- Posted June 24, 2012 by
This iReport is part of an assignment:
What Happens If ACA Overturned Or Upheld?
The nation waits. Business waits. Lawmakers wait.
For President Barack Obama and presumptive Republican presidential nominee Mitt Romney the wait may seem like an eternity. The outcome of the Supreme Court's decision on the Affordable Care Act could determine the fortunes of both men.
As we wait to learn the fate of the ACA, the Kaiser Health Foundation has provided a nice Q&A on what to expect whether the President's signature domestic legislation rises or falls when the Supreme Court renders its decsion expected for this week.
1. I understand that the Supreme Court is reviewing the health law. Will the ruling change my current insurance?
The Supreme Court’s decision should have minimal impact on your current health insurance. But if the court strikes the law down, insurers might decide to change some provisions of your coverage that were mandated by the law, such as allowing an adult child to stay on your policy under age 26 and requiring insurers to provide some preventive services at no out-of-pocket-cost to you.
2. I don't have health insurance. Under the law, will I have to buy it and what happens if I don't?
Right now, you are not required to have health insurance. But beginning in 2014, most people will have to have it or pay a fine. For individuals, the penalty would start at $95 a year, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016.
For families the penalty would be $2,085 or 2.5 percent of household income, whichever is greater by 2016 and beyond. The requirement to have coverage can be waived for several reasons, including financial hardship or religious beliefs.
3. I get my health coverage at work and I'd like to keep my current plan. Will I be able to do that? How will my plan be affected by the health law?
If you get insurance through your job, it is likely to stay that way. But, just as before the law was passed, your employer is not obligated to keep the current plan and may change premiums, deductibles, co-pays and network coverage.
4. What are some other parts of the law that are now in place?
You are likely to be eligible for preventive services with no out-of-pocket costs, such as breast cancer screenings and cholesterol tests.
Health plans can't cancel your coverage once you get sick – a practice known as "rescission" – unless you committed fraud when you applied for coverage.
Children with pre-existing conditions cannot be denied coverage (this will apply to adults in 2014).
Insurers will have to provide rebates to consumers if they spend less than 80 to 85 percent of premium dollars on medical care.
Some existing plans, if they haven't changed significantly since passage of the law, do not have to abide by certain parts of the law.
5. I want health insurance but I can’t afford it. What will I do?
Depending on your income, you might be eligible for Medicaid, the state-federal program for the poor and disabled. Currently, in most states nonelderly adults without minor children don't qualify for Medicaid. But beginning in 2014, anyone with an income at or lower than 133 percent of the federal poverty level, (which currently would be $14,856 for an individual or $30,656 for a family of four) will be eligible for Medicaid (based on current poverty guidelines).
6. What if I make too much money for Medicaid but still can't afford to buy insurance?
You might be eligible for government subsidies to help you pay for private insurance sold in the state-based insurance marketplaces, called exchanges, slated to begin operation in 2014. Exchanges will sell insurance plans to individuals and small businesses.
7. Will it be easier for me to get coverage even if I have health problems?
Insurers will be barred from rejecting applicants based on health status once the exchanges are operating in 2014.
8. I own a small business. Will I have to buy health insurance for my workers?
No employer is required to provide insurance. But starting in 2014, businesses with 50 or more employees that don't provide health care coverage and have at least one full-time worker who receives subsidized coverage in the health insurance exchange will have to pay a fee of $2,000 per full-time employee. The firm's first 30 workers would be excluded from the fee.
However, if you have a firm with 50 or fewer people you won't face any penalties.
9. I'm over 65. How does the legislation affect seniors?
The law is narrowing a gap in the Medicare Part D prescription drug plan known as the "doughnut hole." That's when seniors who have paid a certain initial amount in prescription costs have to pay for all of their drug costs until they spend a total of $4,700 for the year. Then the plan coverage begins again.
That coverage gap will be closed entirely by 2020. Seniors will still be responsible for 25 percent of their prescription drug costs.
The law also has expanded Medicare's coverage of preventive services, such as screenings for colon, prostate and breast cancer, which are now free to beneficiaries. Medicare will also pay for an annual wellness visit to the doctor.
The health law reduced the federal government's payments to Medicare Advantage plans, run by private insurers as an alternative to the traditional Medicare. Medicare Advantage costs more per beneficiary than traditional Medicare. Critics of those payment cuts say that could mean the private plans may not offer many extra benefits, such as free eyeglasses, hearing aids and gym memberships that they now provide.
10. Will I have to pay more for my health care because of the law?
No one knows for sure.
11. Has the law hit some bumps in the road?
Like any major piece of legislation, some aspects have not worked out as well as its authors intended.
For example, the law created high-risk insurance pools to help people purchase health insurance. But enrollment in the pools has been less than expected. As of March 31, 61,619 people had signed up for the high-risk pools, but the program, which began in June 2009, was initially expected to enroll between 200,000 to 400,000 people. The cost and the requirements have been difficult for some to meet.
Another feature of the law that hasn't worked as envisioned is its long-term care provision. The Community Living Assistance Services and Supports program (CLASS Act) was designed for people to buy federally guaranteed insurance that would have helped consumers eventually cover some long-term-care costs. But last fall, federal officials effectively suspended the program even before it was slated to begin, saying they could not find a way to make it work financially.
From the Cornfield, whether the Court upholds the law, throws out part of the law or rules the whole law unconstitutional, the outcome may have a defining effect on the presidential election.