The Affordable Care Act (ACA) is a 2010 federal law. This health reform made profound changes to health insurance. It is often called “Obamacare” since it was enacted during the administration of former President Barack Obama.
ACA is intended to lower health insurance costs. It starts from the premise that should share the cost of insurance between the government, employers, and individuals. It also seeks to prevent restrictive practices in the health industry.
How does the ACA (Affordable Care Act) work?
The main objective of Obamacare is to reduce medical costs in the US. To this end, it included the obligation to purchase health insurance, subsidies for health insurance premiums, and new regulations for the health insurance industry.
Who benefits from Obamacare subsidies?
Obamacare subsidizes premium costs to help lower-income people pay for their insurance. It also makes payments to health providers to keep deductibles relatively low.
Insurance regulations
The ACA added a significant number of requirements for health insurance. Prohibits insurance companies from:
- cancel policies when the holder becomes ill;
- deny coverage to individuals with pre-existing conditions;
- Offer different premiums to people of the same age and geographic group.
Individual mandate
Initially, the ACA contemplated a fine for those who did not buy an individual health insurance plan, known as the “individual mandate.” The reason for forcing everyone to buy a health plan was to make the premiums of young and healthy people help cover the health costs of older and poorer people. In 2017 the fine was eliminated.
Rights granted by the ACA.
Obamacare has made changes to the United States health system and grants the following rights:
- Allow children to be covered by their parent’s health plan until they turn 26.
- Allow people to compare programs and sign up for coverage through state health insurance centers. This is known as the “health insurance marketplace.” The federal government facilitates it. The enrollment period to buy health insurance is from November 1 to December 15.
- Make those earning up to 133% of the federal poverty level eligible for Medicaid. This is known as the expansion of Medicaid. Not available in Alabama, North Carolina, South Carolina, Florida, Georgia, Kansas, Mississippi, Tennessee, or Texas.
- Make subsidies to purchase health insurance available to those with incomes up to four times the federal poverty level. These subsidies are delivered through tax credits.
- Minimum standards for health insurance policies. All insurance plans must cover certain essential benefits and include pregnancy, mental health, and preventive care.
Rights for those with health insurance
If you already have insurance, Obamacare protects you in the following ways:
- Insurers must give you a summary of the benefits.
- Insurers cannot cancel a plan in response to illness.
- Certain preventive health services must be covered at no cost.
- You can choose any doctor within the plan’s network, and you can use any emergency services outside your plan’s network. Before requesting medical attention, it is essential to verify that the professional of your choice is within the insurance network.
- You can appeal (in English) whenever the insurer denies payment for health services.
Does Obamacare protect me if I am undocumented?
No. ACA protections only apply to those who are lawfully present in the United States. Undocumented immigrants cannot access the protections of Obamacare. Neither do those protected by Deferred Action for Childhood Arrivals (DACA). In practice, they cannot access low-cost health insurance through the health insurance market. These people also do not qualify for health coverage through Medicaid or Medicare.
According to the Department of Health and Human Services, people with the following immigration statuses are legally in the United States:
- American citizens;
- permanent legal residents, who are those who have green cards;
- asylees;
- refugees;
- Cuban and Haitian entrees;
- those who have permission to stay temporarily (“parole”) in the United States for humanitarian reasons or significant public benefit;
- battered spouses and their children and parents;
- victims of trafficking and their spouses, children, siblings, or parents;
- those with the withholding of deportation or removal under the Convention Against Torture (¨CAT¨, for its acronym in English);
- those with non-immigrant status, such as those on work visas, student visas, U visas, or T visas;
- those with Temporary Protected Status (TPS);
- those with Deferred Enforcement of Removal (DED);
- those with deferred action status;
- Temporary legal residents.
How to choose the right health plan for my needs?
Obamacare is intended to make health care more affordable for everyone. Visit the Health Insurance Marketplace to see if you qualify for free or low-cost coverage.
The Marketplace offers four coverage options to help you compare:
- Bronze
- Silver
- Gold
- Platinum
Bronze plans typically charge the lowest premiums but pay less money when you get health services. On the other hand, Platinum plans charge higher premiums but will spend more money when you receive a health service.
For example, you may have to pay $600 per month for a platinum plan and $200 for a bronze plan. Although the platinum plan is more expensive, you will most likely have to pay less money each time you use a health service. So if you have appendicitis and you get a $30,000 hospital bill, the platinum plan will likely cover a more significant portion of that bill.
Is the ACA still in effect?
The constitutionality of Obamacare has been debated several times in the Supreme Court. There has been speculation that judges nominated by former President Donald Trump may declare it unconstitutional. However, until December 2020, the ACA remains in effect. The only thing that has been removed is the mandate to purchase a health insurance policy.
