The national health care reform law known as the Affordable Care Act, has several nicknames such as the ACA and ObamaCare. The law used Massachusetts’ landmark 2006 health care reform law as one of its key templates*. This is a three part blog post focusing on the ACA. The first two parts share important information and web links about the ACA as it pertains to individuals and families. The focus of the third part is to highlight how important it is for artists of all disciplines to become involved in health care reform policy. Artists of all disciplines are a population that has one of the highest rates of uninisurance in our country and it is usually double the rate of the general public. Our population needs to be highly visible on all levels of the health care policy arena (local, state, federal) to best ensure that reform is successful for our community.
One key tip we can not stress enough for artists of all disciplines: Find a local community health center and/or a health care advocacy organization in your region that can act as a resource and hopefully as an advocate for you. This is especially important if you are self employed, have some self employment income, are a seasonal employee, have multiple employers, have fluctuating, and/or hard to determine income. Do not go it alone when enrolling or navigating the new ACA programs. Trust us on this. Two on-line resources to help you find a community health center:
*HealthcareforAritsts.org’s home state is Massachusetts.
Part One- Some of the Key Basics on the ACA
1) Pre-Existing Conditions and Dropped Coverage
The artist community has sadly experienced the horrible results of wide scale discrimination from health insurance companies. In the 80’s and early 90’s, during the first wave of the HIV/AIDS crisis in our country, those living with the disease often lost their coverage either from losing their jobs that provided their insurance* or losing their jobs from being too sick to work. The insurance companies also dropped coverage when it learned of someone’s “condition” or if they decided the person belonged to what was deemed a high risk group more susceptible to contracting the disease. If the person was able to obtain health coverage from another job or tried to obtain it on their own, they were usually denied coverage due to their “pre-existing condition” and/or if they were thought to belong to a “high risk group” .
Massachusetts in the early 1990’s banned insurance companies from using pre-existing conditions as a means to deny coverage. It also banned them from dropping coverage when ever they felt like it. The ACA has followed suit. By 2014, everyone in this country will have these same needed protections.
* At that time people living with HIV/AIDS had no legal protection from discrimination.
2) No life time caps, annual limits on coverage, waivers or riders.
The ACA will also bar insurance companies from placing life time caps or annual limits on coverage. In other words, they won’t be able to deny financial coverage to any one who needs expensive health care such as cancer treatment, heart transplants and other types of care that have a high price tag.
Please be aware that the only exceptions from this rule are the health insurance plans offered to students by colleges/universities or if the employer’s plan is self-insured. In those cases, check with your insurance company, not the employer/college/university for clarification.
* Many large companies, unions, or other large organizations often self insure their health plans- ask your HR department if your employer sponsored health plan is self insured.
3) Children can stay on their parent’s health insurance plan up to the age of 26.
Parents should check to see if their employer sponsored health plan offers this as an option. Again it is best to check with the insurer. Self-insured health plans are exempt from this requirement. Some self-insured plans, however, may decide to offer this benefit to remain competitive in the “job market”.
4) Insurance companies won’t be able to charge women more than men for their health plans.
No more discrimination based on gender. Enough said.
5) The ACA now requires insurers to be transparent with how they spend the money they collect from premiums.
Starting in 2011 insurers are now required by the ACA “to spend between 80 and 85 percent of every premium dollar they collect on medical care (as opposed to administration, advertising, etc.). If insurers exceed this threshold, they have to rebate the excess to their customers.” This is called the Minimum Medical Loss Ratio for Insurers.
Above quote from:
6) Many individual and families will qualify for health care tax subsidies.
Many individual and families who are earning 400 percent or less of the Federal Poverty Line (FPL) will more than likely qualify for tax subsidies to help them pay for their health insurance. The tax subsidies are on a sliding scale and are based on income levels. Basically premiums are capped for those 400 or less of the FPL. Worth noting from the Kaiser Family Foundation online calculator: “All individuals and families with incomes at or below 133% of the federal poverty level will be eligible for Medicaid. Others with higher incomes may also be eligible, depending on rules that vary by state.”
These subsidies are only for those who are purchasing coverage on their own through the Exchange and there are certain exceptions (The Exchange and the exceptions will be discussed in Part Two). For example, those who have income between 300 to 400 percent of FPL, who have or are offered employer sponsored insurance health insurance that requires a premium payment that is 9.5 percent or less of their annual gross pay/income, will not be eligible for the subsidy. From the Kaiser Family Foundation online calculator: “In general, full-time employees with employer coverage available that meets specified requirements are not eligible for premium subsidies, unless the employee would have to pay more than 9.5% of income for the employer-provided coverage.”
The Kaiser Family Foundation has created an online calculator to show the subsidies and the caps for different families and individuals at different income levels:
7) Some links worth reading:
11 Facts about the Affordable Care Act
FACT SHEET: The Affordable Care Act: Secure Health Coverage for the Middle Class
Kaiser Family Foundation Summary of the New Health Reform Law
Kaiser Family Foundation Health Care Reform Source website:
Next Up- Part Two- The Exchanges, The Individual Mandate, and Income Eligibility