Healthcare Reform: In, Out, Delayed?

Healthcare Reform: In, Out, Delayed?

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by Jonathan Schulman on 07/04/2013Leave a Comment
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Three years ago, the Affordable Care Act was signed into law with the main goal of extending health coverage to the more than 30 million uninsured people in this country.

How has the Affordable Care Act changed since it was initially signed into law?


When the Affordable Care Act was signed into law, it included a proposal to provide basic long-term care insurance at an affordable cost. Before the program ever got off the ground, it was dropped after final cost estimates proved it would be unsustainable.

COVERAGE FOR THE NEEDIEST? Only in some states.

The law envisioned millions of the neediest Americans gaining health insurance by enrolling in Medicaid, with coverage starting in January. However, the Supreme Court threw a wrench in that plan last year when it gave states the right to opt out of the Medicaid expansion plan. Currently it looks like nearly 2 in 3 of those who would qualify for new Medicaid coverage may be out of luck because their state lawmakers have not agreed to expand the program.

WHAT ABOUT WORKERS? A longer wait.

The law requires companies with 50 or more workers to offer affordable coverage to full-time employees or risk a series of escalating tax penalties. Originally, that requirement was supposed to take effect on Jan. 1, 2014. However, the administration is pushing that requirement back a year, citing the complexity of the undertaking. Most medium and large business already offer health insurance. Those most likely to be affected by the delay: low-wage workers at hotels, restaurants and stores.

WHAT’S LEFT? Plenty.

Starting next year individuals will be required to carry health insurance or face fines. People who are uninsured will be able to shop for affordable coverage through online marketplaces. Middle-class people who don’t have coverage through their jobs will use the marketplace to apply for tax credits to help pay their premiums. Low-income people will be steered to the Medicaid expansion — if their state participates. Insurance companies will be required to accept people regardless of their medical problems. A number of other changes already have taken effect, including a provision that allows young adults to stay on their parents’ insurance until age 26 and a ban on lifetime limits on insurance coverage.

CONCERNS?  Subsidy funding for 2014.

The “Pay or Play” provision, now delayed until 2015, which penalized employers not providing minimum value and affordable coverage was designed to create revenue.  This revenue would be used to help provide subsidy dollars to individuals whose income falls within 400% of the federal poverty level.  Since the exchanges are still due to open in January 2014, we have to wonder where the subsidy dollars are going to come from since a major source of that funding has been delayed.  We’ll have to wait and see.

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