It’s been nearly five years since President Obama signed the Patient Protections and Affordable Care Act (commonly known as Obamacare) into law, and these five years have seen significant changes in the way Americans receive and pay for health insurance. Regardless of where one stands on the political spectrum, it’s important to understand the basics of how the health insurance system in the US now operates. The main goal of the law is to expand affordable healthcare to a wider range of Americans, using a multi-pronged approach, which includes these key elements (as well as others not listed here):

  • Requiring nearly all citizens and legal residents to have health insurance
  • Requiring large employers to offer their employees coverage, and in some cases to enroll them automatically
  • Require states to create Exchanges, which are online platforms in which to research and purchase health insurance (they can elect to have the federal government run these instead)
  • Giving tax benefits to small employers who elect to offer their employees coverage
  • Expanding Medicaid in certain states to include anyone, not just elders, who earn up to 133% of the poverty-line income
  • Providing credits and cost-sharing subsidies, which vary based on income, to reduce the cost of health insurance purchased through Exchanges
  • Providing credits to privately insured individuals with pre-existing conditions, to ensure their coverage
  • Allowing young adults (up to age 26) to be included on their parents’ plan
  • Disallowing insurance providers to limit the dollar-value of coverage, or to rescind coverage
  • Tax changes: taxing those who do not enroll in a health insurance plan, increasing taxes on high-earning individuals and certain large employers, imposing fees on insurance providers and pharmaceutical companies
  • Develop strategies to better test treatments and increase medical research, as well as to emphasize preventative care and wellness services

Getting Covered—A Quick Guide

The requirement on citizens to have health insurance can be daunting, particularly for those with a low level of income. Keep in mind, however, that the items that follow it on the list are designed to mitigate that burden. One major tool in helping Americans receive their required coverage is the Marketplace, which is the government website on which people can determine their eligibility for, and then purchase, a health insurance plan. The Marketplace provides information about each state’s exchange—an exchange is a market where one actually buys insurance, and there are still private ones in addition to the public ones each state is now required to have. According to HealthCare.gov, in 2015, approximately 11.4 million people have either signed up or been automatically renewed for accordable care through the Marketplace.

Though they are required to have at basic health care plan, users can choose from a variety of plans that vary in cost and level of coverage. As outlined in the bulleted list, many Americans are eligible for credits and tax benefits that reduce the cost of those plans; each exchange employs experts to help users navigate the options. Alternately, many are newly eligible for Medicaid, but some fall into the “coverage gap,” earning too much to be eligible for Medicaid, and too little to be eligible for ACA coverage. This is a serious problem that legislators need to resolve. For anyone who is eligible for ACA coverage, the window for enrollment through the Marketplace for the following year is from November 15 to February 15, though this may be extended in special circumstances. Admittedly, the ACA is complicated and has its pitfalls—but understanding the basics, and benefits, will help you make the best possible choices for yourself and your family.

Staff (63 Posts)