As arrival time nears for major components of President Barack Obama’s historic health care overhaul, polls continue to show a sharp divide in public sentiment about the law. Most people think they know whether they like or dislike it. But when it comes to knowing what’s actually contained within this mammoth retooling of our health insurance system, most of us may not be smarter than a failing fifth grader.
Recent polls by the Kaiser Family Foundation found that more than two-thirds (67%) of uninsured Americans age 65 and younger and 57% of the overall population say they do not understand how the Affordable Care Act will affect their lives. And, 42% of us are still unaware that health care reform has been the law of the land since 2010.
It’s understandable. The ambitious law runs to 2,700 pages and the benefits that have already taken effect have been overshadowed by a Supreme Court challenge and widespread uncertainty over the new online public health exchanges coming in 2014.
With early enrollment through those first-ever, federal-state health insurance marketplaces beginning Oct. 1, perhaps it’s time to acquaint ourselves with the changes that have already occurred and those soon to come.
Here are the facts to dispel eight fictions that have grown up around the Affordable Care Act.
Mandate muddle
Fiction: Everyone must purchase health insurance beginning in 2014, no exceptions.
Fact: While most uninsured Americans will be required to buy health insurance or pay a penalty (or tax, if you like) beginning in 2014, several groups are exempt from the so-called individual mandate.
They include those whose income is so low, they don’t file federal tax returns; anyone who would have to spend more than 8% of their income on health insurance; undocumented immigrants; people who are incarcerated; members of Native American tribes; and those who qualify for a religious exemption.
There’s also one other large set of people who won’t need to buy health insurance.
“Everybody who is eligible for Medicaid or Medicare does not have to purchase additional coverage,” notes Deborah Chollet, a senior fellow at Mathematica Policy Research in Washington, D.C., who is helping states set up the new health exchanges.
“The Urban Institute and others have estimated that only about 3% of Americans will be subject to the penalty,” says Kathleen Stoll, director of health policy for the health care consumer group Families USA. “The rest of Americans either will have insurance or will fall under an exemption.”
Misplaced worker apathy
Fiction: If you’re insured through your employer, health care reform won’t affect you.
Fact: On the contrary, many new consumer protections under the Affordable Care Act are already benefiting people with job-based health insurance.
For example, the health care reform law bars insurers from placing lifetime limits on what they will pay for a worker’s medical care, plus there are new restrictions on annual benefit limits. Insurers are no longer able to arbitrarily cancel your insurance policy when you get sick, except in cases of fraud, according to the Centers for Medicare & Medicaid Services.
Other new features for job-based policies include: no more copayments or deductibles for preventive health services, including cancer screenings; the right to see obstetricians and gynecologists without a referral; better access to out-of-network services in an emergency; protections against unfair administrative fees; and the right to keep dependents younger than 26 on your policy.
“If you have employer coverage, health care reform will actually make your life a little better,” says Chollet.
Date: June 19, 2013