The Uninsured (2009 Estimates)
- 50 million adults under age 65 are uninsured.
- More than three-fourths of the uninsured are from low-income working families.
- Individuals living under the Federal Poverty Level (FPL) are 40% of the uninsured.
- Non-elderly adults are 80% of the uninsured population.
- Young adults ages 18-29, have the highest uninsured rate, 32%, of any age group.
- Minorities are more likely to be without coverage than whites.
- The average uninsured American has gone three years or more without health insurance.
On March 23, 2010 President Obama signed into law the Patient Protection and Affordable Care Act (ACA) or what has become affectionately known as “Obama-Care”.
ACA is designed to promote greater health coverage by building on the current private-public coverage system, filling gaps by expanding the Medicaid program, supplementing employer sponsored coverage and providing subsidies to make private insurance affordable.
ACA has several provisions including:
In 2014, Medicaid will be expanded to cover nearly all individuals under 65 with incomes up to 138% of the Federal Poverty Level. A uniform eligibility process for all states will be implemented and low-income adults without children will be afforded the opportunity to get coverage.
New Health Insurance Exchanges/Premium Subsidies
Health insurance exchanges are health marketplaces where individuals and employers can purchase insurance. This market place is designed to provide a competitive environment and provide customers information on coverage care and quality.
Changes to Private Insurance
Insurance companies are PREVENTED from denying coverage for any reason including health status and from charging more to cover those who are ill, more often. Insurers are allowed to charge older adults but the charge is limited. All new health plans provide comprehensive coverage which includes a minimum of services provided, a cap on out-of-pocket spending, does NOT impose cost sharing for preventative services and lifetime limits on coverage. These changes include keeping young adults on their parent(s)’ coverage until age 26. A pre-existing condition insurance program provides coverage for those with such conditions without insurance for at least six months.
Employer Requirements and Incentives
Employers are NOT mandated to provide coverage. Those employers with more than 50 employees will be assess a fee of $2000 per employee if affordable coverage is NOT provided and they have an employee who receives premium credit through an exchange. A tax credit is provided to small employers (25 employees or less) and the average annual wage is less than $50,000.
In 2014, law will require MOST individuals to have health insurance. But this ONLY applies to those with access to affordable coverage (no more than 8% of their annual income) Those who chose NOT to have coverage and who are NOT exempt from requirements will pay a penalty through taxes.
The Congressional Budget Office (CBO) estimates that by 2019 more than half of the currently 50 million will be covered. The legislation will enroll 16 million Americans in Medicaid and Children’s Health Insurance Program (CHIP) and about 24 million will receive coverage in the health insurance exchanges.