Your Questions About the Affordable Care Act

I can’t take it anymore. I just can’t take the lies and misinformation out there about the Affordable Care Act (ACA) and healthcare reform. Nearly ever  time I tell someone something about the Act, or answer a question, they are surprised at how the truth differs from what they’ve heard.

To that end, I put out the word to friends and others to send me their questions about the ACA. Here’s the first batch. If you have any questions, send them on. I’ll keep answering them until we run out.

Question: Are the insurers currently participating in the system locked in on Jan 1st? Can they decide to pull out during the year?

Answer: If they decide to participate in the exchanges they must provide coverage for the year so no, they can’t pull out during the year. The only reason they can cancel your coverage is if you lie on the application.

Question: How will income be calculated?

Answer: Based on adjusted gross income (AGI), which includes certain deductions. Note that income is based on your household income, not individual, and that it is based on estimated income for the following year. If you estimate wrong and received a subsidy, you’ll have to settle up with the IRS at tax time.

Subsidies are available to those with household incomes between 100 and 400 percent of the federal poverty level (higher than you might think). See where you fall here.

Question: Will the premiums (subsidized or not) still be fully deductible?

Answer: Sure, just as it is today — if your total medical expenses (including premiums) are above 10 percent of your AGI. Of course, you also need to itemize your deductions at tax time.

Question: Why do the Republicans want to strangle the act/law by defunding it through the budget negotiations and are holding our government and people hostage?

Answer: If I knew the answer to that I would be also be able to turn water into wine.

Question: Why do so many of the American people think the act is a job killer?

Answer: Because that’s what they’ve been told. The reality is that more jobs have been created since the ACA was passed, primarily in full-time positions. That’s not my opinion, that’s from September’s Bureau of Labor Statistics monthly report.

Question: What happens if there are no health exchanges in my state or my governor refuses to expand Medicaid to provide access?

Answer: The federal government is running exchanges in states that refused to run their own. If a state did not expand Medicaid, then those individuals who do not qualify for Medicaid can shop on the exchanges. However, since the law assumed the Medicaid expansion, there are no subsidies available for people with incomes below 100 percent of the federal poverty level. Hopefully, that glitch will be fixed with future legislation (assuming we can ever Congress to work again).

Question: It looks likely that some states will have substantially elevated premium increases when the health exchanges are put in place, while other states are reporting that they expect only minimal (or no) rate increases compared with existing prices. Why is this?

Answer: I’m not sure what you mean by “substantially elevated premium increases.” Are you referring to the cost of insurance on the exchanges? If so, then the majority of people purchasing insurance on the exchanges who already had individual insurance should see their premiums drop substantially given that they can no longer be charged premiums based on gender or pre-existing conditions. We’ve already seen this in New York.

individual premiums have always been high because people typically only purchase insurance when they need it, ie, when they’re sick. By mandating coverage, insurers now have premiums from healthier people that will help bring down the cost of insuring sicker people.

In addition, estimates are that between 80 and 90 percent of people shopping on the exchanges will be eligible for subsidies. A report last week from the department of Health and Human Services estimated that about 6.4 Americans purchasing health insurance through the exchanges will pay less than $100 a month, thanks to subsidies. Add in other expanded insurance programs like Medicaid and the Children’s Health Insurance Program (CHIP) and that number jumps to about 20 million currently uninsured people.

A recent analysis from the Kaiser Family Foundation found that most of the 18 exchanges evaluated have three or more insurance companies participating, and that while premiums will vary across the country, they “are generally lower than expected.”

What is clear is that the more health insurers that participate in the exchanges, the lower the premiums (thanks to price competition).  Some large insurers have a adopted a wait-and-see approach regarding the exchanges. Experts predict they’ll jump into the pool next year.

Question: How can a person find out what to do if they are self-employed?

Answer: You can get help navigating the exchanges online, in person, or on the phone. Just visit www.healthcare.gov, enter your state, and you’ll be directed to your state’s exchange (or the federal exchange), which will have information on navigators.