Obama Health Law Fact Sheet

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OCTOBER 1 AFFORDABLE CARE ACT LAUNCH: FACT SHEET 

Insurance exchanges in all 50 states are supposed to be ready to enroll applicants in health insurance, provide subsidies to those who are eligible, and refer lowest-income applicants to Medicaid.

HOW MANY PEOPLE WILL GET COVERED?

The Congressional Budget Office predicts that 6 million people

will enroll in private health plans on the exchanges, and 9 million will enroll in expanded Medicaid.  The big increase in coverage is through Medicaid, not subsidized private health plans.

WHAT ARE EXCHANGES?

These are virtual marketplaces operated by the states (17 plus D.C.) or a federal/state partnership (7) or by the federal government (26 states). Each will have a toll free number, a website, and one or more DMV style offices manned with navigators, assistors, and in some cases, insurance brokers.

 WHO IS ELIGIBLE FOR A TAXPAYER-FUNDED SUBSIDY?

Individuals  and households earning up to 400% of poverty are eligible for a subsidy, which is paid directly to the insurer to reduce the monthly premium you owe. Some insured will also be eligible for help with out-of-pocket expenses such as paying deductibles and copays.  In 2014, individuals making $45,960, couples making $62,040, and households of 4 earning up to $92,200 are eligible for at least some sliding-scale subsidy.

WHO GAINS ACCESS TO MEDICAID?

That depends on what state you live in, your immigration status, and how much you or your household earns.  The Supreme Court ruled that states could opt out of the ACA Medicaid expansion.  As of mid-September 2013, 19 states and DC have opted in, including surprisingly, Arizona, despite Gov. Jan Brewer’s opposition to Obamacare, and New Jersey, where Gov. Chris Christie ® presides.

The other participating states are: California, Colorado, Connecticut, Delaware, Illinois, Maryland, Massachusetts, Michigan, Minnesota, New York, North Dakota, Oregon, Rhode Island, Vermont, Washington and Virginia. States still arguing about whether to expand: Hawaii, Kentucky, Nevada, Ohio, Indiana, Iowa (approved by Governor Branstad but still awaiting federal approval) Oklahoma, Pennsylvania. The Medicaid expansion offers coverage to single adults (many states previously offered it only to households and women with children) , and raises the household income eligibility to 133% of the federal poverty line.

Newly arrived legal immigrants are not eligible for Medicaid. There is a five year waiting period. But they are eligible for subsidies on the state exchanges, even if their household income is below 133% of poverty.

 WHAT ARE NAVIGATORS?

 Section 1311 of the ACA provides for navigators and assisters to encourage people to enroll in  insurance, and guide them through the enrollment process.  Federal and state grants have been made to community activists groups, unions, community health centers, soup kitchens, and civil rights and immigration advocacy groups, hospitals and public health departments to hire ‘navigators.’ Navigators are supposed to receive 20 hours of training.  Some states, such as Florida, Texas, and Ohio, have also imposed criminal background check requirements.

IS EVERYONE READY?

 Federal officials warn that the computer system that will tell applicants their monthly premium, after subsidy, may not be ready October 1.  The Federal Data Hub, which links the Department of Homeland Security, IRS, Department of Health and Human Services, and state agencies, is still being tested.  In addition, several states, among them California and Oregon, have said they will scale back their October 1 launches because of a lack of readiness.

WILL THERE BE STICKER SHOCK?

Premiums on the federal exchanges have not been released.  In the 16 states that have approved rates and announced them, premiums will be on average 24% higher than last year, according to a Manhattan Institute for Policy Research interactive map. In New York, however, rates may be lower or about comparable to what they were last year.

 


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