ACA basics

Discussion in 'West Mall' started by hornpharmd, Oct 11, 2013.

  1. hornpharmd

    hornpharmd 5,000+ Posts

    This information details the basic components of ACA and specifically focuses on the health insurance marketplace. These are the factual components of ACA to help answer questions one might have regarding this law. This information is not a list of the benefits of ACA or does it discuss the overall impact this law will eventually have on healthcare quality/costs or the overall impact this law will have on the economy.


    The primary goal of ACA is to lower healthcare costs, increase the number of people covered by health insurance, increase benefits, improve quality, and increase the focus on prevention. Expanding coverage will be achieved by Medicaid expansion, health insurance marketplace (exchanges which can provide subsidies for those who qualify), prohibiting pre-existing conditions as a denial criteria, allowing kids to stay on their parents plan until age 26, and the individual mandate. I found an easy to read chart which summarizes the basic components:
    The Link

    The Health Insurance Marketplace helps uninsured people find health coverage. When you fill out the Marketplace application we’ll tell you if you qualify for private insurance plans or Medicaid/CHIP. Some enrolling in private plans may qualify for lower costs based on household size and income, which includes tax credits for people with incomes between 100% and 400% of the federal poverty level. For those that qualify for Medicaid/CHIP, the appropriate state agencies will be notified and will contact them. Some states have expanded Medicaid by increasing the enrollment criteria (those under 65 making less than 133% of federal poverty level) in order to cover more people (Texas has not expanded Medicaid at this point but could still do so). Under the law, the federal government will pay states all of the costs for newly eligible people for the first three years. It will pay no less than 90% of the costs in the future (this is tax money for instance that Texans have already paid the federal government but will not be utilizing and instead these funds will be used to pay for those living in other states...meanwhile our uninsured will likely still show up at county hospitals and get free care which Texans will have to pay for out of state and local taxes). Plans must cover essential health benefits, pre-existing conditions, and preventative care. Only grandfathered plans that you purchased outside of your job-based plan do not have to cover pre-existing conditions. You can switch to a Marketplace plan during open enrollment and get coverage for pre-existing conditions.

    To learn more about essential health benefits click here:
    www.healthcare.gov/what-does-marketplace-health-insurance-cover/

    To learn more about preventative care benefits click here:www.healthcare.gov/what-are-my-preventive-care-benefits/

    Some states operate their own Marketplace, and in other states the Marketplace is run by the Federal government. 16 states are running their own marketplace (Texas is not one of them) and you can learn more here:
    The Link

    Most people who don’t have coverage in 2014 will have to pay a penalty of $95 per adult, $47.50 per child, or 1% of your income (whichever is higher). The fee increases every year. The penalty is paid when you file your income taxes the following year. Some people may qualify for an exemption. You can learn more about exemptions here:
    www.healthcare.gov/exemptions/

    You are covered if you have Medicare, Medicaid, CHIP, job-based plan, private plan purchased through the marketplace, COBRA, retiree coverage, TRICARE, VA health coverage, or other health coverage. If you are eligible for a job-based plan you may be eligible to purchase a different plan through the marketplace. You can learn more here:
    www.healthcare.gov/what-if-i-have-job-based-health-insurance/

    Marketplace enrollment is from 10/1/13 to 3/31/14. If you enroll by December 15, 2013, coverage can begin as soon as January 1, 2014. If you enroll after the 15th of any month your coverage will start on the 1st the following month (example, enroll 12/16/13, coverage starts 2/1/14). After open enrollment you cannot enroll in Marketplace coverage unless you have a qualifying life event:
    www.healthcare.gov/glossary/qualifying-life-event/

    Small employers generally may start offering health insurance coverage to their employees through the SHOP Marketplace at any time during the year.

    There are 4 categories of Marketplace insurance plans: Bronze, Silver, Gold, and Platinum. The categories help you choose a plan that’s right for you. All Marketplace insurance plan categories offer the same essential health benefits and do not reflect the quality or amount of care the plans provide. The category you choose affects how much your premium costs each month, what portion of the bill you pay for things like hospital visits or prescription medications, and your total out of pocket cost.
    The Marketplace also offers "catastrophic" plans to people under 30 years old and to some people with very low incomes. Learn more about catastrophic plans here:
    www.healthcare.gov/can-i-buy-a-catastrophic-plan/



    I am not an authority on this legislation but may be able to answer questions if you have them. Seems to be many people that do not understand the marketplace, components of plans, enrollment period, etc, so I wanted to help provide some of this info to help clarify. This is not an endorsement of ACA.
     
  2. dalhorn1

    dalhorn1 1,000+ Posts

    Thanks for your post.

    You lost me in the second paragraph when you forgot to mention that the primary goal of the ACA is actually to grease the wheel for the pending single-payer system to be put into effect. [​IMG]
     
  3. militaryhorn

    militaryhorn Prediction Contest Manager

    Where is the part where I get to decide on whether I want health insurance or not? Also, you stated the goal is to lower insurance costs. Is that for all that pay for insurance or for those who can't afford it now?
     
  4. JohnnyYuma

    JohnnyYuma 500+ Posts


     
  5. UTChE96

    UTChE96 2,500+ Posts


     
  6. hornpharmd

    hornpharmd 5,000+ Posts


     
  7. hornpharmd

    hornpharmd 5,000+ Posts


     
  8. Hu_Fan

    Hu_Fan Guest

    Everybody that wanted the legislation is going to get what they asked for. Good and hard.

    That's all I got to say about it. [​IMG]
     
  9. dillohorn

    dillohorn Guest

    ^^^ What Hu said.
     
  10. 77horn

    77horn 500+ Posts


     
  11. militaryhorn

    militaryhorn Prediction Contest Manager


     
  12. Larry T. Spider

    Larry T. Spider 1,000+ Posts

    I am nothing near a healthcare expert so I have a few questions.

    1. Costs. How does aca reduce costs? If we are shifting costs from individuals to the government, then the cost is the same. I want an actual reduction in costs. I'm not going to blame aca for my premiums going up though, they have gone up massively every year that I have been employed full time (8 years).

    2. End of life care. Does it do anything to solve this issue without the government pulling the plug on grandma? I have no solutions here but there has to be some middle ground between death panels and 2 million dollar hospital bills for an extra three weeks with no quality of life.

    3. Chronic, but treatable, illness. People like my wife who you would watch run a half-marathon and think they are healthy, cost the system tremendously. She has done everything right and has always had health insurance, kept fit, etc. But she got a job with a small employer that does not offer health insurance. We called insurers and were literally laughed at when asking to purchase a plan. In the end, we had to change our wedding date in order for her to not have a lapse in coverage after her cobra expired. I think aca actually solves this problem to a certain extent. But, it doesn't solve the problem that she would destroy any small employer that actually was trying to offer health insurance.
     
  13. hornpharmd

    hornpharmd 5,000+ Posts


     
  14. hornpharmd

    hornpharmd 5,000+ Posts

    Larry the 3rd column under the first link addresses the cost issue. I can expand on it if needed. please explain how we are shifting costs from individuals to the government.

    don't think it addresses end of life care.

    small employers if under 50 employees I believe will not have to offer health ins but the employees will be able to receive subsidies to purchase their own plan. similar to what walgreens is doing it actually makeshealthcare a fixed cost for the. employer.
     
  15. hornpharmd

    hornpharmd 5,000+ Posts

  16. UTChE96

    UTChE96 2,500+ Posts


     
  17. theiioftx

    theiioftx Sponsor Deputy

    Link not working. Is it posted wrong or just par for the course ACA? [​IMG]
     
  18. l00p

    l00p 10,000+ Posts

    I wish there was a way they could refuse health care to people without insurance if they don't have cash up front. that or be able to go after them and make them pay. Garnish checks, take vehicles or homes if need be.

    If you want to be responsible to take care of your health needs, be responsible enough to have coverage in this day and age. I lived through periods of my life without coverage and paid a price for it, hefty.

    I had a kidney stone that took me a good while to pay but since I have morals and a sense of obligation I paid it off. At times I picked up a second job and other times cut back on things like travel and entertainment. But dammit, I paid it off. And I got insurance quickly after that.
     
  19. AustinBat

    AustinBat 2,500+ Posts

    100P, you are way out of what seems to be the new norm. I am afraid that more and more of our fellow citizens are quite willing to be irresponsible and then expect government - the taxpayers - to bail them out. When working taxpayers get sick of it and other countries refuse to lend us more money, this whole country will collapse. I hope I don't live to see it, but it seems inevitable to me. Once you give people entitlements, subsidies etc. politicians will never have the guts to take them away. Except for Social Security, of course - that is always threatened first, even though it is not a subsidy or entitlement, [​IMG]
     
  20. Mr. Deez

    Mr. Deez Beer Prophet


     
  21. Sangre Naranjada

    Sangre Naranjada 10,000+ Posts

    Gotta' keep that Ponzi scheme going somehow.
     
  22. hornpharmd

    hornpharmd 5,000+ Posts


     
  23. hornpharmd

    hornpharmd 5,000+ Posts

    " link not working"

    theiioftx, I fixed it for you. my bad.
     
  24. theiioftx

    theiioftx Sponsor Deputy

    Thanks. However, looks like one of the basics of ACA is favors to democrat allies. The unions are poised to get their gift as things stand now.
    The Link

    Sickening.
     
  25. UTChE96

    UTChE96 2,500+ Posts


     
  26. hornpharmd

    hornpharmd 5,000+ Posts


     
  27. hornpharmd

    hornpharmd 5,000+ Posts


     
  28. UTChE96

    UTChE96 2,500+ Posts

    I am not going to quibble with you about the average wait to get insurance if you get sick. Enrollment will likely occur on an annual basis plus some wait period. Whether the average wait is 6 months or 9 months, it doesn't matter. On average, healthy young people that are not subsidized are going to take that chance if it means saving a substantial amount on health insurance premiums every year.

    I look forward to having this discussion in a year to listen to your excuses on why your predictions of lower health insurance costs did not come to fruition.
     
  29. msdw24

    msdw24 1,000+ Posts


     
  30. NJlonghorn

    NJlonghorn 2,500+ Posts


     

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