Affordable Care Act
The Patient Protection and Affordable Care Act (PPACA), often referred to simply as the ACA, is a federal statute signed into law on March 23, 2010, designed to decrease the number of uninsured Americans, provide new protections for people who have health insurance, improve the health of Americans, and improve the efficiency and quality of health care delivery. The ACA requires insurance plans to provide minimum essential benefits, including mental health and substance use disorder services, as well as preventive services with no out-of-pocket costs.
One major change in the delivery of health care brought about by the ACA is the development of health care exchanges, also referred to as marketplaces, which allow individuals to purchase health insurance from a list of competing plans that qualify based upon a set of minimum essential benefits.
California was one of the first states in the nation to open a health care exchange, called Covered California, which allows California residents to calculate which health care plans are available to them based on their income, the number of people in their families, and age. Covered California has contracted with 12 insurance companies that represent a mix of major insurers and smaller companies, regional and statewide doctor and hospital networks, and both for profit and nonprofit plans. Of the 12 plans, only one plan is available in San Benito County: Anthem Blue Cross.
The ACA requires that:
• Almost all Americans be insured in some form; each person who is required, but doesn’t purchase health care coverage, will face increasing annual penalties.
• Americans with an income of up to 400% of the Federal Poverty Level (FPL) who don’t receive employer-sponsored benefits (or Medicaid, Medicare or military coverage) will qualify for government subsidies, a break on health insurance premiums in the form of tax credits. Although individuals can purchase insurance directly from brokers, only those who purchase through the exchange are eligible for the subsidies.
• People with a household income at or below 138% of the FPL (which in 2013 is about $16,000 for a single person and $32,000 for a family of four) annually, will qualify for Medi-Cal.
• Insurance companies will be required to cover all applicants, and offer the same rates regardless of pre-existing conditions, age, or gender.
Resources for Individuals
- Covered California Health Care Exchange: www.coveredca.com
- National Health Care Exchange: www.healthcare.gov
- Consumer Reports Guide to Health Insurance: https://www.consumerreports.org/health-insurance/guide-to-health-insurance/
- Health Reform Beyond the Basics: www.healthreformbeyondthebasics.org
- California Health Benefit Exchange: www.healthexchange.ca.gov
- Families USA: https://www.familiesusa.org/
Resources for Businesses
- U.S. Department of Labor: www.dol.gov
- The Henry J. Kaiser Family Foundation: www.kff.org
- Internal Revenue Service: Small Tax Credit for Small Employers: www.irs.gov
- American Health Care Association: Employer Requirements: www.ahcancal.org
- Covered California: Small Businesses: http://www.coveredca.com/forsmallbusiness/