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Time to accept reality – the Affordable Care Act is the law

By on November 13th, 2012
Filed: Advice, Health Insurance, Health Reform, You

Last week we published a survey showing that two-thirds (69%) of small employers did not  understand basic tax provisions and coverage requirements in the Affordable Care Act (Health reform). And, three out of four (77%) said they were not making any long-term plans, based on what’s in the law.

It’s not hard to guess why so many people still are not aware of what’s in the law. Some folks were likely hoping it (and the president) would go away, while were likely hoping for the opposite. In either case, the election is over and it’s time to accept reality: “Obamacare” is the law, the law is Obamacare, and you need to start preparing for 2014 when the major provisions of the law go into effect.

A number of small but important changes have already occurred, including:

  1. Adult children can stay on a parent’s health plan until age 26
  2. Children under age 19 cannot be declined coverage due to pre-existing medical conditions
  3. Improved preventive and women’s health care coverage with no out of pocket costs
  4. No lifetime coverage caps for most covered medical services
  5. Special tax breaks are available for small businesses offering health insurance

New changes in the pipeline for 2014 include:

  1. The mandate, requiring most people without coverage to buy it for themselves.
  2. Subsidies to help people buy insurance if they earn less than 400% of the federal poverty level.
  3. People who buy their own insurance (not from an employer) can’t have their application declined because they have a pre-existing condition.
  4. Employers with fifty or more full-time employees will be required to provide coverage or face penalties if their employees buy subsidized insurance through an exchange.

What needs to happen between now and 2014 to make the Affordable Care Act work?

Governments at every level have to take quick action to meet looming deadlines.  By October 1, 2013 (less than 11 months from now) the Affordable Care Act requires states to have “exchanges” ready so that people can enroll in new qualified health plans (QHPs).

To make that happen, there are some important things that need to get done, including:

  1. “Real Time” Income Verification - Developing a way to verify household income so exchanges can administer low-income subsidies is one important task for exchanges. IRS data looks back, not forward, so there needs to be another way for exchanges to determine what a person is making each month, and how much of a subsidy/discount they should receive for their health insurance.
  2. What’s the definition of a qualified health plan (QHP)? In order to make sure people are enrolling in quality coverage, the government has to define the benefits that must be covered in a qualified health insurance plan, or QHP. Only people enrolled in a “QHP” will qualify for a low-income subsidy on their health insurance.
  3. Have a marketing and enrollment strategy: At eHealth, we know from experience that it’s not always easy to find customers or for them to find you. Some states, like California, have pretty robust marketing plans but others may be at square one.  To be successful at enrolling the uninsured, we here at eHealth think states should consider licensing companies like ours as a“web-based entity” so we can help with the efforts to enroll lower income Americans who are eligible for premium tax credits.

What should the uninsured do today?

If you’re uninsured today, don’t wait until 2014 to get coverage.  There are plenty of quality options available right now. “Obamacare” does not make health insurance free, it doesn’t excuse people from paying their medical bills, and it doesn’t enroll you automatically if you become ill.


If you’re uninsured today, here what you can do to protect yourself and family:

  1. Don’t procrastinate. It can only hurt you – You’re not required to buy coverage on your own until 2014, but going without coverage today can put you at serious financial risk in case of unexpected illness and injury. Buying health insurance now protects you from injury and gets you a jump on the individual mandate.
  2. Health insurance is better now than it used to be. Look back at the first section of this post. A number of changes to the individual health insurance market have already been implemented, which improve the health insurance plans you can buy today. Most offer better preventive and women’s health care coverage, and eliminate lifetime coverage limits for most services.
  3. It’s easy to compare plans and buy online. State exchanges may not be live yet, but private health insurance exchanges like ours have been around years, and we’re not going anywhere. Visit eHealthInsurance.com to review quotes from insurers in your area, compare plans side by side, and apply for coverage online.


About Amir Mostafaie

Amir Mostafaie plays a lead role in training and educating new and existing agents in our customer care center, and over the past 9 years has enjoyed helping numerous people find health coverage that fits their needs. His background in the medical field and expertise in the health insurance marketplace allows him to provide unbiased assistance and insight on a broad range of health insurance topics.

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