Credits to: By
Diane Bullock
Jul 26, 2013 as published by MINYANVILLE
ProCon.org does have
definitive answers right now to many of our burning queries. Following
are a sampling with clear-cut yes or no replies that we thought most
relevant to Minyanville readers. {This is shared because I feel it is put in simple understandable terms and answers many questions still on people's minds Use the links at the bottom of this article for access to Minyanville.com.}
1. Can this thing still be repealed?
The big challenge to this came from the constitutional question -- which
was answered 5-4 -- so it’s not going to get repealed by the Supreme
Court. The other place it could’ve been axed was in Congress. The House
of Representatives has voted over 30 times to get rid of Obamacare but
it’ll never happen without passing the [Democrat-controlled] Senate. And
even if it did pass the Senate, there’s no way Obama would sign it. So,
between the Supreme Court, the legislature, and then the president all
saying “no,” it looks like Obamacare is here to stay.
2. What parts of the Affordable Care Act have already taken effect?
In September of 2010 we started having coverage for young adults up to
age 26 on their parents’ plan. We’ve had free preventative care for
services such as mammograms and colonoscopies, being done without a
deductible, copay, or coinsurance. Insurance companies
can’t rescind your coverage if you make some kind of technical mistake
on your form (like forgetting to put your middle initial). If your
insurer says, “We don’t approve your new heart valve, our policy doesn’t
cover it” you can appeal that. The lifetime limits on insurance
coverage were lifted. And this is all nationwide, as federal law. In
2011 we started seeing more services for senior citizens. They can now
get free wellness visits and free personalized prevention plans on
Medicare.
Also, insurance premium rebates took effect if health insurers profit by
more than 15%; so at least 85% of all the premium dollars they collect
have to be spent on health-care services and health-care quality
improvement. If they spend less than that they have to give back rebates
to their members. Here at ProCon.org, we have received checks from our
insurer because they were compelled to do so as a result of the Affordable Care Act.
3. So what’s left to kick in?
January 1, 2014 is when a lot of the meat of Obamacare takes effect. The
big ones are the establishment of state-run health insurance exchanges
and the individual insurance mandate that requires every single person
in the United States to have insurance coverage. If you’re not insured,
you have to pay a fine.
4. Is anyone off the hook for buying coverage?
There are literally some exceptions to the mandate. If someone already
has insurance through Medicaid, Medicare, an employer, or a veterans
health program, they don’t have to buy insurance because they already
have it.
Prisoners, undocumented immigrants, some religious groups -- those who
have been historically exempt from the Social Security system such as
the Old Order Amish and religious groups whose members pay for one
another’s health care. Also, if you’re an American Indian and subject to
the sovereign laws of your tribal community.
5. How will the fines work for not buying coverage?
It’s a little bit complicated. First, they give you a year and they
shake their finger at you. [Referencing the Cleveland Plain Dealer] in
2014, the penalty is either $95 for every adult and $47.50 for every
child under the age of 18 in the household, or 1% of taxable income for
the household, whichever is larger. And then it gets worse.
In 2015, they start shaking their fist. It's $325 for every adult and
$162.50 for every child (up to $975 for a family), or 2% of taxable
income, whichever is larger.
In 2016, that fist turns into a foot and it goes up to $695 for every
adult and $347.50 for every child (up to $2,085 for a family), or 2.5%
of income, whichever is higher. After 2016, the penalty increases
annually by the cost-of-living adjustment.
6. How will the subsidies work for those who can’t afford coverage, and what kind of criteria need to be met to qualify?
There will be no penalty for those who can't afford insurance, including those who don't make enough to file federal taxes
or whose insurance premiums will cost more than 8% of their household
income. The government will help them pay for it and try to do what it
can to make that insurance affordable.
The White House says broadly that there will be tax credits for middle class families, small businesses, and millions of Americans will soon be eligible for tax credits, and if you can’t afford insurance, it basically says don’t worry about it, we’ll help you.
The way Consumer Reports describes it, if you buy insurance on an
exchange as an individual, you may qualify for a subsidy in the form of a
tax credit if your household income is between 100% and 400% of the federal poverty level.
7. How does the mandate work for employers?
The way the Affordable Care Act
is written, the term “applicable large employer” means a company that
employed an average of at least 50 workers during the preceding calendar
year. They’ll have to pay a fine of $2,000 per full-time worker if any
of their employees turn around and get premium tax credits through the new health insurance exchanges. So if the small business has 51 workers and one of those workers gets a tax credit
to help them buy insurance, even though they’re already getting insured
through their company, then the business has to pay a $2,000 fine per
employee, per year.
8. So the mandate doesn’t apply at all to companies with under 50 employees?
No, and there’s no debate.
9. Can you keep your current coverage?
The White House says yes, and the answer is technically true, but -- and
this is a big but -- a lot of the insurance providers will no longer be
offering the exact plan. Part of the reason is that Obamacare mandates a
certain level of quality and a certain number of services to be offered
in their insurance packages. So if the insurance package you currently
have doesn’t perform a certain service that Obamacare requires, that
insurance plan will likely become a different plan. So your exact same
plan may no longer exist because now they have to comply with some of
the requirements of Obamacare, which are the ones intended to increase
quality coverage.
Whether the forced, low-tier plans will cost more is still subject to
debate because -- and this is one of the main theories of the Affordable Care Act
-- by mandating that everyone get insurance, they are creating this big
carrot for the insurance company. They’re saying we’ll give you 30
million more customers and that will help your bottom line. In exchange
for doing that, we’re going to ask that you provide them a little more
coverage. And in effect we hope that, on net, it’s a plus for all
because more people are insured, you have more customers, they are still
profitable, everyone’s happy. That’s the theory.
Whether it increases premiums or not, we won’t know until the mandate
has kicked in. I can tell you that [at ProCon.org] for our particular
company plan, our premiums have not gone up. In fact we’ve received
rebates. Other people will say the opposite, that their premiums have
gone up. So the bottom line is to be determined on that one.
10. Will Obamacare raise my taxes?
There will be 19 new taxes in the form of brand new taxes, fees, and
penalties that have never existed and in the elimination of tax
deductions. For example, we’ll see a $50,000 tax penalty on charitable
hospitals that fail to meet five new requirements, a 2.3% excise tax on
medical device manufacturers, and a removal of executive salary tax
deductions for health insurance companies that compensate executives over 500,000 a year.
For individuals and families, an increased penalty of 20% will apply to
early withdrawals from health or medical savings accounts, and people
who buy indoor tanning products will incur a 10% excise tax.
11. What if I have [insert chronic disease]? Will I get to
participate in the exchange? Will there be a limit on how much carriers
can increase my premium, and how can they afford to cover me anyway?
A press release from the Department of Health and Human Services said that under the Affordable Care Act
, in 2014, Americans with preexisting conditions cannot be denied
coverage, cannot be charged significantly higher premiums, be subject to
an extended waiting period, or have their benefits curtailed by an
insurance company.
There’s specific language to the effect that increases have to be
reasonable. The government will help subsidize what it calls “high-risk
pools” so that it is not as cost-prohibitive for the insurers to offer
those types of plans. But the law is very specific in that it says they
cannot be denied coverage for a preexisting condition. No debate.
The social and economical gains we have made in the last 80 years are worth fighting to keep. Short changing our children and grandchildren, by turning over a bankrupt, environmentally spoiled world with a crumbling infrastructure in a nation intellectually unprepared for the future is not an option. We will not go back!
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