Starting today, Americans will begin to get a handle on what the Affordable Care Act is all about — and what it means to individuals and the country. Sure, much of the talk in Washington, D.C., about a government shutdown revolves around stopping health care reform cold; but no matter the outcome of congressional brinkmanship, key provisions of the ACA kick in.
That means those without insurance — an estimated 1 million in Washington state and 50,000 in Yakima County — can start signing up today. This enrollment period runs through March 31, 2014; a shorter period will go into effect later in 2014. By the end of next year, everybody must have insurance or pay a penalty when they file their 2015 income taxes; this is the “individual mandate” that the U.S. Supreme Court upheld a year ago.
With the mandate comes financial help for those who have trouble affording insurance. Those in the very lowest income brackets — under $15,856 a year for individuals and $32,499 for a family of four — likely will qualify for an expanded Medicaid program in Washington state. Subsidies may be available for those with higher incomes — up to $45,950 for an individual or $94,200 for a family of four.
And while individuals have their mandate, so do health insurance companies, which no longer can reject customers for a pre-existing condition or chronic illness. Businesses did get a break on their mandate; in July, the government extended until 2015 the requirement that employers with more than 50 full-time equivalent workers provide insurance.
And where will people get insurance? This is the realm of much-discussed health insurance exchanges; Washington has set up Healthplanfinder at http://www.wahealthplanfinder.org. Information also can be found at the website of the Office of the Insurance Commissioner at www.insurance.wa.gov and the Yakima Herald-Republic’s The Pulse health care blog at www.yakimaherald.com/blogs/health.
Of course, all this leaves about 6 million in Washington state and 200,000 in Yakima County who have insurance and are wondering what will change for them. What we’re hearing so far is that those with employer-sponsored insurance, Medicare, Medicaid, military or veterans plans, other group plans or individual plans are fairly well set. Those who already have insurance may qualify for subsidies based on income. Individual plans may change, and those who aren’t happy with their current insurance plan can seek out alternatives.
This also means people are going to have to take more responsibility for their health care — and not just those who are newly entering the insurance market. With costs constantly on everyone’s mind, customers and companies that provide insurance will hear more information about healthy habits that keep costs down, and they’ll likely find more incentives — some may call it arm-twisting — to adopt or retain those habits.
The health care law will affect Americans in different ways — some people will see drastic changes and others very little — and that uncertainty is unsettling. What is certain is that health care consumers, and by law that will be all of us by next year, will need to get educated about their rights and responsibilities as the country enters a new era in health care.
• Members of the Yakima Herald-Republic editorial board are Sharon J. Prill, Bob Crider, Frank Purdy and Karen Troianello.