Oklahoma Decides: Runoff election results

Top 4 questions about Obamacare & how it affects you

Pres. Obama

WASHINGTON – The government has shut down. So what does that mean for Obamacare?

What happens on today with Obamacare and the government shutdown?

The health insurance exchanges established by the Affordable Care Act, or Obamacare, are open for business. Millions of uninsured Americans are now able to enroll in health plans before the law kicks in on January 1, 2014. Second, the U.S. government shut down. These two events are linked.

Do I have to sign up for a new health insurance plan on today when open enrollment for Obamacare begins?

Maybe — Take this quick survey and we’ll find out:

A. Do you get health insurance from your employer? 
If the answer is yes — and this is by far the No. 1 way Americans get health insurance — go on about your business. Obamacare doesn’t really affect you. At least not yet. A lot of people think that because of Obamacare, fewer companies will offer health insurance, particularly to low-paid workers and retirees. There is some evidence of this. These employers would have to pay a per-worker fine to the government but it might be cheaper for them in the long run to pay this fine to the government rather than offer insurance. Other companies might cut hours for some workers, making them part-timers working fewer than 30 hours a week in order to avoid helping pay their health insurance. But it will take some years to see if it really comes to pass. However, if you get health insurance at work, you could probably drop that coverage and buy health insurance on the Obamacare exchanges. But you might not want to. You won’t qualify for any government help to buy your insurance and your employer wouldn’t be contributing any of the money it is now.

B. Do you get health insurance from the government? 
If the answer is yes, go on about your business. Obamacare doesn’t really affect you. At least not yet. While Obamacare relies on making Medicare more efficient as a way to pay for some new services for younger people, it is not supposed to change the services offered by Medicare. One big test of this promise is Medicare Advantage. These are privately administered insurance plans that provide Medicare services to seniors. They cost the government more per person to provide Medicare. So, Obamacare seeks to bring their spending back in line with the rest of Medicare. This could lead to changes in Medicare Advantage options, like gym memberships and other items that are offered as enticements. But the same core Medicare services are supposed to remain in effect. The same goes for Medicaid. If you get your insurance from one of the 50 state-run Medicaid programs, Obamacare should not affect you. But you’ll have a lot more company in these programs, which will grow to insure a larger portion of Americans.

C. Do you have an individual health insurance plan?

If yes, Obamacare is going to affect you. It is possible that your insurance plan won’t change but it’s just as likely that your plan doesn’t meet all the minimum requirements the law imposes. These include new rules for how much profit companies can take for plans, new rules for coverage of women’s services, new rules for how much more insurance companies can charge for women than men and a lot more. So, you might have to buy a more expensive plan. In this case, your insurance company has probably already let you know. It’s also possible you might want a new plan. Check out your new state health insurance exchange or the one the federal government set up in your state if your state government refused to do so. People who like and dislike Obamacare have something to like about costs of individual plans. Preliminary estimates have come in lower than some government prognosticators expected. So it is fair to say Obamacare might be cheaper than expected for some individuals. But it is also accurate to say that premiums are likely to rise for healthy people on the individual market. Why? They’re going to get more robust insurance plans that cover more things. At the same time, a lot of sick people who get private insurance now pay a ton for it; their costs could decrease.

D. Are you without health insurance?

If so, Obamacare is for you, like it or not. You’re either going to have to enroll in Medicaid or buy health insurance from a private company on an “exchange” organized by either your state government or the federal government. If you’re single and you make less than $15,281.70 ($31,321.50 for a family of four), you’re likely to get Medicaid, although some states have refused to expand their programs; Oklahoma is one of them. Those income levels for Medicaid, 133 percent of the federal poverty level, will increase from year to year.

How much is Obamacare going to cost me?

It depends. What if you make more than $15,281.70, but not that much more? You don’t get Medcaid. You don’t have employer-sponsored health insurance and you do want coverage. How are you supposed to afford a new health insurance plan?

The government is going to help a lot of people pay for it. If you’re single and you make less than $45,960 ($94,200 for a family of four), you’ll qualify for a government-sponsored subsidy to help you buy insurance. The Kaiser Family Foundation has estimated the average government subsidy for a family will be about $2,700 and the average premium costs will be about $8,250. Those costs will vary depending on the age and number of family members and the level of plan they choose to buy. Try your own scenario here.

What happens if I don’t buy health insurance?

You’re young and healthy. You don’t really want health insurance. No sweat. You don’t have to buy it. You can “opt out.” But then you’ll have to pay a fine of between $95 for every adult in your house or 1 percent of your income after $10,000, whichever is larger. So if you’re single and you make $50,000, you’d have to pay a $400 fine for not having health insurance. The Supreme Court called this fine a tax. You can look at it that way. Or you can view it as an upfront payment for having hospital and ambulance services able to come get you if you need them.