Today is the day: If all goes as planned, the health-insurance marketplaces, the centerpiece of the 2010 Affordable Care Act, are scheduled to go live in all 50 states and the District of Columbia.
The marketplaces, also known as exchanges, are designed to help people meet one of the most controversial requirements of the health law: the "individual mandate" that requires them to secure coverage. Assuming technical or other glitches don’t impede the rollout, people without insurance — or who are thinking about switching plans — can shop on the marketplaces over the next several months for coverage that will take effect in January.
The federally operated health-care exchange in Ohio will go live at 8 a.m. EDT. The federal government also is opening exchanges for 35 other states, while 14 states are opening their own today.
Software problems threaten opening-day glitches. Over the weekend, armies of information-technology specialists tested and re-tested the complex interfaces needed to make the exchanges functional.
From insurance companies and hospital executives to policy experts and politicians, there will be intense focus on how the exchanges function, and how many customers they attract. For weeks, however, the Obama administration as well as the states have played down expectations for today.
"We are expecting a slight upturn of activity," Rebecca Lozano of the Portico Health Net, a Minnesota group that will help people enroll, said last week. "We’re not imagining a run on the banks" today.
"Those with pre-existing conditions are the people we expect to be at the door when the door opens," said Reagan Hunt, executive director of Kentucky Voices for Health. "We have no idea what that number looks like."
Many probably will want to see how it goes for the first wave of applicants before they jump in.
Eventually, at least half the nation’s nearly
50 million uninsured people are expected to get coverage through the Affordable Care Act, either through subsidized private plans sold in the new markets or an expanded version of Medicaid in states accepting it for low-income adults. (Ohio has not expanded Medicaid.) Immigrants in the country illegally will be the largest group remaining uninsured.
As many as 7 million Americans are expected to sign up for health coverage via the new exchanges for 2014. Eight million others are expected to receive benefits through the expansion of the government’s Medicaid program.
Health and Human Services Secretary Kathleen Sebelius said yesterday that "the key date really is the 15th of December," the deadline for buying coverage that starts on Jan. 1.
"For millions of Americans, the new options are going to be affordable, within their own budgets. So Jan. 1 can be a new day. It can begin to change the statistics where we will no longer have a large population in this country who doesn’t have access to the best medical care."
Although the law takes effect Jan. 1, the initial enrollment period continues through March 31. If you get insurance by then, you will not face penalties for not being insured.
The individual mandate requires you, your children and anyone else that you claim as a dependent on your taxes to have health insurance in 2014 or pay a penalty. That coverage can be supplied through your job, public programs such as Medicare or Medicaid, or an individual policy that you purchase. The online health-insurance marketplaces can help you shop for plans.
The marketplaces will offer tax subsidies to reduce premiums if your income is less than
400 percent of the federal poverty level ($45,960 for an individual and $94,200 for a family of four in 2013). Subsidies also will reduce the deductibles, co-payments, coinsurance and total out-of-pocket spending limits for people with incomes up to 250 percent of the federal poverty level ($28,725 for an individual and $58,875 for a family of four in 2013).
Consumers also could run into problems getting their right subsidy amounts. People with complicated tax returns and extended families living under the same roof could find they need assistance to work out the issues. Referrals to state Medicaid programs might go smoothly in some states, not so well in others.
If you do not have the minimum level of coverage and do not qualify for an exemption, you must pay a penalty at the end of the tax year. The penalty for the first year is up to $95 per adult and $47.50 per child, or 1 percent of family income, whichever is greater.
The fine increases over time; in 2016, it will be as much as $695 per adult and $347 per child (up to $2,085 for a family) or 2.5 percent of family income, whichever is greater.
There are exceptions to the mandate: People who cannot afford coverage because the cost of premiums exceeds 8 percent of their household income or those whose household incomes are below the minimum threshold for filing a tax return are exempt. People with certain hardships, including those who would have been eligible for Medicaid under the health law’s more-expansive rules but whose states chose not to expand their programs, also are exempt.
Other exempt groups include prisoners, Native Americans eligible for care through the Indian Health Service, immigrants who are in the country illegally, people whose religion objects to having insurance coverage and individuals who experience a coverage gap of less than three consecutive months.
You will not have to report your coverage or exemptions to the government until you file your 2014 income-tax return, which is due in April 2015. Insurance providers also will be required to help their plan members report their health coverage. The Internal Revenue Service says it will put out details later about how the reporting will work.
Information from Kaiser Health News, the Associated Press and Reuters was included in this story.
Source: Columbus Dispatch
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