The Affordable Care Act is hundreds of pages long, and it is confusing and complicated.
These are some of its key terms.
Affordable Care Act
Short for the Patient Protection and Affordable Care Act, also called PCACA, ACA or “Obamacare,” this bill was passed by Congress in 2010. Its primary goal is to enroll as many uninsured Americans in a health insurance plan as possible through a variety of mechanisms.
Also called the insurance exchange, the marketplace is a new platform where residents can compare, shop for and purchase a health insurance plan.
The marketplace is accessible online, www.healthcare.gov, or by phone, 800-318-2596.
Some states chose to establish their own marketplaces. South Carolina leaders decided to participate in the federally facilitated marketplace.
The marketplace opens for enrollment on Oct. 1.
The requirement established by the ACA that nearly everyone must enroll in a health insurance policy. Adults who don’t comply face a $95 fine in 2014, a $325 fine in 2015 and a $695 fine in 2016.
There are a few exceptions to the individual mandate. Prisoners, undocumented immigrants, members of Indian tribes, and any member of a religion that opposes health insurance benefits will not be obligated to pay a fine.
Also, if a family’s total income is too low to file a tax return or if paying for health insurance would cost more than 8 percent of an individual’s or family’s annual income after tax credits and employer contributions, the mandate does not apply, and there will be no penalty.
Minimum essential coverage
Coverage needed to avoid a financial penalty under the law. Employer-sponsored insurance plans, government-subsidized health plans like Medicare and Medicaid, plans purchased through the new marketplace or plans available for purchase outside the marketplace all qualify as minimum essential coverage.
The vast majority of residents who are already insured meet the minimum essential coverage requirement.
Some middle- and low-income individuals who earn between 100 percent and 400 percent of the federal poverty level will qualify for a subsidy, in the form of a tax credit, to help offset the cost of health insurance on the federal marketplace. The marketplace will help individuals calculate how much financial assistance they may be eligible for based on their 2014 income.
The law tried to expand Medicaid to any individual earning up to 138 percent of the federal poverty level, about $15,800 per person, but the Supreme Court ruled in 2012 that states are not required to expand the entitlement program designed to provide health insurance for the poor.
Some states are moving forward with Medicaid expansion under the Affordable Care Act, but South Carolina is not.
Conservative leaders in South Carolina have been criticized by hospitals and other groups for refusing that federal money, an estimated $4.1 billion through 2017. After 2017, states that choose to expand Medicaid will be required to chip in some of the costs, but never more than 10 percent of the total bill.
Source: The 2010 Patient Protection and Affordable Care Act and the Kaiser Family Foundation
Reach Lauren Sausser at 937-5598.