September 26, 2017
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Just the FAQs, ma’am

By Lindsay Tice, Sun Journal

What is this “Affordable Care Act” of which you speak? It’s a controversial 900-plus-page federal law (officially the Patient Protection and Affordable Care Act) that was signed by President Barack Obama on March 23, 2010. It makes some sweeping changes to health care, like requiring almost all Americans to have health insurance. Some people say it goes too far. Others say it doesn’t go far enough.

This is universal health care, right? No. In places with universal health care (think Canada), the government pays for all care. The ACA, on the other hand, requires that people pay for their own care by buying insurance. The ACA did expand government coverage — Medicaid — to some people, but the U.S. Supreme Court ruled that states didn’t have to accept that expansion. So many states, including Maine, didn’t.

So, I must have health insurance now? Yes, unless you are very poor (under the federal poverty level) and live in a state that didn’t expand Medicaid (like Maine). You can also get an exemption to the penalty if:

• Your religion prevents you from accepting insurance benefits.

• You’re part of a health care sharing ministry.

• You are a member of a federally recognized Indian tribe.

• You lack insurance for less than three months in a row.

• You have suffered a certified hardship.

• You can’t afford coverage because you’d have to pay more than 8 percent of your household income for coverage.

• You’re behind bars.

• You are not a U.S. citizen, a U.S. national or an alien lawfully present in the U.S.

For this first year of the ACA, open enrollment for insurance lasts from Oct. 1, 2013, to March 31, 2014. The insurance mandate starts Jan. 1.

Hmm. I need insurance by Jan. 1 but I have until March to buy a plan? That sounds fishy.: The requirement for insurance starts Jan. 1, but there’s no penalty if you’re without insurance for fewer than three months in a row. So you could get insurance after Jan. 1 but before those three months are up and be fine.

Why is the ACA also known as Obamacare? Opponents came up with that name back in 2007 as a dig at Obama. It stuck.

When do the death panels start? There are no death panels and never were. There is a board (the Independent Payment Advisory Board) that was established to recommend Medicare cost-saving changes. However, it is not allowed to recommend rationing care, limiting who or what Medicare covers or raising the cost on patients. An early draft of the ACA also would have allowed patients to talk with their doctors about end-of-life care and have that consultation covered by Medicare. That provision proved so controversial that it was taken out of the bill and is not part of the ACA. The Obama administration brought it up again in 2010, then quickly dropped it.

This ACA thing is really a ploy to install microchips in our brains, isn’t it? Um, no. However, colonoscopies are free.

When does the ACA take effect? Many parts already have. (See timeline.) The insurance mandate, one of the biggest and most controversial parts of the law, starts Jan. 1, 2014. Individuals and small businesses and groups can start buying insurance off the upcoming marketplace (and get subsidies and tax credits to do so) starting Oct. 1, 2013.

Wait, a subsidy? If you can’t get affordable health insurance through your job and you are between 100 percent and 400 percent of the federal poverty level, you can get money from the feds to help pay for insurance. If you’re between 100 percent and 250 percent of the federal poverty level, you can also get a discount on your out-of-pocket health care expenses. This will all be on a sliding scale — the less you earn, the bigger your subsidy.

What’s the federal poverty level? Right now, $11,490 a year for one person (modified adjusted gross income). For a family of four, $23,550.

Did we get something wrong? Please, Let us know, submit a correction.

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