The main provisions of the Affordable Care Act (ACA), the most significant federal health care overhaul in half a century, got off to an inauspicious start this month amid partisan wrangling and a partial government shutdown. Reactions ranged from indifference to frustration to plain old confusion.
"How will the law affect me?" is the most common question, and I wish I could give you one simple answer, but ACA, or Obamacare as it is commonly called, will mean different things to different people.
This is partly by design, for two reasons. One, the law is intended to address many different health care and health insurance needs and gaps in the current system. And two, the massive legislation resulted from a compromise between those who favored a simple single-payer system (think Canada) and those who fought to preserve the role of competition among private companies in the marketplace.
While there are many other facets to the law, such as regulations requiring insurance plans to cover children on family policies to age 26, and mandated coverage for immunizations and other preventive services that trade short-term expense for long-term savings, the ACA's landmark provisions, effective in 2014, are two new programs designed to help many of the nation's 50 million uninsured adults, and an estimated 12,000 Western U.P. residents between the ages of 18 and 64, qualify for low- or no-cost health insurance.
The first of these new insurance programs is an expansion of Medicaid, a health insurance program for certain low-income people, funded federally but managed by the states. Currently, Medicaid covers most low-income children (Michigan's plan is called Healthy Kids), plus a few adults with very low incomes or disabilities. The other massive federal insurance program, Medicare, is for senior citizens, and is not affected by the new law.
Adults between ages 18-64 with household incomes below 138 percent of poverty, or about $32,500 for a family of four, will be eligible for the expanded Medicaid program in some states, including Michigan, but not all states. According to the Supreme Court, states have the option of accepting or turning down the Medicaid expansion money, because while the feds cover 100 percent of the initial costs, in future years there will be some cost to states.
Michigan decided just this September to accept the funding. So while perhaps as many as half a million low-income Michigan adults will be newly eligible for health insurance, they'll have to wait a while longer, until April 2014, for the state's program to become operational.
For other uninsured adults, help may be on the way sooner. For those whose employers either do not offer insurance or provide it with unaffordably high employee premiums relative to salaries, by enrolling at the healthcare.gov website, they can submit their family size and income, determine the level of tax credit they may be eligible for, and shop in the on-line Michigan Marketplace from among 31 private insurance plans with varying levels of costs and benefits. Coverage from these private insurance plans may begin as soon as January 1.
So, to repeat, to see if you are eligible for health insurance, apply at healthcare.gov. If you are low-income, you will be routed to Medicaid. At higher incomes, above 138 percent of poverty, you can choose from among private plans.
Still confused? The health department and the Copper Country League of Women Voters are hosting two free public presentations, each at 7 p.m., Oct. 28 at CLK High School and Oct. 29 at Houghton High School. Then I'll be heading to other counties to continue ACA outreach and education.
Or for enrollment help, call the health department office in Hancock at 482-7382 to speak to a Certified Application Counselor. Or, if you are enrolled in the Western U.P. Healthcare Access Coalition, call them at 482-7122.
Editor's Note: Ray Sharp is Western U.P. Health Department's Manager of Community Planning and Preparedness