The Affordable Care Act: What's in the Fine Print?
By Jeremy Howell, MHA, CTU Faculty, HealthCare
Despite the kerfuffle, the Affordable Care Act (ACA), or Obamacare, has arrived. Health care exchanges opened to the public for the first time on October 1, 2013, allowing individuals to sign up for marketplace insurance plans that will begin coverage on January 1, 2014. Unfortunately, many of the men and women seeking health care coverage through their state's health-insurance exchange are still perplexed by the law and are uncomfortable making a decision for themselves or their families. Nevertheless, benefits can be foreseen, though unintended consequences loom with the ACA's implementation.
Allow me to highlight some of the benefits of the ACA. In 2014, when policies sold in the exchanges go live, they must cover 10 essential health benefits: (1) hospitalization, (2) ambulatory services, (3) emergency services, (4) maternity and newborn care, (5) mental health and substance-abuse services, (6) prescription drugs, (7) lab tests, (8) chronic disease management, (9) pediatric services and (10) rehabilitative services. Furthermore, preventative care is free, and out-of-pocket expenses will be limited starting in 2015.
Consumers will find there are four plan options, or "metal tiers," to choose from: bronze, silver, gold and platinum. It is important to understand that the tiers do not represent quality but the total share of monthly premiums. For example, a gold plan will pay 80 percent of average health care expenses, and an enrollee will be responsible for 20 percent of expenses through deductibles, co-pays, etc. Premium subsidies and cost-sharing credits will be available to individuals and families based on their income tax returns.
However, some part-time workers now covered by employer-paid health insurance may not see the promise fulfilled. If the employer chooses to reduce an employee’s hours to fewer than 30 per week in order to avoid paying for his/her health-care plan, that employee will be on his/her own to choose an adequate plan at a cost s/he may or may not be able afford. Because that person will be shopping as an individual on exchanges, s/he will pay more for reduced benefits. And because s/he will be working fewer hours, his/her weekly pay will be reduced.
News reports of these unanticipated consequences of the ACA have generated heated discussions. Opponents of the ACA will see that voters hear more about the negative effects on part-time workers in the 2014 political campaigns. Unions will focus efforts to make sure that workers will not lose the contracted benefits of health insurance. Only time will tell if the ACA will be a colossal success, a mega failure or another mediocre government program. For now, all we can do is wait and see if the promised benefits of the ACA will become reality.
Jeremy Howell is a member of CTU’s HealthCare Faculty. A career officer with the U.S. Navy, he is a lieutenant in the Navy's Medical Service Corps, and he currently serves at the Bureau of Medicine and Surgery. He holds a Master’s in Health Administration from the U.S. Army-Baylor University, and his undergraduate degree from Embry-Riddle Aeronautical University. Opinions expressed herein are solely those of the author and do not necessarily reflect those of his employer(s).
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