You may have been hoping you could ignore the topic of health insurance, but Oct. 1 is almost here, and with it the new health insurance landscape brought by the Affordable Care Act. And we’re going to help you navigate through it.
Here is an outline of what we’ll write about, basically a handbook on how to buy health insurance. We’ll also include tips, tools and so on. Don’t feel like reading? Here’s a video from the Kaiser Family Foundation.
Who: Everybody. The Affordable Care Act, also known as Obamacare or the Patient Protection and Affordable Care Act (PPACA), seeks to cover everybody with some form of health insurance. Even if you don’t have employer-sponsored insurance, or parent-sponsored insurance, and you don’t feel the need for it, you’ll have to buy it or face a penalty, with a very few exceptions.
Employer-sponsored health insurance is changing too, but in ways that are less visible. We have
talked a bit about that elsewhere; that’s not the focus of this series, and the 125 million or so people covered by employers will be less interested in parts of this series.
If you have insurance now that is not employer-sponsored – Freelancers Union, or an individual policy like mine through GHI/Emblem Health – you’ll probably have to replace it with a new plan, maybe one from the new exchanges.
If you have not been able to buy coverage because it’s been too expensive, the act is supposed to rectify that. It’s particularly important for people with pre-existing conditions, who have found insurance prohibitively expensive. Many people with pre-existing conditions either go without insurance or are covered by a mélange of state and federal programs.
Planning to go without? We’ll talk about that too – there’s no way of knowing how many people will skip it entirely. There are about 51 million uninsured people in the country, and they’ll be urged to buy; about 15.4 million others buy their own health insurance because they’re self-employed, or otherwise are not covered by employer-sponsored health insurance, Medicare or Medicaid.
What: If you don’t have health insurance now, you’ll have a range of offerings and aids to purchasing. The health insurance exchanges, mandated by the Affordable Care Act, are designed to make the job of shopping for insurance – a messy, complicated, confusing process – a little more transparent.
To do this, the act establishes certain categories of coverage. From the most expensive (and the most extensive coverage) to the least expensive and extensive, they are named platinum, gold, silver, bronze and catastrophic.
The law also provides for the expansion of Medicaid, the joint state-federal program for the poor, to expand coverage for those who have not had it for various reasons.
Some states have refused to expand Medicaid, a right they were given in the Supreme Court’s ruling in summer 2012. Here’s a map and report of what Affordable Care Act will mean for both the uninsured and Medicaid-eligible people.
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 1, 2014, to allow latecomers. Some confusion is expected, since this is a big undertaking, and the idea is to make coverage available to all.
To make things more complicated, 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.
Where: The idea is that people 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. So some of the states (33 total) didn’t set up their own exchanges. By law, that means that they effectively delegate to the federal government the running of their exchanges; in the 17 others, plus the District of Columbia, the states are running their own exchanges.
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, 51 million people are uninsured, and our general state of health is measurably not better as a nation than the general health of other developed nations. Making insurance available and affordable for everybody was one of the biggest goals of the act.
How much: That’s the biggest question of our time. Many states have already revealed a grid of premiums to be charged by the insurers taking part in the exchanges. Here’s one for New York; here’s an analysis of expectations for Montana.
Many of these reports are preliminary; many are also being updated on the web as the exchange date opening approaches.
Subsidies? Penalties? It’s confusing: Yes it is. We’re here to help.
What about me? Got a question? E-mail us at info [at] clearhealthcosts.com, and we’ll call forth our experts to answer it. Here’s a quick FAQ from Covered California that, well, covers a lot of the bases.
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Today’s tip: The most important points of the Affordable Care Act, collected into two pages, in a complete once-over-lightly.
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 ClearHealthCosts.
She was previously a fellow at the Tow Center for Digital Journalism at the Columbia University School of Journalism. ClearHealthCosts has won grants from the Tow-Knight Center for Entrepreneurial Journalism at the Craig Newmark Graduate School of Journalism at the City University of New York; the International Women’s Media Foundation; the John S. and James L. Knight Foundation with KQED public radio in San Francisco and KPCC in Los Angeles; the Lenfest Foundation in Philadelphia for a partnership with The Philadelphia Inquirer; and the New York State Health Foundation for a partnership with WNYC public radio/Gothamist in New York; and other honors.
Her TED talk about fixing health costs has surpassed 2 million views.