US Shutdown health law article

While Congress continues to create cliffhangers over whether the Affordable Care Act will be de-funded, we are continuing with our series on the implementation of the Affordable Care Act. This is Part 4.  Part 1 is here; Part 2 is here and Part 3 is here.

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When: The exchanges are scheduled to open for business on Oct. 1, 2013, with coverage to enter into force Jan. 1, 2014. The exchanges are also to be open through March 31, 2014, so anyone who doesn’t get done in time for the Jan. 1 grand opening will still have plenty of time to sign up and avoid a penalty.

This is handy, because it’s clear that some of the exchanges will be open only on a limited basis on Oct. 1, because of the challenges of building the technically complicated systems. Also, activity in Congress pretty much assures that there will be confusion on opening day, though some of the states are likely to press ahead anyway because of what they have in place.

“It’s looking more and more like Tuesday will be a split-screen day: The government will shut down, and Obamacare will open for business,” Politico wrote.

To get covered starting Jan. 1, you’ll generally need to sign up by Dec. 15.

Where: The idea is that people  who currently are not insured by employers or by the government

(Medicare, Medicaid) will buy insurance on the health insurance exchanges. These are virtual marketplaces set up with an extensive online presence showing the range of options, making the choices easy to compare.

But. It couldn’t be that easy. Insurance and health-care coverage are a mix of state and federal jurisdictions. Also, the Affordable Care Act raised a lot of opposition, particularly from Republican governors or legislatures in the states who wanted nothing to do with it. Also, the technology is complicated. So some of the states  didn’t set up their own exchanges. By law, that means that they effectively delegate to the federal government the running of their exchanges.

Not sure where your state’s exchange is? Find it here.

Want to know the rates in your state? Here’s a handy state-by-state update from Kaiser Health News.

If you have not been able to buy coverage because it’s been too expensive, the act is supposed to rectify that by offering subsidies based on income and family size; see the subsidy calculator here.

Planning to go without, or wondering if you should? This calculator tool walks you through some of the calculations of what penalty you might expect.

Do you have to do this at all? Maybe not. We’ve covered such topics in previous parts of the series, or, take a look here: The most important points of the Affordable Care Act, collected into two pages, in a complete once-over-lightly.

Also, many insurance companies have chosen not to take part in the exchanges, and are selling their insurance policies separately. While there are many big players off the exchanges in all states, a recent study by the health information company HealthPocket found that the premiums off the exchanges could be cheaper – and yet, those off-exchange policies will not be eligible for a subsidy.

So if you don’t qualify for a subsidy, you might find a better deal off the exchanges.

Anybody can buy insurance on the exchanges, but people with employer-sponsored health care will have little or no reason, same as people on Medicare or Medicaid. The exchanges generally are designed to make insurance buying easy for people who are uninsured, or who buy their insurance themselves. The only people specifically barred from the exchanges are immigrants who are undocumented.

Why: Health care costs are out of control, running $2.7 trillion annually. We spend more per-capita than any other nation in the world, and it’s a bigger part of our GDP than it is for any other nation in the world. And yet, nearly 50 million people are uninsured. Making insurance available and affordable for everybody was one of the biggest goals of the act.

More questions? Here’s a thorough roundup from the folks at Kaiser.

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Today’s tip: There’s a lot of information, and a lot of misinformation, flying around about the Affordable Care Act:   (“Ohmygosh, your premiums will be really really high” or  “The whole system is failing” or  “Buy this, it’s perfect for you” or “Quick, renew your old insurance right now so you don’t have to go under Obamacare.”).

Make sure the source of your information is independent and doesn’t profit from you. Don’t believe everything you’re told. Do your research. Inform yourself.

The federal government’s site is

Want a non-government source? We’ve already mentioned the Kaiser Family Foundation, but there are also other resources in the states.

A good clearing house for state-by-state updates is the National Council on State Legislatures, which has a health information page here.

The National Women’s Law Center has a lot of information about what the law means, and what you can do if you think you’re not getting what you’re supposed to get. Here’s a fact sheet on LGBT issues, for example; here’s one on women’s preventive services and coverage under the ACA. Here’s a step-by-step fact sheet on what to do if you think your plan should be covering birth-control pills but does not; these suggestions could be transferred to other situations as well.

Jeanne Pinder

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...