The future of the Affordable Care Act (ACA), aka “Obamacare,” was very much in question during the 2012 presidential campaign. The voters spoke on November 6, and health care reform is once again on track. Now is a good time to revisit the major provisions of the law and the implementation schedule. An excellent source for accurate, up-to-date information about ACA in Illinois is Illinois Health Matters, a collaborative of Illinois health policy and community based organizations. Information in this article was drawn from their website: www.IllinoisHealthMatters.org. I encourage you to visit the site and sign up for their monthly newsletter.
Here’s a quick review of key elements of the Afffordable Care Act:
- Everyone will be able to buy coverage in 2014, even those with pre-existing conditions. Today, you are not required to have health insurance. But beginning in 2014, most people will have to have it or pay a fine. For individuals, the penalty would start at $95 a year, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016.
- After 2014, Medicaid will cover very low-income people who have not been covered before, in particular, non-disabled adults without children. In our area (Evanston, Niles and New Trier Townships) the state estimates that 8,151 low-income people who currently are not covered will become eligible for Medicaid in 2014.
- Insurance companies will no longer be able to drop people when they get sick.
- Insurance companies will also be required to cover free preventive care.
- Your premiums will no longer be based on your gender or health condition.
- Small businesses will get tax credits to help secure coverage for their employees.
- Individuals and small businesses will be able to have more choices and improved quality when shopping for insurance through a new competitive health care marketplace (commonly called a health insurance exchange).
ACA and Medicare:
The law is narrowing a gap in the Medicare Part D prescription drug plan known as the “doughnut hole.” That's when seniors who have paid a certain initial amount in prescription costs have to pay for all of their drug costs until they spend a total of $4,700 for the year. The coverage gap will be closed entirely by 2020. Seniors will still be responsible for 25 percent of their prescription drug costs. So far, 5.6 million seniors have saved $4.8 billion on prescription drugs, according to the Department of Health and Human Services.
The law also expanded Medicare's coverage of preventive services, such as screenings for colon, prostate and breast cancer, which are now free to beneficiaries. Medicare will also pay for an annual wellness visit to the doctor. HHS reports that during the first nine months of 2012, more than 20.7 million Medicare beneficiaries have received preventive services at no cost. Here in Illinois, only 5 percent of eligible Medicare beneficiaries used the free annual wellness visit last year.
The health law reduced the federal government's payments to Medicare Advantage plans, run by private insurers as an alternative to the traditional Medicare. Medicare Advantage costs more per beneficiary than traditional Medicare. Critics of those payment cuts say that could mean the private plans may not offer many extra benefits, such as free eyeglasses, hearing aids and gym memberships, that they now provide.
One issue of concern to older adults—the cost of long-term care—remains unresolved. A long-term care provision of the ACA is dead for now. The Community Living Assistance Services and Supports program (CLASS Act) was designed for people to buy federally guaranteed insurance that would have helped consumers eventually cover some long-term-care costs. But in October 2011, federal officials effectively suspended the program even before it was to begin, saying they could not find a way to make it work financially.
Illinois Health Matters hosts a blog that is chock-full of information and commentary about ACA. You can access the blog – and contribute to it – at: http://illinoishealthmatters.blogspot.com/