The ACA, also known as the Affordable Health Care Act, was found by the Supreme Court to be constitutional. In a five (5) to four (4) vote, the Supreme Court decided to uphold the individual provision which requires all American citizens to be insured or be subject to a penalty tax. Insurance can be obtained through an employer, through a private health insurance company or a public plan such as Medicare or Medicaid. The individual mandate penalty tax will be paid only by those people who don’t obtain health insurance or qualify for a hardship exemption. The amount of the penalty rises annually from 2014 to 2016 and is adjusted for inflation thereafter. In 2014, the penalty will be no more than $285 per family or 1% of income, whichever is greater. In 2015, the cap rises to $975 or 2% of income. If you don’t have insurance or an exemption, beginning in 2016, you will be fined, or taxed, $695, or 2.5 percent of income up to $2085.00 per family, whichever is greater. It has not yet been clarified how this tax will be enforced in the event one fails to comply.
Exemptions are offered to:
- people with very low incomes who don’t have to file a tax return
- members of certain religious groups
- people who face insurance premiums that would exceed 8% of family income even after including employer contributions and federal subsidies.
Medicare is a health insurance program for people 65 years of age and older, some people with disabilities under age 65 and people with end-stage renal disease requiring dialysis or transplant. Medicare has two parts, Part A and Part B.
Part A covers hospital insurance; most people do not have to pay for Part A. This helps pay for care in hospitals as an inpatient, critical access hospitals (small facilities in rural areas with limited inpatient and outpatient services), skilled nursing facilities, hospice care and some home health care.
Part B covers medical insurance; most people pay monthly for Part B. This helps pay for doctors, services, outpatient hospital care and some other medical services that Part A does not cover, such as physical and occupational therapy and some home health care. Part B helps pay for these services when they are medically necessary.
Medicaid is a jointly funded federal/state health insurance program for certain low-income and needy people. It covers approximately 36 million individuals including children, the elderly, the blind and/or disabled and people who are eligible to receive federally assisted income maintenance payments.
The Medicaid provision in the law that requires states to comply with the expansion of Medicaid or lose all of their Medicaid funding was struck down. The ruling basically makes participation optional. Should a state opt not to expand medical coverage, this could potentially result in the denial of coverage to needy citizens.
The following provisions are also part of the decision and should prove beneficial to mesothelioma patients as well as those suffering from other asbestos related cancers such as Colon Cancer, Stomach Cancer, Laryngeal and Pharyngeal cancer.
- Discrimination based on pre-existing medical conditions has been eliminated.
- Annual and lifetime insurance caps have been eliminated.
- Insurers are required to provide consumers with easy-to-understand summaries about their coverage.
- Health plans in the individual market are required to offer essential benefits needed to prevent and treat a serious condition such as mesothelioma.
- States are required to create online Health Exchanges that give individuals access to compare health insurance plans and choose what is best for their family.
One of the main goals of the ACA was to bring some type of insurance coverage to every American; and to make sure they are able to keep it even when, no especially when, they are confronted with a life threatening illness that will require extensive and extended treatment.
N.Y. Times: Supreme Court Upholds Health Care Law, 5-4, in Victory for Obama
CNN MONEY: What Health Reform Could Cost You
HealthReform.Gov – Fact Sheet: The Affordable Care Act’s New Patient’s Bill of Rights