In a surprise decision, the U.S. Supreme Court has upheld the constitutionality of the Affordable Care Act passed in 2010. You will hear a lot of commentary from legal and policy experts in the next few weeks about this decision, but this post is about what the Court action means for YOU personally.
The outcry from the right will be deafening, and there will be attempts by the House Republicans between now and November to take out sections of the law, although the Senate Democratic majority is not likely to approve any of those actions. Obviously, if the Republicans win the presidency and the Senate in November, the full ACA may be whittled away before its full 2014 implementation date. Now is the time to acquaint yourself with what the health reform law really means to you -- while you still have it.
1. If you are employed and enjoy health insurance as part of your work benefit package: The Affordable Care Act does not currently have a large impact on large self-insured companies; however, as the law is fully implemented in 2014 and beyond, there is a chance that your employer may determine that employees can get cheaper coverage through a state exchange and over time some employers may drop employer-sponsored coverage. If you work for one of those companies, you may actually have more choice of plans through an exchange and depending on whether or not the employer subsidizes you or you are eligible for a federal subsidy, you may pay less than you do now. Until that time, you will see a few benefits of the ACA -- no lifetime limits on your benefits; restrictions on annual limits; preventive services without co-pays; and adult children allowed to stay on parents' plans until age 26.
2. If you are lucky enough to be on Medicare: The Affordable Care Act has brought seniors a number of significant benefits already. The doughnut hole in prescription drug coverage is being closed every year and will disappear by 2020. In 2011 alone, 3.6 million seniors saved $2.1 billion on their prescription drugs because of health reform. Another benefit for seniors is the preventive services that are available without co-pays and the 4% reduction in premiums for seniors enrolled in managed care Medicare plans (called Medicare Advantage) in 2012.
However, looming on the horizon if there is a Republican sweep in November are big changes to Medicare, including a potential rollback of some of the ACA benefits and an attempt to switch to a voucher system which would give you a fixed amount to buy a plan without any guarantee that the amount would be sufficient to cover what you currently have.
3. If you are self employed and have an individual insurance policy for yourself and your family: Try to keep your policy while you wait for the state exchanges to be put in place -- that is, if you can continue to afford it. Don't let it lag because we do not know the outcome of the November elections or what your state may do with its exchange, and if parts of the Act are overturned, you could be on the streets again, trying to get coverage as an individual and potentially being turned down for pre-existing conditions.
4. If you are uninsured but are hoping to be able to get it through the Affordable Care Act and a State Exchange: The good news about the fact that the Court upheld the entire law is that you will still have the option to buy insurance through an Exchange in your state and if your state does not offer one, through a federal exchange. And you will get help affording that premium via a federal subsidy that will allow you to earn up to 400% of the federal poverty level before the subsidy phases out. For those who have a pre-existing condition, the law still guarantees that insurers must accept you starting in 2014.
5. If you are a small employer and were hoping to be able to help your employees get health insurance at a reasonable rate through the state exchanges: There will still be options for you and your employees. The state exchanges will be open to individuals and small business, offering a variety of plan options at a variety of prices, much like the Massachusetts exchange. Up to now, small businesses have found it very expensive to insure their employees, particularly if any of them have been sick.
If Republicans sweep the November elections, it may not matter how the Supreme Court has ruled. The Republicans will surely make a show of repealing the entire Affordable Care Act even though they have no plan to replace it with a plan that could make health care more affordable. Don't forget that the Republican plan for health reform has only three or four main provisions -- protect doctors with malpractice reform; allow fly-by-night insurers to sell their "hospital gown" plans (looks good in the front but is bare in the back) across state lines; and make you, the consumer "more accountable" for your health care costs (translation: you pay more).
No matter what you hear on Fox News, this is NOT a tax on the middle class! This is a tax on people who do not have insurance and will not take personal responsibility for their health care. This is a tax on those who would shift their costs to the rest of us!
There are many benefits of the Affordable Care Act. Educate yourself and fight to keep them.