The Benefit of Getting Health Insurance Under the ACA
For the past few years, politicians from both major parties have debated national healthcare and talked about it almost constantly on the media. It’s a hot-button issue, and hot-button issues get continuous play especially during election years. Unfortunately, the message that gets transmitted to the American people isn’t always the message that needs to get sent. For example, did you know that the Affordable Care Act addresses low-income communities by giving doctors incentives for creating health programs in these areas? There might be a lot that you don’t know about Obamacare because the media often overlooks key facts in favor of ratings.
You may support the new healthcare law, and you may not. America enjoys a unique advantage over a lot of other countries in that citizens can disagree with each other and still get along. It is okay to disagree with Obamacare, but you should know the facts before you write it off on principle. The ACA changed the scope of the American healthcare industry.
Over the next decade, American citizens will join the rest of the industrialized world in being able to afford real healthcare. Already, millions of people enjoy this benefit and many others as a result of the Affordable Care Act. The following article offers a detailed look at the primary advantages afforded by the new healthcare law.
The Text of the Law
Chances are that you probably haven’t read the full text of the Affordable Care Act, and you’re not alone. Few individuals have read the law in its entirety because the ACA is more than a thousand pages long. Unfortunately, ignorance leads to theories, and theories lead to misinformation. Rumors abound when it comes to Obamacare because people rarely trust new government programs. President Johnson’s administration faced similar distrust when it rolled out Medicaid and Medicare in 1965. As these programs started working, people started accepting them for what they could be and what they could do for the nation’s poorest and oldest citizens.
To clear up some of the rumors that get spread about Obamacare, we’re going to go over the ten “titles” that make up the Affordable Care Act. We offer a basic summary, but you can find the full text of the law by visiting the U.S. Department of Health & Human Services website. The following ten titles make up the crux of Obamacare:
- Title I: This is the heart of the law: Under Title I, people will be given more choice when it comes to healthcare. Individuals and small business owners will be able to purchase health insurance on respective marketplaces in which insurers compete for business.
- Title II: Title II provides for social programs such as Medicaid and encourages individual states to create programs that help low-income communities gain access to better healthcare.
- Title III: For seniors and people living in rural areas, medical treatments will improve under Title III of the ACA. This title encourages medical providers to develop more efficient and effective ways to treat Medicare beneficiaries.
- Title IV: Title IV provides for the creation of a national campaign on prevention. Without proper education, families will continue to make poor nutritional choices. This title seeks to give people the right resources to make better long-term health decisions.
- Title V: In an effort to make sure that the healthcare workforce matches the demand for care, Title V establishes funding programs for people who go into medical fields.
- Title VI: Through this title, patients will now have access to clear information regarding their medical providers including nursing homes.
- Title VII: Title VII offers incentives to medical professionals in low-income communities for creating low-cost alternatives in the field of prescription drugs. Additionally, this title wants to see generic drugs drive down nationwide prescription costs.
- Title VIII: The goal of Title VIII is to create a long-term care plan that’s separate from insurance plans purchased on the marketplaces and helps reduce the economic impact of Medicaid. This long-term care plan would not be tax-supported.
- Title IX: This title discusses funding for Obamacare’s various programs.
- Title X: Title X reinstates the Indian Health Care Improvement Act and helps Alaskan Natives as well as federally recognized Native American tribes gain access to adequate healthcare. As a result, these tribes will not have to pay a premium for healthcare.
Aside from the title involving funding, each title seeks to help different portions of the population gain access to better healthcare in America. Why does the law run more than a thousand pages? Well, the government isn’t known for its brevity for one thing. But more important, healthcare in America needed a complete overhauling. We go over the story behind reform in a separate article, but suffice it to say here that we desperately needed a new system because ours was hideously broken.
Lawmakers wanted to change healthcare for good, and a new law should cover its bases as thoroughly as possible. Despite this, opponents of the ACA have done their best to challenge the law on technicalities. While the U.S. Supreme Court has already ruled that the law is binding, people continue to hack away at its language. It remains to be seen how the law will evolve over time, but the law as it stands serves a vital purpose in modern American life as we’ll discuss in the following sections.
It’s great to know what the government intends to do with Obamacare, but how does the new law actually help you as a consumer? After all, the reason we elect representatives in the first place is to safeguard our rights as citizens. The Affordable Care Act offers a wide range of rights and protections, and in this section we’ll discuss the “ten essential benefits” provision of the law.
Under this provision, every new health insurance plan offered in the United States has to offer at least ten essential benefits. Old plans that have been grandfathered in don’t have to offer these benefits, but you must be notified by your insurer if your plan doesn’t offer them so that you can look into new options if you want. At the very least, every plan sold on the federal or state health insurance exchanges will include these benefits. Here are the ten essential benefits you’ll enjoy under the ACA:
- Emergency services
- Hospitalization and surgery
- Lab testing
- Maternity care before, during and after labor
- Mental health care
- Outpatient services
- Pediatric services
- Prescription drugs
- Preventative care
- Rehabilitative equipment and care
You might argue that you don’t need all of these treatments so you shouldn’t have to pay for them. For example, men will not need maternity care. In truth, some people will pay for insurance they never use. The better care you take with your body, the less likely it is that you’ll need expensive medical care over time. However, you can’t predict the future. Men may not need maternity care, but they might use pediatric care for their kids or prescription coverage for blood pressure medicine. Like home or auto insurance, health insurance offers benefits that you may not always need or use. Unlike other types of insurance, healthcare coverage gives you the choice to monitor your situation proactively.
Preventative care is the best way to detect serious problems early and prevent a wide range of medical conditions from happening or getting worse. Cancer can’t always be prevented, but early detection could mean the difference between months and years of treatment as well as your chance for survival. Plus, certain cancers are almost always treatable when detected at early stages. Ovarian cancer in particular can be treated with minimum impact in most women as long as it’s found early enough. With access to preventative care via new health insurance plans, you may be able to avoid a lot of heartbreaking situations.
One of the major perks of Obamacare is the establishment of the federal health exchange site. Also referred to as the Marketplace, the exchange site acts as a virtual store where you can pick out the plan you want from dozens of applicable options. States can also set up their own exchange sites, but so far only about half of the states have done so. In the future, other states may decide to create their own websites to facilitate the process for their residents. The Marketplace is a powerful tool for helping you get the insurance you need, and we’ll talk about some of its key features here.
There’s never been a time in America’s history in which information was so readily available as it is now, and the Marketplace embodies that ideal by giving you up-to-date resources on health insurance, regulations and other information that make buying insurance easier than ever before. Keep in mind that you don’t have to use the Marketplace to buy insurance. The Affordable Care Act established the health insurance exchanges primarily as a means of offering subsidies to low-income families. You can still purchase insurance through your employer or a private insurer, but the Marketplace offers year-round information on everything you need to know to comply with the law.
In addition, the Customer Service Center administered by the federal government can walk you through paper and telephone applications if you’re not keen on using the computer to purchase insurance. The customer support staff will also answer questions related to technical difficulties and other concerns you may have. In an effort to keep people aware of their rights and responsibilities, the Marketplace serves as a hotspot for consumer information.
Not only is the Marketplace informative, but it’s also easy to use. When the site was first launched in 2013, complaints abounded nationwide regarding technical glitches and other malfunctions. The government called on technical experts to sort everything out, and the exchange site has been fully functional ever since. Clearly labeled tabs and links make it easy for you to find the information you need, and the site will guide you to the right page by offering suggestions.
As we said, the primary purpose of the Marketplace aside from giving people easier access to health insurance plans is to offer low-income families financial assistance to pay for premiums. Subsidies are one of the top advantages under the new law. Before Obamacare became law, millions of people lived without health insurance simply because monthly premiums were too expensive. Subsidies resolve that problem.
How much are subsidies worth? The answer to this question depends on certain factors like your tax filing status, family size, residence and tobacco use. While insurers can no longer discriminate based on gender or pre-existing condition, they can charge a penalty fee for tobacco users because they goal of Obamacare is to help people take better control of their healthcare decisions. Subsidies work by giving people a set amount to apply toward the cost of their monthly premiums.
- For example, let’s say single man in his 40s might have to pay $300 per month for a basic Bronze Plan on the Marketplace.
- Because of his income, he can get $185 in subsidies to pay for insurance.
- He could take that $185 and apply it to the $300 plan, which makes his monthly cost $115.
- Alternately, he could apply that $185 to a more expensive plan with lower co-pays to save more money long-term.
This is a pretty generic example because so much of the cost of insurance varies based on your unique situation. Subsidies essentially act as stipends or credits that you can use to make health insurance even more affordable. You might get a better deal on the Marketplace, but you may benefit from a private plan outside of the Marketplace. In any case, you can only get subsidies using the Marketplace; outside insurers cannot offer them. In the next section, we’ll take a look at the real value of insurance.
Can’t I Just Pay the Fine?
You may know about the “individual mandate” that requires American citizens to purchase health insurance or pay a fine for non-compliance. To some, the idea of forced health insurance contradicts the basic premise of American freedom. To others and the Supreme Court, the individual mandate is a tax that falls within the rights of the American Congress to impose. Regardless of your stance on the issue, the individual mandate requires you to participate in Obamacare one way or another. In 2014, the individual fee for not having insurance is $95 or one percent of your income; families are charged more for children and other adults.
With such a relatively low fee, many people assume that they can just save money by paying the fine and forgoing insurance. As a citizen, you have that right. You can choose to forgo insurance and take your chances with the penalty fee. But before you do that, let’s take a look at an example to see how insurance might help you in the long run:
- Katie lives in Elizabethtown, Kentucky and earns $25,000 per year working as a paralegal in a moderately sized law firm. Unfortunately, the firm doesn’t offer insurance.
- She is single, doesn’t smoke and has no children.
- Katie works out fairly regularly and eats a decent diet. Because she rarely gets sick, she decides that paying the fine for not having health insurance would cost a lot less than buying a plan on the Marketplace. Her fee for non-compliance is $250 for the year in 2014.
- If Katie were to buy insurance on the health exchange, she would pay about $1,729 for the year or $144 per month, which represents just less than seven percent of her income.
You might agree with Katie in this opening scenario. After all, her fee is only $250 while her insurance would cost almost seven times that amount. She’s healthy, right? Why does she even need insurance?
- One night, sharp pains in her lower abdomen wake Katie up in a cold sweat. She runs to the bathroom, but nothing happens. Doubled over in pain, she takes some pain relievers and crawls back into bed. Twenty minutes later, she can’t take the pain anymore. She dials 911 and is rushed to the hospital.
- In the emergency room, Katie fills out paperwork and tells the admitting nurse that she doesn’t have any insurance. He makes a note of this on her file.
- Hours pass, and finally Katie sees a doctor just as her pain has started to subside. The doctor performs an exam and determines that Katie is suffering from a ruptured ovarian cyst. These cysts are common in women Katie’s age and usually heal on their own. The doctor sends her home with instructions to rest and an optional prescription.
- Katie decides to get the prescription filled just in case this happens again. To her surprise, the prescription only costs $10 at her local pharmacy. Pleased with the low cost of treatment, she returns home and forgets about the cyst entirely.
- A month later, Katie receives a bill from the emergency room for $650. They’ve given her a small cash discount because they know she has no insurance, but she’s responsible for the rest. Suddenly, the “low-cost” treatment has skyrocketed into a staggering expense.
Emergencies happen. Katie didn’t know that she had ovarian cysts because most cysts rupture without pain for many women. You should always call 911 if you’re unsure about sudden pain, but know that emergency rooms aren’t free for most people. By law, ERs have to accept anyone who comes in, but they don’t have to provide free care.
Katie might continue to have problems with cysts, which is a condition known as polycystic ovary syndrome or PCOS. Over time, the condition could interfere with her menstrual cycles and even her ability to conceive. Without routine gynecological care, Katie might not get the treatments she needs to manage her symptoms. Suddenly, the low cost of the individual mandate fee seems less important to Katie than protecting her reproductive health.
More Rights and Protections
If you have what insurers call a “pre-existing condition,” then you know that finding health insurance was nearly impossible in the past. And when you could find an insurer willing to offer coverage, you probably faced exorbitant fees that were way out of your price range. It seems a great irony that the people who need healthcare the most should be denied insurance, but insurers often only see the bottom line instead of the person.
Holding Insurers Accountable
Now, people with pre-existing conditions don’t have to worry about being denied coverage. In fact, Obamacare makes it illegal for insurers to discriminate based on pre-existing condition or your gender. Before the ACA took effect, women could pay more for insurance and medical treatment than men. That’s not the case anymore. Under the new law, men and women will pay the same for comparable insurance and care. People with pre-existing conditions will also receive medical care that they can actually afford.
Other perks of the new law include the fact that insurers can’t just drop your coverage without warning or for dubious, ill-defined reasons. This practice was common prior to 2010 as a means of saving money for insurers, and beneficiaries had little to no recourse when it came to challenging these types of decisions. Now, you have a right to know when your policy will be canceled and to make a formal complaint challenging the decision. In addition, insurers can no longer drop you from a plan or deny coverage based on administrative errors on your application. Nationwide, you can expect better clarity and accountability from insurers.
Healthier Choices for Americans
While Obamacare was designed primarily with healthcare coverage in mind, insurance isn’t the only way that people can stay healthy, and the new law addresses that. We mentioned in the first section that Title IV seeks to give people information on nutrition and healthy living. Information is one of the keys to fighting modern problems such as obesity, heart disease and tobacco use. The government doesn’t want to judge people for overeating or making poor lifestyle choices; rather, it wants to arm people with the right information to make different choices if they want.
The Power of Choice
The beauty of living in America is that we have the choice to smoke or not smoke, eat fast food or vegetables, exercise or sit on the couch. People lead different lives, and there’s no guaranteed way to prevent certain cancers or ensure that you live to be 100. Obamacare doesn’t take away choice: It celebrates it. The new law doesn’t force you to make nutritional choices that go against your personal preference. Instead, the new law helps you decide how to eat based on the full picture. For example, restaurants will now have to post the nutritional information so that consumers can make informed decisions about their meals.
It’s easy to get caught up in the rhetoric of politics when it comes to healthcare because this is such a big issue, but the fact is that healthier choices lead to a decreased need for medical care in the first place. Again, some medical conditions can’t be avoided by taking the stairs instead of the elevator or replacing sour cream with Greek yogurt on your tacos. However, some of the leading causes of death in America – heart disease, respiratory conditions, and diabetes – can be avoided or mitigated by simple lifestyle choices. Working with the government instead of against it, we can revolutionize healthcare in this country while improving the quality of our own lives.
Protecting Each Other
Do you have the right protection in place to cover accidents or unexpected crises? We mentioned above that health insurance works differently from other types of insurance. You’ll only need auto insurance if there’s a problem with your car. With health insurance, you can use the benefits throughout the year to prevent major problems down the road. However, health insurance also covers you during unexpected medical emergencies and sudden crises that can’t be avoided. Accidents happen, and having enough healthcare coverage ensures that you get appropriate treatment when you need it most.
Not only does buying health insurance protect you and your own family, but doing so also makes it possible for low-income families to gain access to healthcare. While Medicaid has existed since 1965, the program is only for those who truly can’t afford any kind of insurance. There’s a large sector of the population that lives in the grey area just above the federal poverty line. They may be able to afford decent homes and lifestyles, but they can’t afford health insurance. These are the people that Obamacare helps most. You might even be one of them.
Take the time to consider the facts before dismissing Obamacare. Millions of Americans now have unprecedented access to lifesaving medical care regardless of their political party affiliation. It’s time to re-evaluate your position on healthcare reform and realize what it actually means for your family and the nation at large. The next enrollment period for the federal health exchange begins on Nov. 15, 2014 and runs through Feb. 15, 2015. Visit www.HealthCare.gov to learn more about your options on the marketplace, and sign up for health insurance to protect the people you care about most.