included under all insurance plans:

  • Hospitalizations
  • Ambulatory and outpatient care
  • Emergency services
  • Maternity care
  • Mental health services
  • Pediatric care
  • Laboratory services
  • Preventive care
  • Rehabilitative and habilitative services
  • Vision and dental care for children
  • Prescription drugs

Individuals and families who earn between 138% and 400% of the federal poverty level will be eligible for sliding-scale tax credits. This year, 400% equals $45,960 for an individual or $94,200 for a family of four.

ACA’s open enrollment period will run from Oct. 1, 2013, through March 31, 2014. If you don’t sign up by March 31, 2014, you will incur a penalty. In 2014, the penalty will be $95 per adult or 1% of family income, whichever is greater. The penalty will increase every year until 2016, when it will be $695 or 2.5% of family income.

Here are some of the most important objectives of Obamacare:

  • Increase the quality and affordability of health insurance.
  • Lower the number of uninsured by expanding public and private insurance coverage.
  • Reduce the cost of healthcare for individuals.
  • Improve the quality of care that Americans receive by providing better preventive care with no co-payments or deductibles.
  • Eliminate preexisting conditions and gender rate discrimination.
  • Regulate the health insurance industry and reduce spending on healthcare.
  • Provide tens of millions of low-income and middle-income Americans with access to quality healthcare by providing discounts and tax credits.
  • Allow parents to keep their young-adult children on their insurance policies up to age 26.
  • Prevent insurance companies from dropping you when you are sick.

Individual Mandate

You are exempt from buying coverage if you are on Medicare or Medi-Cal; have VA benefits, Tricare or employer group insurance; or if you have individual insurance that is at least as good as bronze coverage. All other citizens and legal residents are required to purchase health insurance, apply for Medi-Cal or pay a fine.

Undocumented immigrants are ineligible for Covered California plans.

People with Medicare

Medicare will not be affected by the ACA. Medicare benefits will stay the same, and Medicare beneficiaries do not need to contact Covered California.

However, people with Medicare should consider reviewing their insurance during the Annual Election Period (AEP) for Medicare beneficiaries. This year, it will run from Oct. 15 to Dec. 7. Not all Medicare plans are the same, and depending on your current needs, it might be to your benefit to make a change.

During the AEP, Medicare beneficiaries can do the following:

  • Change to a Medicare Advantage Plan from Original Medicare and vice versa.
  • Change your Medicare Advantage Plan.
  • Join a Medicare Part D Plan.
  • Change your Medicare Prescription Drug Plan.
  • Opt out of Medicare Part D coverage completely.

Employer Mandate

The ACA’s employer mandate requires that all businesses with more than 50 employees offer “affordable and adequate” insurance to employees working a minimum of 30 hours as of Jan. 1, 2015.

Businesses with fewer than 50 employees are not required to provide health insurance to their employees under Obamacare. They can provide health insurance or do nothing. The employer and the employees may qualify for the individual ACA tax subsidies. If these employees buy insurance outside the insurance exchange they will not qualify for tax benefits.

Employers with less than 25 full-time employees may qualify for tax credits, tax breaks and other assistance for offering employer-sponsored healthcare to their employees.

Ethnic Minority Help

Many local organizations serving communities of color will provide assistance with Obamacare. These groups include Fresno Metro Ministry, Fresno Interdenominational Refugee Ministries (FIRM), Centro La Familia, Centro Binacional para el Desarrollo Indígena Oaxaqueño, California Rural Legal Assistance and ACT for Women and Girls. Several local groups are working with the California Pan-Ethnic Health Network (CPEHN) of Oakland (www.cpehn.org; Ruben Cantu, 510-832-1160 x301 or rcantu@cpehn.org).

Now It’s Up to You

Insurance is not the most exciting topic. But beginning this year, most of us are required to have healthcare insurance. Not doing so can result in inescapable financial penalties. The choices you make will determine the cost of your premium and the benefits you receive. I urge you to take time to be informed.

For more information, visit Covered California at www.coveredca.com and check out Barbara Anderson’s articles in the Fresno Bee: www.fresnobee.com/2013/09/07/3485593/starting-oct-1-thousands-in-valley.html and www.fresnobee.com/2013/09/07/3485594/decisions-making-the-right-choice.html.

*****

Dan Yaseen is on the editorial board of the Community Alliance newspaper. He is an independent health and life insurance broker. Contact him at danyaseen@comcast.net or 559-251-3361.

  • The Community Alliance is a monthly newspaper that has been published in Fresno, California, since 1996. The purpose of the newspaper is to help build a progressive movement for social and economic justice.

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