09 Aug 2012

5 Common Misunderstandings about the Health Care Reform

09 Aug 2012

A recent Kaiser Health Tracking poll shows that twenty-six percent of Americans have an opinion on the Affordable Care Act but could be persuaded otherwise, and 20 percent said they hadn’t yet decided how they feel about it. The indecisiveness is understandable considering the ambitious law runs to 2,700 pages, some of its regulations have yet to be written, and the benefits that have already taken effect have been overshadowed by the barrage of political advertising surrounding November’s presidential election.

I know how I feel about the law, and have recently had many discussions with friends and family. Everyone is entitled to their own opinions, and as  I pointed out in another recent blog post, positions on Obamacare depend on personal circumstances. The most interesting thing though that I’ve noticed in my conversations is that although many of us already know how we feel about the law, we don’t know what’s actually contained in the law. Here are the most common misunderstandings I’ve encountered in the past few weeks following the Supreme Court’s decision:

1. Everyone must purchase health insurance beginning in 2014. 

– While most of us will be required to buy health insurance or pay a penalty beginning in 2014, several groups are exempt from the individual mandate. Those whose income is so low that they don’t even file a tax return, anyone who would have to spend more than 8 percent of their income on health insurance, undocumented immigrants, people who are incarcerated, members of Native American tribes, those who qualify for a religious exemption, and everyone who is eligible for Medicaid or Medicare are all exempt from the individual mandate.

2. If you’re insured through your employer, you will not be affected.

– Quite the opposite. 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. Insurers are also no longer able to arbitrarily cancel your insurance policy when you get sick. Other new features for job-based policies include: no more co-payments 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.

3. The Affordable Care Act creates a new government-run insurance plan.

– The law does call for the creation of new insurance plans, but the government won’t run them.The federal Office of Personnel Management is required to contract with at least two private insurance carriers, including at least one nonprofit, to offer coverage in every market nationwide. How the government is stepping in is through the expansion of the existing Medicaid program, increased federal regulation of the health insurance industry, and tax credits to make private insurance more affordable.

4. All businesses will be required to provide employee health insurance.

– The Affordable Care Act does not require employers to provide health coverage. It does however impose a penalty on companies with more than 50 employees that either do not offer a plan or offer unaffordable coverage.

5. States that don’t set up health exchanges will be exempt from the Affordable Care Act.

– If states decide not to establish a health exchange, the federal government will set up and run one for them. By January 1, 2014, consumers in every state will have access to private health insurance options on an Affordable Insurance Exchange, regardless of whether that exchange is run by the state, the federal government or a partnership between the two. But the Supreme Court’s ruling on the Affordable Care Act said states may, in fact, opt out of another part of the health care reform law: its expansion of Medicaid, which is designed to make health insurance affordable for an additional 16 million Americans. States that do decide to opt out would be turning down millions of dollars in Medicaid funding, because the federal government plans to foot the entire bill for expanding Medicaid in the first few years.

I believe that the reason for so many misunderstandings about the law lie in the fact that the law itself was not advertised properly. All many of us heard was “massive healthcare overhaul,” and we weren’t given a clear description of how the law works and actually benefits us. I expect things to be less cloudy as many of the law’s provisions begin to take effect.

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  1. Teri Darnell September 17th, 2012 9:08PM

    Thanks so much for this clear explanation.