With the Supreme Court ruling the Affordable Care Act constitutional, attention is now shifting to the details of the law – especially how the individual market will function in the insurance exchanges.
I had the opportunity to work on the Clinton health reform plan in 1992–1993. As part of this work, the White House sent us to various groups to present the proposed plan. I usually spoke to provider groups. At the beginning of the presentation, I always asked the audience to “Please raise your hand if you know someone who is uninsured or who has difficulty getting health insurance.” Almost all the hands in the room were raised.
My guess is that this question would yield similar results today. Although it’s likely that many health professionals are already working on implementing sections of the ACA (such as ACOs, medical homes, reducing re-admissions, etc.), they may not have paid a lot of attention to the individual market insurance details. Here are some basics to remind us of the details and some resources to share with any friends who are uninsured.
- The insurance exchanges will be operational on January 1, 2014, and will provide health insurance that is community rated and does not discriminate based on pre-existing conditions.
- If you choose not to purchase health insurance, you will pay a tax on your federal return. The tax starts at $95 per year in 2012 and rises to 2.5% of your taxable income in 2016.
- Graduated subsidies are provided to purchase health insurance up to 400% of the Federal Poverty Level (FPL for individuals is currently $11,170 per year, so 400% would be $44,680). If an individual’s income is below 133% of the FPL, they will be covered by Medicaid and their insurance is free (this may vary in some states based on the Supreme Court’s ruling that the Medicaid expansion is voluntary for the states.)
- Similar subsidies are available for families and small businesses.
The Kaiser Family Foundation has provided a great tool to calculate estimated premiums and government assistance for a specific individual.
I encourage everyone to share this resource with your uninsured friends.