Understanding Health Reform
What’s the Affordable Care Act (Obamacare) All About? It’s Simple!
Our health care system is big and complex. While most Americans are able to get health insurance through their employer, a growing number found themselves shut out, priced out, or outright denied coverage when they tried to buy insurance on their own. Still more were finding that when they tried to use their insurance, they faced an uphill battle – facing arbitrary annual and lifetime limits restricting their coverage, or having to struggle to get their insurer to cover what their doctor prescribed. And for decades, Americans with insurance were paying more and more for less and less coverage.
To address these problems, the ACA focused on creating three things:
- SECURITY: The health care law makes sure your coverage is secure, and that you’ll have quality options no matter your age, health history or income.
- VALUE: The health care law makes sure we get our money’s worth when we buy insurance by requiring plans to cover the “essential benefits” we need to stay well — including preventive care with no co-pays.
- A LEVEL PLAYING FIELD: The health care law puts US in control of our healthcare, not insurance companies by putting in place some rules of the road that stop the worst insurance company abuses like denials of coverage and charging women more than men.
So How Will It All Work and What Does It All Mean for You?
Insurers Cannot Deny You Coverage or Charge You More Based on Your Health Status or Gender:
The days when an insurance company can deny you coverage because you have a health condition, or charge you higher rates because you happen to be female, are over. Insurers must offer coverage to everyone who seeks it, and cannot charge you more if you’ve been sick in the past.
You Can Rest Assured That Quality Coverage Will Be There When You Need It:
If you’re facing a layoff, struggling to find full-time work with benefits or thinking about starting your own business, you no longer have to face the threat of being uninsured.
Insurance companies will compete for your business based on plan quality and value. Insurers will have to provide you with a standardized, easy to understand description of what their plans cover and how much you can expect to pay for covered services so that you can make apples-to-apples comparisons and choose a plan that’s right for you and your family — or your small business.
You Are Protected Financially and Have the Right to Comprehensive Coverage You Can Afford:
Gone are the days of being pushed to the brink of financial ruin over health care costs. Gone are the days of languishing uninsured if you’re a low-income worker, or laid off.
Now, if you earn between 138 and 400% of the federal poverty level and purchase coverage in the new marketplace, you will get substantial tax credits to lower your monthly premiums (before you pay them!) and will be protected financially with caps limiting how much you have to pay in out-of-pocket expenses for health care each year. If you’re below Marketplace eligibility, don’t worry. You can be covered through a comprehensive expansion of Health Choices, Pennsylvania’s Medicaid program.
If your employer offers you a plan that would cost more than 9.5% of your household income, or if it covers less than 60% of the cost of covered benefits, you can reject that plan, choose a plan in the new marketplace, and receive the same tax credits as everyone else.
Want to learn more? Here’s a six minute video explaining health reform from the Kaiser Family Foundation: