Back to Basics: Obamacare for Individuals with Disabilities

 April 18, 2013
Posted by M&LAdmin4

Thursday, April 18th, 2013

In March of this year, the Kaiser Family Foundation released the results of its latest Kaiser Health Tracking Poll. The poll, which “tracks the public’s experiences in the health care system, their ranking of health as a policy priority and their views on health care reform options[i]” revealed some surprising results. According to the survey, “…three years after passage [of the law], a majority of Americans (57%) say that they do not have enough information about the Affordable Care Act to understand how it will affect them.[ii]To read the results of the Kaiser Health Tracking Poll in full, please click here. Considering the controversy that still surrounds Obamacare, it isn’t really surprising that this level of confusion still exists. Despite the 64 million hits that results from a Google search of “Obamacare”, sifting through the millions of blogs, articles, and documents that are political, biased, and often inaccurate to find relevant, concise and accurate information can be challenging.

In July of last year, M&L Special Needs Planning published a blog titled What Obamacare Really does for Individuals with Disabilities. In the interest of further clarification (and in light of this recent survey) we have decided to revisit this topic, and provide a more in-depth analysis of Obamacare and how it can affect you, your family, and your family member with special needs.

Obamacare: The Essentials

The primary purpose of Obamacare is to ensure that every American can access affordable health care insurance.  In order to reach that goal, the Act first proposes to ensure that every American has access to health insurance. As basic as this sounds, due to pre-existing condition clauses and lifetime limit clauses, insurance companies were previously able to decline or cut coverage to certain individuals, therefore limiting access to health insurance for many Americans. The solution as outlined in the Affordable Care Act, which began July 1st, 2010, was the Pre-Existing Condition Insurance Plan (PICP) which “provides health insurance options to individuals who have been uninsured for a period of at least six months – this program is intended to act as a “bridge” to 2014, when all discrimination against pre-existing conditions will be prohibited.[iii]”   As well, “under the health care law, job-based and new individual plans are no longer allowed to deny or exclude coverage to any child under age 19 based on a pre-existing condition, including a disability.[iv]” This new law is incredibly beneficial to all Americans, but particularly to families and individuals with special needs, who no longer need to worry about switching employment, moving, or suddenly losing coverage and struggling to find a new health care insurance provider.

The next step outlined by the act was to make insurance affordable. Here is where it gets a bit tricky. Obamacare proposes a number of ways to ensure that Americans can access affordable health insurance, including mandatory insurance coverage, an expansion of Medicaid, and health insurance exchanges.

Mandatory Health Insurance, or individual/employer responsibility, is perhaps the most controversial of all the reforms enacted under Obamacare. Under the Affordable Care Act, beginning in 2014, all Americans must have health insurance coverage, either through a personally purchased insurance plan, an employee insurance plan, or a government program. Americans who do not have insurance after this time will be subject to a tax penalty. (Note:  Americans who currently have health insurance coverage and who would like to remain on the same plan are able to do so.) As well, beginning in 2014, employers with more than 50 employees are subject to a responsibility fee if they do not offer affordable insurance coverage to their employees. Businesses with less than 50 employees are exempt from this, but are eligible to receive a tax credit should they offer health insurance to their employees.  Those Americans who aren’t offered insurance by their employers, or can’t afford to purchase insurance either from a private insurance company or via the health insurance exchange may qualify for free or low cost insurance under Medicaid or other programs, or they may be exempt from individual responsibility. To access information regarding exemptions from individual responsibility, please click here. Details regarding the tax penalties for those who fail to obtain health insurance can be accessed here.

Medicaid is a state run program which offers health insurance coverage to individuals, families and children with lower incomes, older people, and individuals with disabilities. Currently, Medicaid eligibility requirements vary from state to state, although most states do provide an income cut off level as an eligibility requirement. Beginning in 2014, the Medicaid expansion ensures that most individuals in all states with incomes of $15,000 per annum and less are eligible for Medicaid health insurance coverage.

The Health Insurance Exchange (also known as the Health Insurance Marketplace) proposed by Obamacare is “a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans[v].” It is intended to allow consumers to choose their health insurance plans by comparing price, benefits, and quality of each plan, via an online shopping site. As a part of Obamacare’s commitment to promoting transparency, all information and plans on the health insurance marketplace will be in plain language – clear, concise, and easy to understand.  Enrollment for the insurance exchange begins in 2013. However, it is important to note that when the Supreme Court delivered its ruling on the Affordable Care Act in 2012, it stipulated that state participation in the health exchanges be voluntary. As a result, each state will have a marketplace, but it will choose whether it will be state run, or supported by the Department of Health and Human Services. Please click here to access information on which states will be participating. To determine if you are eligible to enroll, or to access information on how to begin preparing for enrollment, please visit the website for information.

Obamacare and Individuals with Disabilities

As we wrote in our earlier blog, the reforms proposed under Obamacare that are especially beneficial to individuals with disabilities include the elimination of the pre-existing condition clause, the age increase for children on a parental insurance plan, the elimination of the coverage limit, and inclusion of preventative services in health insurance plans.

According to the website, under the section “The Affordable Care Act for Individuals with Disabilities”, Obamacare contains a number of other reforms that may be beneficial to individuals with disabilities, including additional funding to “extend and enhance” the Money Follows the Person program (a program which works with individuals with disabilities towards the goal of transitioning from institutional to community life). It also proposes to improve Medicaid home-and-community based services such as the Community First Choice Program, by giving incentives to states to offer home and community based services as care alternatives to institutions, and by improving the option for states to create Home and Community Based Service Plans. In addition to this, Obamacare also expresses a commitment to assuring “accessible, affordable, quality care to individuals with disabilities, by investing in preventative care (ensuring that health insurance plans include things such as cancer screenings and wellness checks), improving access to diagnostic equipment, fighting health disparities, and improving the coordination of care for populations with complex health needs[vi].

To read about these and other reforms in greater detail, please visit the website.

Additional Information and Resources

As previously mentioned, finding a resource which provides clear, unbiased, and accurate information can be a challenge. Throughout the course of our research, we found these articles and websites to be particularly helpful:

Hopefully, this has helped to clarify some of the confusion surrounding Obamacare.  If you should have any questions regarding this topic, please visit our previously published blogs titled What Obamacare Really Does for Individuals with Disabilities, and Obamacare Update: Changes to Expect in 2013. Of course, feel free to call, email or leave a comment with any questions or suggestions you may have regarding this or any other special needs planning topic.

Thanks for stopping by our blog today; have a wonderful Thursday!


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  1. Norbert Demere

    health insurance is very important because it gives us a level of security during times of need.^::^


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