Affordable Care Act, Where We Are Now

Before the Affordable Care Act was passed, the number of Americans without health insurance has been estimated to be as high as 44 million. Current statistics indicate that about 7.26 million have enrolled in the program so far. Every citizen is required by law to get insurance. If you don’t have health insurance through work, enrolling will keep you from getting hit by an IRS-enforced tax/fine.

Prior to ACA’s enactment, 18% of American adults had no health insurance. In 2014, eight million people signed up for health insurance, dropping uninsured to about 14%. Thirty million are expected to remain uninsured, even after a few more years of enrollments. Health insurance is clearly something that still needs to be addressed.

States have the right to choose two different paths concerning Medicaid money. They can expand Medicaid availability by partnering with the Federal Government on the Marketplace Exchange. If they choose to do so, then more federally-funded Medicare dollars become available to those states. In states that expanded Medicaid, the uninsured fell from 28% to 17%, but in states that didn’t, the average uninsured rate only fell from 38% to 36%.

North Carolina is not moving forward with Medicaid Expansion at this time and is not alone in this choice. In fact about 50% of our country (23 states) chose to not pursue Medicaid Expansion. These states have chosen to not use the federal end of the Marketplace website. They have chosen a route that has less federal red tape.

About 90% of those who remain uninsured are unaware that there is another enrollment window. The Marketplace is full of all kinds of useful information to help folks make decisions about policies, a better understanding of health insurance basics, where to go for additional help. Small business owners can find plan options there as well.

The next enrollment window is November 15, 2014 – February 15, 2016. This will be for coverage that starts as soon as January 1, 2015. Outside of this enrollment window, you can’t sign up unless you have a life-changing event, such as getting married, having a baby, job loss, or moving outside your current insurance’s covered area. With most rules, there are exceptions and ACA is no different: Medicaid and CHIP (Child Health Insurance Program) is available for enrollment year round.

People who have the greatest need for health insurance are usually the poorest. They are typically the least informed, least educated, and last to know about changes in the law, probably due to limited access to the internet, news, etc. They tend to have poorer health and some have had to often rely on Emergency Rooms for ordinary medical care. They are the group that will have the hardest time paying the penalties for failing to comply with the law. Obviously, this is a niche that needs to be educated about Marketplace and Medicaid/Medicare/CHIPS options.

Check out the Health Insurance Marketplace. You can compare plans (similar to shopping for airline tickets) even find out if you’re eligible for tax credits, which is based on income. Subsidies are available to offset the expense of ACA policies. Up to 400% of the poverty line qualify. That’s about $97K/yr gross income. Blue Cross Blue Shield of North Carolina can give you more information, and sign-up details. Getting a policy is probably going to be a better decision than paying the non-compliance tax.