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ACA Mandate Myths & How the Affordable Care Law Affects You
Last edited Sun Jul 1, 2012, 07:37 PM - Edit history (1)
Mandate mythsMyth 1: Everyone is required to buy insurance.
That’s not true. Over 80%* of Americans have insurance through their employers or receive insurance because they are in the military or are veterans or are poor or old. No one in these categories is required to buy individual insurance.
(Actually no one at all has to buy health insurance because, if they fall under that provision and don’t buy it, they can pay the penalty instead. The penalty is far cheaper than the cost of insurance.)
*81% of Americans under 65 have insurance. People over 65 have single-payer coverage; i.e., Medicare (with some holding additional private insurance).
Myth 2: People who don’t have insurance will be forced to buy insurance they can’t afford.
This is also untrue.
People with the lowest incomes are covered under Medicaid, which was expanded by the ACA for those with incomes up to 133% of the poverty level.
For those with incomes between 133% and 400% of the poverty level, subsidies are available so they can afford to buy health coverage in the new health care exchange.
There is a hardship exemption for those who don’t have insurance and say they can’t afford it.
And, as noted under myth 1, no one actually must buy health insurance, since they can pay the penalty instead.
(Please Go To Pollways Link For Other Myths, very informative)
That’s not true. Over 80%* of Americans have insurance through their employers or receive insurance because they are in the military or are veterans or are poor or old. No one in these categories is required to buy individual insurance.
(Actually no one at all has to buy health insurance because, if they fall under that provision and don’t buy it, they can pay the penalty instead. The penalty is far cheaper than the cost of insurance.)
*81% of Americans under 65 have insurance. People over 65 have single-payer coverage; i.e., Medicare (with some holding additional private insurance).
Myth 2: People who don’t have insurance will be forced to buy insurance they can’t afford.
This is also untrue.
People with the lowest incomes are covered under Medicaid, which was expanded by the ACA for those with incomes up to 133% of the poverty level.
For those with incomes between 133% and 400% of the poverty level, subsidies are available so they can afford to buy health coverage in the new health care exchange.
There is a hardship exemption for those who don’t have insurance and say they can’t afford it.
And, as noted under myth 1, no one actually must buy health insurance, since they can pay the penalty instead.
(Please Go To Pollways Link For Other Myths, very informative)
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ACA Provisions
How does the Patient Protection and Affordable Care Act (ACA) change health coverage in the U.S.?
The ACA makes dramatic changes to the way millions of Americans access health care. This comprehensive reform of health insurance attempts to make insurance more affordable, higher in quality and more accessible for people. It also expands Medicaid, imposes new responsibilities on individuals to purchase insurance and provides new incentives for employers to provide insurance for their employees. Together, these changes are estimated to expand coverage to 32 million people who were previously uninsured.
Insurance reforms
Beginning in 2014, the ACA requires health insurers to accept all applicants for insurance, regardless of their health status. In addition, insurers will no longer be allowed to charge higher premiums or exclude benefits because someone has a pre-existing condition. Most insurers will also be required to provide coverage that meets federal standards for benefits and cost-sharing.
As of September 23, 2010, a number of insurance reforms went into effect, including requiring insurers to:
Cover certain preventive services without deductibles or cost-sharing
Allow parents to keep adult children up to age 26 on their insurance
Cover all children under the age of 19, regardless of health status
Create an internal and external appeals process to handle consumer complaints and denials
Eliminate lifetime limits on benefits and significantly raise the annual limits for benefits (eventually it will also eliminate annual limits)
Spend a minimum of 80 percent of premiums on medical services and quality improvement
Justify unreasonable premium increases
Eliminate the practice of rescissions (when a health plan retroactively cancels coverage after the enrollee gets sick)
Allow patients to choose their health care professional as a primary care provide
The ACA makes dramatic changes to the way millions of Americans access health care. This comprehensive reform of health insurance attempts to make insurance more affordable, higher in quality and more accessible for people. It also expands Medicaid, imposes new responsibilities on individuals to purchase insurance and provides new incentives for employers to provide insurance for their employees. Together, these changes are estimated to expand coverage to 32 million people who were previously uninsured.
Insurance reforms
Beginning in 2014, the ACA requires health insurers to accept all applicants for insurance, regardless of their health status. In addition, insurers will no longer be allowed to charge higher premiums or exclude benefits because someone has a pre-existing condition. Most insurers will also be required to provide coverage that meets federal standards for benefits and cost-sharing.
As of September 23, 2010, a number of insurance reforms went into effect, including requiring insurers to:
Cover certain preventive services without deductibles or cost-sharing
Allow parents to keep adult children up to age 26 on their insurance
Cover all children under the age of 19, regardless of health status
Create an internal and external appeals process to handle consumer complaints and denials
Eliminate lifetime limits on benefits and significantly raise the annual limits for benefits (eventually it will also eliminate annual limits)
Spend a minimum of 80 percent of premiums on medical services and quality improvement
Justify unreasonable premium increases
Eliminate the practice of rescissions (when a health plan retroactively cancels coverage after the enrollee gets sick)
Allow patients to choose their health care professional as a primary care provide
Much more on ACA Provisions at community catalyst here
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For those that are uninsured
Without question, uninsured Americans will be most affected by health care reform. If you don’t have health insurance because you’re unemployed or don’t make enough to afford it, you’re going to get a subsidy to help cover the cost of coverage. The subsidy will be based on your income, but the result will be that at least 30 million people who couldn’t afford insurance will now theoretically be able to.
And if you have lingering doubts that this group of people really needed the government’s help, check out a couple of news stories we recently did about how the uninsured suffer:
This one is called Killer Hospital Bills: it’s about an uninsured woman went to the emergency room with stomach pains and emerged hours later with a $12,000 bill.
And here’s one about a senior citizen who had to file bankruptcy because of health costs.
So the news is good for uninsured Americans who needed and wanted coverage, but there’s another group of uninsured who may not be so happy: those that can afford insurance but choose to forgo the expense by going without. In an effort to encourage all Americans to have health insurance, beginning in 2014 these people will face fines for that kind of risk-taking. The proposed fine is 2.5% of income, up to $2,085, so the incentive to have insurance will be powerful.
Without question, uninsured Americans will be most affected by health care reform. If you don’t have health insurance because you’re unemployed or don’t make enough to afford it, you’re going to get a subsidy to help cover the cost of coverage. The subsidy will be based on your income, but the result will be that at least 30 million people who couldn’t afford insurance will now theoretically be able to.
And if you have lingering doubts that this group of people really needed the government’s help, check out a couple of news stories we recently did about how the uninsured suffer:
This one is called Killer Hospital Bills: it’s about an uninsured woman went to the emergency room with stomach pains and emerged hours later with a $12,000 bill.
And here’s one about a senior citizen who had to file bankruptcy because of health costs.
So the news is good for uninsured Americans who needed and wanted coverage, but there’s another group of uninsured who may not be so happy: those that can afford insurance but choose to forgo the expense by going without. In an effort to encourage all Americans to have health insurance, beginning in 2014 these people will face fines for that kind of risk-taking. The proposed fine is 2.5% of income, up to $2,085, so the incentive to have insurance will be powerful.
More at MoneyTalksNewshere
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This DHS site has some great information as well
Affordable Care Act: Opportunities for the Aging Network
http://aoa.gov/Aging_Statistics/Health_care_reform.aspx
Affordable Care Act: Opportunities for the Aging Network
http://aoa.gov/Aging_Statistics/Health_care_reform.aspx
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Link to the Affordable Care Act (Full Law) here
Link to Affordable Care Act (Amendments) here
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Here is a nifty tool from WaPo that you can use to determine how your family might be affected by ACA.
What does the Supreme Court's health-care ruling mean for me?
The court's decision to uphold all but one component of the health-care law means new rules for insurers that have already taken effect will remain in place. Beginning in 2014, virtually all Americans will have to obtain health insurance or pay a penalty. There also will be new opportunities to get coverage, including state-based marketplaces known as exchanges* (through which individuals will be able to purchase private plans that meet strict benchmarks for quality) and federal subsidies to help low-income people buy plans on the exchanges. The law will also expand the eligibility rules for Medicaid, but the Court found that states can not be penalized if they decline to comply with the expansion, raising questions as to how effectively the federal government will be able to implement it.
The court's decision to uphold all but one component of the health-care law means new rules for insurers that have already taken effect will remain in place. Beginning in 2014, virtually all Americans will have to obtain health insurance or pay a penalty. There also will be new opportunities to get coverage, including state-based marketplaces known as exchanges* (through which individuals will be able to purchase private plans that meet strict benchmarks for quality) and federal subsidies to help low-income people buy plans on the exchanges. The law will also expand the eligibility rules for Medicaid, but the Court found that states can not be penalized if they decline to comply with the expansion, raising questions as to how effectively the federal government will be able to implement it.
Take the quiz at the link and find out
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http://www.healthcare.gov/ is an excellent source of info and policy plans available to you.
Thank you Honeycombe8 for pointing out this one.
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The Affordable Care Act is a step in the right direction. With it in place I believe it will be easier to progress to single payer in the future. The purpose of this OP is for anyone who might not know what all is in the ACA and how it might affect them.
39 replies
= new reply since forum marked as read
= new reply since forum marked as read
thank you so much for that link! I'm going to add it to the OP
my deciding to respond here. I took the opportunity to read both of your replies in this sub-thread.
I hope that you will qualify for a subsidy or hardship. I hear you about debt, I think the Bush years have done a lot of damage to all of us in the middle class and the poor. The debt has piled up and I wish you much success decreasing your debt load.
Here's to hoping you qualify
On edit thank you for the link to the article above, I will read it.
You are correct in the link though
thank you
I hope it helps 
