Affordable Care Act Reality Check

What is Obamacare and is it for you?
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NEW YORK (MainStreet) — I'm self-employed, middle-aged, healthy and chronically uninsured – and a target enrollee for a new healthcare plan through the Affordable Care Act (ACA), also known as Obamacare, come October 1, 2013 (that's less than two weeks away). But what even is Obamacare, what will these health plans cost and is it for me?

These are burning questions all Americans have, according to a new monthly report, Health Insurance Pulse. The most recent report found that 28% of Americans wonder how the ACA will affect their current healthcare plan followed closely by 24% who want to know how it will affect their household budget (that's me). Still some 20% wonder if the Affordable Care Act is really going to happen and 15% just want to know what Obamacare is.

I called up Dr. Sherry Glied, Ph.D., who chairs the Department of Health Policy and Management at Columbia University's Mailman School of Public Health to ask her if there is enough being done to educate the American public about the healthcare changes coming next year.

Glied noted that there is plenty of time for Americans to learn about the ACA and how it will affect them. In fact, the ACA is really going to happen, and though open enrollment begins on October 1, 2013 for health plans that start on January 1, 2014, you really have until March 31, 2014 to sign up when open enrollment ends.

We Americans (doctors included) aren't quite sure about how things might change as a result of the Affordable Care Act either or whether they will change at all, and many don't know what, when or if they are supposed to do something about it.

So, I decided to find out. In this ACA Reality Check series, I will answer these questions and you can follow me on my quest to find out about healthcare coverage through the ACA.

First of all, what the heck is Obamacare?

The ACA is a set of new health care laws that offer new rights and protections that is supposed to make health insurance coverage fairer and more understandable. According to the official government website for the ACA, the law:

  • Creates the Health Insurance Marketplace (also called the "exchange", a new way for individuals, families, and small businesses to find, compare and buy health coverage
  • Requires insurance companies to cover people with pre-existing health conditions
  • Helps you understand the coverage you're getting
  • Holds insurance companies accountable for rate increases
  • Makes it illegal for health insurance companies to cancel your health insurance arbitrarily just because you get sick
  • Protects your choice of doctors
  • Covers young adults under 26 on their parents plan
  • Provides free preventive care included in your premiums
  • Ends lifetime and yearly dollar limits on coverage of essential health benefits
  • Guarantees your right to appeal

As an uninsured American, I am hoping the Affordable Care Act would create something better than what I have already experienced and am looking forward to checking it out.

How many others are there like me? Well that depends on what research you read and who it includes. According to the Commonwealth Fund 2012 Biennial Health Insurance Survey, 84 million people¿nearly half of all working-age U.S. adults¿went without health insurance at some time last year or had such high out-of-pocket costs relative to their income that they were considered underinsured. But The U.S. Census Bureau's most recent report says that 48.6 million people were uninsured in 2011 -- down from 50 million the year before and that the percentage of uninsured people also ticked lower, inching down from 16.3% to 15.7%.

Anyone who might want to participate in a healthcare plan offered through the state exchanges should start their research (that's right, there's research) right now, to make an informed decision on the actual plans once they are available on October 1, 2013.

So, that's you if:

  • You are self-employed
  • You are currently uninsured
  • You are not eligible for insurance through an employer
  • You are not eligible for Medicare (under age 65)
  • Your employer's insurance (is crappy and/or) requires you to pay more than 9.5% of your income for premiums
  • You recently lost your job and/or are paying for healthcare via COBRA (only good for 18 months)
  • You work a job you hate solely for the health insurance and you want to see if you are eligible for something better through the exchanges so you can quit
  • You are currently on Medicaid or your income is below 133% of the federal poverty line (that is income of $31,322 for a family of 4)
  • You are a small business with 50 or less employees you want to provide health coverage for

If you (or anyone you know) is someone listed above, your first step is to visit the official government ACA website.

The official website tries to answer questions and provide basic, factual information about the purpose of the Affordable Care Act and whom it's designed to help and protect. Once you start looking at it you might get confused and it may seem overwhelming. If you are uninsured or someone from the above list, don't give up...keep reading.

Written by Naomi Mannino for MainStreet