Thinking About Health: The coming of Obamacare and what it means for you


Editor's note: The Rural Health News Service is funded by a grant from The Commonwealth Fund and distributed through the Nebraska Press Association Foundation, the Colorado Press Association and the South Dakota Newspaper Association.

The Affordable Care Act formally makes its debut Tuesday when its central feature, the state shopping exchanges and accompanying government subsidies to help low- and moderate-income people, opens for business.

Just how will this new act affect you? First, it’s important to understand what the Affordable Care Act is not. Contrary to what many politicians and others have claimed, it is not socialized medicine, and it is not government-run health care. It’s not even a national health insurance system like Medicare or the health systems in other countries.

Delivery of health care in the U.S. is mostly private with doctors still being paid fees for their services by insurance companies or government payers like Medicare. With the exception of a few county or municipally funded facilities, hospitals are run privately. Although they may be nominally nonprofit businesses and receive certain tax advantages, they increasingly concentrate on the bottom line. In effect, there’s not much difference between for-profit and nonprofit facilities.

At its core, the Affordable Care Act calls for improvements in existing American health insurance arrangements. That arrangement loosely can be thought of as a kind of public/private partnership with Medicare available for those 65 and older and some disabled people, Medicaid for people with very low incomes and the commercial market with for-profit and nonprofit insurance companies selling to everyone else.

The problem has been that some 50 million Americans — about 716,000 in Colorado, according to the Kaiser Family Foundation — have no coverage from any of those insurance arrangements. Because most have had no way to pay for care, they often tried to do without it and developed serious health problems as a result.

The Affordable Care Act aims to bring more of those Americans under the insurance tent primarily by making more people eligible for Medicaid and by making it easier to buy insurance in the so-called individual market. Most of those seeking insurance will shop in the new state exchanges that will offer a range of policies sold by private insurance companies regulated by the states. The federal government can try to persuade insurers to lower their rates if increases exceed 10 percent.

Even with these expansions, the Congressional Budget Office estimated that some 30 million Americans will continue to be without health insurance. Some will take the small penalty for not having insurance, some will be living in the country illegally and others are those with very low incomes in states that have chosen not to expand their Medicaid programs.

Insurers no longer can turn down people who have pre-existing medical conditions. Even very ill people will be guaranteed the right to buy health insurance. What you buy in the exchange depends on how much you can spend and your tolerance for risk — the risk of having to pay out of pocket for many of your medical needs.

The cheapest insurance, so-called bronze policies, will cover only about 60 percent of your medical bills. A silver plan will cover 70 percent, a gold plan will cover 80 percent and a platinum plan will cover 90 percent. The more coverage, the higher the premium.

The policies offered in any of these tiers are not identical, however. One company’s silver policy might offer a low deductible but charge policyholders high copayments or high coinsurance, say 20 or 50 percent of a medical bill. Another company’s plan might do the opposite — low coinsurance or copayments as a trade-off for a high deductible.

Because insurance is so expensive, some people shopping on the exchanges will be eligible for subsidies in the form of tax credits. The subsidies are highest for individuals and families with the lowest incomes, but people with incomes as much as 400 percent of the federal poverty level, or about $94,000 for a family of four, could qualify for some help.

People can sign up online or in person at one of the agencies in a state that provides help from specially trained navigators. The buying decision will not be an easy one, and buyers will need all the help they can get. My next column will explain how to find these navigators and the decisions people will have to make.


jerry carlton 3 years, 7 months ago

If your employeer does not pay for the majority of your insurance or you are not on Medicare, you are even in more trouble than you used to be. Now they are going to fine you because you can not afford medical insurance. Congress medical care will only get better and it is already the best in the country at tax payers expense. Health Insurance executives are laughing all the way to the bank.


Scott Wedel 3 years, 7 months ago

I have not spent any time figuring out the various programs of ObamaCare.

I do know someone whom is working, but not making much that recently had enough of a health issue to visit the hospital. He has been told that he should sign up quickly since with his low income that it hardly cost him anything. So instead of sometimes receiving emergency care resulting in bills which he cannot pay that he will have healthcare with affordable copayments.

I don't know how it will work out, but if it works for him as claimed then it would seem to save the healthcare system a bunch of money. He will be able to afford to go to a doctor before his health issues become emergencies and then receiving expensive medical that he'll probably never pay.

It is the well off that can afford their healthcare, but that refuse to have healthcare insurance are then potentially at risk from being fined.


John St Pierre 3 years, 7 months ago

Curious how many that go to our own Emergency room here in town have Insurance.... as most 20-30 do not.... and who pays for their skiing / biking accidents????

So if it is not mandatory... who pays??????? maybe we should go back to the old days when the underprivileged were left in the gutters.... as there are no more "free" hospitals as there was back then for the poor... The question still has not been answered by the right WHO PAYS FOR THE NON INSURED?????????


Michael Bird 3 years, 6 months ago

We ,who pay income taxes, pay for the uninsured via the Federal Govt's payments to hospitals. Unitl the early 90s actual costs were covered by Uncle Sam but then block amounts were given to hospitals, which were inadequate, so bills were increased significantly and insurance premiums were raised about 34% the first year after the change . They continued to be significantly raised afgerwards. Thus we have paid doubly for the uninsured -taxes and higher insurance premiums to cover the part not covered by Uncle Sam. Ain't it fun.


Dan Kuechenmeister 3 years, 7 months ago

It will interesting to watch the implementation of the Affordable Care Act. There will be winners and there will be losers. As it is a government program the implementation will most likely be messy and ultimately probably cost a lot more then forecast. Tough to pay for in an economy that continues to struggle to recover and one where we are creating more part time jobs then full time jobs. The question I have is how much more should we, who can "afford" to pay for health care, be willing to, have to, be forced pay so that John's question - well accusation of the right - all caps so are you yelling - regards who pays for the non insured (and by non insured I hope that does not mean people who choose not to have insurance but can afford it.) Which then begs the question - as it looks like there will be no income verification how will we know who should or should not receive subsidies.


Al Reiner 3 years, 6 months ago

Okay you are over 65 , a tea bagger and hate Obama, understand the ACA or Obama care does for you . Now on Medicare, a smaller doughnut hole , and now the annual wellness exam includes blood work ups, as part of the fee. I paid into Social Security for over 50 years, it is not charity, I earned it. Do you really care that insurance companies now are limited in the salaries they pay to top executives, and the Newspaper ads that they spend out of you're premiums? Does it bother you that they no longer can cancel you after you get cancer.


mark hartless 3 years, 6 months ago

When I was a kid I used to hear an old story about two poor brothers who asked Santa for a pony for Christmas.

On Christmas morning they rushed downstairs to find they had been left nothing more than a bucket of ashes and a stick to stir them with.

After a few moments one of the boys noticed his brother stirring around in the ashes with the stick and asked his brother "What are you doing digging around in that bucket of ashes?"

With a still excited and optimistic tone the other boy replied "There's just gotta be a pony in here somewhere."

I never knew the name of that optimistic but incerdibly naive young boy until tonight...

His name was Al Reiner.


mark hartless 3 years, 6 months ago

"Let's be clear... what I said was... if "I" like your health insurance plan you can keep it..."

"Let's be clear... when I told the IRS I earned $20,000 last year what I meant was... that's what I earned until they found the other $250,000..."

Let's be clear... all this depends on what the meaning of "is" is..."

"Let's be clear... when David Hannum said "There's a sucker born every minute.", referring to P.T. Barnum's "customers" he had no idea how right he was."


rhys jones 3 years, 6 months ago

Hey Mark -- I was gonna go pick up my mail ballot, but I got to feeling guilty, since I don't have any "skin in the game" so I called the courthouse and told them you could vote in my place, they said leave the ballot at the front desk, so you can pick it up there. I will not be responsible for what y'all do.


mark hartless 3 years, 6 months ago

Oh that's too bad I didn't get your message till just now...


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