A user’s guide: 20 things to know about the Affordable Care Act

By Carol Ostrom

The Seattle Times (MCT)

Published: Wednesday, Sept. 25 2013 12:00 a.m. MDT

In this March 23, 2010 file photo, President Barack Obama signs the health care bill in the East Room of the White House in Washington. Millions of people who take advantage of government subsidies to help buy health insurance next year could get stung by surprise tax bills if they don’t accurately project their income.

J. Scott Applewhite, Associated Press

Enlarge photo»

What do you need to know about the Affordable Care Act, aka Obamacare, the health-reform law or the “federal health-care overhaul”?

It’s big, it’s far-reaching and, despite what you may have heard, it’s happening.

And it will change many things about the way you get health care, whether or not you are one of the millions currently uninsured, many of whom may benefit directly.

Basically, the ACA’s aim is to begin to pull, push and persuade everyone to pile into the big “pool” — the insured. In short, that’s because some of those who study health-care systems have come to believe it’s crazy to have health “insurance” that evaporates if you become too sick to work. And of course if you don’t work — and even if you can, for many low-paying jobs — you likely can’t afford insurance in the first place.

Nobody ever tried to argue that having no health insurance somehow magically keeps people from getting sick. They get sick, and they seek care in emergency rooms, or in “free” clinics, which depend on grants, taxes and donations.

This “cost-shifting” — getting someone else to pay the bills — has increased costs in many ways. The “someone else’s” have often been employers, and their steeply rising health costs have prompted pushback.

A fairer way to do this, the proponents of the health-care law argued, is spreading the burden more widely. To do that, there are bits and pieces of tax hikes in the law.

The picture of the near future isn’t all rosy. Bringing a lot of people into the system, many worry, will create its own problems. Are there enough primary-care doctors to care for everyone? Or will health-care systems adapt, perhaps using other skilled workers such as nurse practitioners to full advantage?

And cost remains one of the biggest issues — and one of the most serious criticisms of the federal law. With pharmaceutical companies, doctors, hospitals, device manufacturers, insurers and others all jockeying to keep their income, will costs just keep rising?

As a country, we haven’t yet settled on the best way to get a grip on costs — one that’s politically acceptable, anyway.

One of the biggest challenges, many ACA advocates say, is helping people understand the value of health care and having insurance when you need it.

So what is this ACA thing and what should you know? Here are 20 things to know as you try to understand the new law and the wave of change that is just beginning.

1. Next year, you must have health insurance, one way or another, or pay a penalty. There are exceptions, but they won’t apply to most people.

2. Very likely, you already have insurance, so don’t panic. If you are covered by an employer-sponsored plan, Medicare or Medicaid, military or veterans programs, an individual plan or other group plans, you’re golden. If it’s very skimpy or unaffordable, you can buy on the state’s exchange marketplace, where you might get financial help.

3. If you have an individual plan, you’re considered covered, but your plan is likely going to change, and you’ll have to pick a new one. You’ve probably already received a notice from your insurer. At least one insurer selling plans in Washington’s exchange, LifeWise, will keep some older plans.

For most people, new plans will cover more. For older people, they may cost less. Younger people may pay more. There won’t be lifetime limits on these “essential services,” and your yearly out-of-pocket expenses will be capped.