Health Care Reform
Will Expand Coverage To Millions
After more than a year of debate, the U.S. Congress and the President passed
comprehensive health care reform in March 2010. The new law is expected to provide
coverage to 32 million people who are now uninsured. Medicaid or the Children’s
Health Insurance Program (CHIP) will cover an additional 16 million individuals,
mostly parents and childless adults. Another 24 million people will be able
to gain coverage through a new health care Exchange. The bill also adopts significant
changes to practices in the private insurance market.
The passage of health care reform will help millions of people with low income
obtain health coverage in this country. While the new law is not perfect, it
makes dramatic and important changes to our country’s health care system
and moves us much closer to ensuring that every person in this country has access
to affordable, quality health care.
Changes made by Health Care Reform
Most parts of the law will not go into effect until January 1, 2014. However,
a number of changes will begin this year.
Starting March 23, 2010
(date of enactment)
- States must maintain existing eligibility levels for Medicaid and
CHIP between March 23, 2010 and January 1, 2014. States facing deficits may
reduce eligibility for adults to 133% Federal Poverty Level (FPL) after June
30, 2011.
- Small employers, including non-profit employers, (with less than 25
employees) will receive tax credits covering 35% of health care premiums for
this tax year. This credit will increase to 50% by 2014.
After September 23, 2010
(These changes will go into effect when the “open enrollment” period
comes up for a person’s health plan)
- Young adults can stay on their parents’ health plan until age
26.
- Children with private health insurance can no longer be denied coverage
for pre-existing conditions. (Insurance companies will not be able to deny adults
coverage for pre-existing conditions starting in 2014.)
- Insurance plans can no longer have lifetime caps or restrictive annual
limits on coverage. They also cannot take coverage away when a person becomes
ill.
- New plans must provide free preventive services to enrollees.
Coverage Expansions
These go into effect on January 1, 2014:
- Provide Medicaid coverage to all non-elderly childless adults, who
are not eligible for Medicare, with incomes up to 133% FPL. In Maine,
this means that more than 39,000 uninsured adults will become eligible for
MaineCare (Maine’s Medicaid Program) starting in 2014. The expansion
in coverage to people with low income will be even more significant in other
states. Unlike Maine, most states do not provide any coverage for non-disabled
childless adults. Most states also set eligibility levels below 100% FPL for
parents. All states will receive additional assistance from the federal government
to pay for these newly-eligible adults in Medicaid.
- Create state-based health insurance Exchanges where individuals
and small employers will be able to buy coverage through private insurers.
The purpose of the Exchange is to provide a central location where people
can compare health care plans. It will allow them to see the services each
plan provides and the cost-sharing required by the plan. There will be no
out-of-pocket expenses for preventive services in any of the Exchange plans.
People in these plans with income below 400% FPL (about $73,000 for a family
of 3 this year) will get help with paying for coverage. The Exchange will
be for people who are not eligible for MaineCare.
- Provide premium subsidies and help with other cost sharing for people
with income below 400% FPL who purchase coverage through the Exchange.
The amount of help people can get will be based on your income and household
size. The chart below shows the amount people will pay for their premiums
and the annual limit for all other out-of-pocket expenses including deductibles
and co-pays.
Please stay tuned for more detailed information about coverage through the
Exchange in future issues of the MAIN Update.
Percent of FPL |
Premium Limit as a Share of Income |
Out of Pocket LimitIndividual/Family |
Below 133% |
2% |
$1,983/$3,967 |
133% |
3% |
$1,983/$3,967 |
150% |
4% |
$1,983/$3,967 |
200% |
6.3% |
$2,975/$5,950 |
250% |
8.05% |
$2,975/$5,950 |
300 – 400% |
9.5% |
$3,967/$7,933 |
If you have coverage or are offered coverage by your employer and that employer
does not enroll in the Exchange, you may be able to get help if the cost exceeds
a certain amount of your income. Look for more information about this option
in future newsletters.
Individual Mandate
Starting on January 1, 2014, all U.S. citizens and legal immigrants will be
required to have health coverage. Those who do not have coverage will be required
to pay a yearly financial penalty of the greater of $695 per person or 2.5%
of household income. There will be exceptions for:
- Financial hardship (to be defined by the US Secretary of Health and
Human Services)
- Religious objections;
- Native Americans;
- People who have been uninsured for less than three months;
- Individuals in prison or jail;
- Those for whom the lowest cost health plan exceeds 8% of income; and
- Households and individuals with income below the tax filing threshold
- ($9,350 for an individual and $18,700 for a married couple in 2009).
Other Reforms to Private Health Insurance
Several other changes to private health insurance coverage will also go into
effect in 2014. These changes will:
- Prevent health insurers from denying coverage to people for any reason,
including their health status; (for example, pre-existing conditions like diabetes
or heart disease.)
- Prevent insurers from charging people more based on their health status
and gender; and
- Require new health plans to offer a minimum set of services and limit
annual out-of-pocket expenses.
Health care reform will help millions of more people in this country access
affordable, quality coverage. Thanks to all who advocated for comprehensive
health care reform and for protections for people with low income. Please take
the time to thank Representatives Pingree and Michaud for their support for
health care reform.
MEJP and MAIN will continue to work on the implementation of health care reform
in Maine. Please stay tuned for more information about the implementation of
health care reform in Maine. Our work really has just begun!
MAIN
Update Table of Contents |
MAIN
Home Page |
MEJP Home Page
