The Affordable Care Act became law in March of 2010. It is the most significant healthcare reform law enacted since the Medicare Program in the mid-1960s and is arguably even more significant and far-reaching than that program.
A number of features of the law have already become effective, such as the ability of adults up to age 26 to be covered under their parents’ health insurance policy and the elimination of co-insurance for certain preventative care services.
But 2014 is the year for some of the most significant provisions of the ACA to be implemented – the individual mandate and the offering of insurance, along with subsidies or tax credits for those who qualify, through internet marketplaces called health insurance exchanges.
It was to be the year for even more extensive changes, but the employer mandate was delayed until 2015. And while it was contemplated under the law that all states would be expanding their Medicaid programs in 2014, the U.S. Supreme Court ruled that this provision was unconstitutional. States cannot be coerced into expanding their Medicaid programs but may do so voluntarily, and then may be eligible for additional federal funding.
About 7 million people are anticipated to buy insurance coverage through the health insurance exchanges next year across the country. In Idaho, nearly 200,000 of the estimated 255,479 uninsured are anticipated to enroll for coverage.
About 85 percent of those are expected to qualify for federal subsidies or tax credits, based in part upon their incomes and family size. Those who earn between 100 percent and 400 percent of the federal poverty level will qualify. The subsidies are only available for purchases of health insurance through the insurance exchanges.
In anticipation of Jan. 1, exchanges are to open enrollment and list plan offerings as of today, Oct. 1. Individuals will be required to have health insurance next year or pay a tax penalty when they file their taxes by April 15, 2015.
States had the option to adopt the federal exchange, create their own state-run exchange, or participate in a state-federal partnership. Idaho elected a state-based exchange and is using the federal information technology hub until it is able to operate the exchange on its own, targeted to be Oct. 1, 2014. The Idaho health insurance exchange has been named “Your Health Idaho,” and you can find it at www.yourhealthidaho.org.
Most people who have insurance through their employer are ineligible for subsidies under the health insurance exchange. The only exception is if the employer’s health plan does not cover at least 60 percent of medical costs or if the employee’s share of costs would exceed 9.5 percent of his or her income. Those on traditional Medicare do not need to go to the insurance exchange to continue coverage.
Health plans offered through the exchange are divided into four categories, based upon the portion of medical costs covered by the plan or the individual’s cost share responsibility. Offerings are, in general, less generous in their coverage than employer-sponsored insurance.
The categories are:
Here’s what to know:
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.