How to get it, and why it’s controversial
by Casey Jaywork | Editor in Chief
How to get it
The Patient Protection and Affordable Care Act, also known as the Affordable Care Act (ACA) or Obamacare, was passed into law by the U.S. congress in 2010 and subsequently upheld by the Supreme Court. It’s a complex piece of legislation which, among other things, requires most U.S. citizens and legal residents to either get health insurance or pay a tax penalty. It also sets standards for health insurers such as limiting deductibles (i.e. what the patient pays out-of-pocket before their insurance takes effect), prohibiting insurers from rejecting people with preexisting conditions and from placing lifetime limits on benefits, and requiring insurers to cover customers’ children until age 26. Finally, it requires employers of 50 full-time workers or more to insure their employees or pay a penalty, expands Medicaid (the government health insurance program for the poor), and allocates funds to subsidize low-to-middle-income participants.
The law mandates that states create and regulate individual (non-group) insurance exchanges or “marketplaces” where people can compare and purchase insurance plans. In Washington, this takes place on the Washington Health Benefits Exchange at wahealthplanfinder.org, where this reporter was able to enroll in about half an hour.The exchange opened at the beginning of October and will remain open through March 2014. After that, enrollment will generally be open only in October-December. In other words, people who don’t enroll by March can’t enroll for half a year.
The exchange’s sister-site wahbexchange.org includes a cost calculator, which upon experimentation yielded the following results:
- Anyone making $15,856 per year or less qualifies for Medicaid.
- At $15,857 there’s a shift from Medicaid to a $187 monthly subsidy for market insurance, to which the recipient must add $43 out-of-pocket per month–that is, about 3% of their income.
- Someone making $20,000 per year receives a $231 monthly subsidy and pays $55 monthly – that is, about 3% of their income.
- Someone making $25,000 per year receives an $87 subsidy and pays $144 monthly–that is, about 7% of their income.
- At $31,544 people cease to receive a subsidy, and must pay $230 monthly.
- For people receiving subsidies, neither age nor number of children affect out-of-pocket cost. The recipient’s age, the number of children, the insurance’s total cost, and the government’s subsidy all rise together, so that a childless 21 year old pays the same amount as a 41 year old with three kids.
A note of caution: these results could be adjusted by factors like smoking, zip code, and level of coverage purchased.
Why it’s controversial
Earlier this month, the federal government shut down for more than two weeks in a symbolic attempt by the Republican party to defund the ACA–symbolic because the shutdown did not affect funding of the program. The New York Times has reported that some conservatives were planning the shutdown months in advance. Lawmakers in conservative-dominated states are taking steps to prevent federally-paid “navigators” from helping people navigate the ACA enrollment process: for instance, barring them from state health agency premises and requiring them to undergo complex licensing. At the same time, conservative groups such as Freedom Works and Generation Opportunity (GO) have mounted massive campaigns to convince the young and healthy to “opt out” of the ACA by paying a tax penalty and foregoing health insurance. In addition to launching a nationwide pizza-party college tour, GO created a pair of television ads which equate the ACA with rape (as well as inaccurately construing “Obamacare” as an insurance provider, rather than a law governing insurance providers). While GO’s president claims it’s a “grassroots” organization, it’s actually funded by the powerful conservative lobbyists the Koch brothers. Many observers believe that GO’s real goal in convincing the young and healthy to unenroll is to sabotage funding for the ACA, since insurance depends on spreading risk between high- and low-risk populations. Others have speculated that conservatives both inside and outside Congress are desperate to stop the ACA now because they’re afraid that once it is enacted, it will become too popular to repeal. In the words of Texas Republican Senator Ted Cruz, Americans will become “hooked on Obamacare so that it can never be unwound.”