Making Healthcare Reform Work for You and Your Family

Issues: Healthcare

Nearly 30 million people across the country go without adequate health insurance, in many cases relying on an overburdened, costly emergency room system as their primary care provider.  Over 100,000 people living in the 8th District of Virginia face this situation.

But the Affordable Care Act is about to change this unsustainable dynamic. For the first time, securing affordable, quality, and accessible healthcare coverage will be a right, not a privilege, for every American.  It is about wellness and prevention, economic security and entrepreneurship, the well-being of working families and the strength of the middle class.  In short, this historic law is about a healthier America.

Women will no longer pay more simply because of their gender, over three million young people under the age of 26 have the option to stay on their parents’ insurance plans, and subsidies will be available to help cover premiums for workers making less than $43,000 and families making less than $94,000, a large number of which are young people just starting out in the workforce.  The ACA is a major step forward for better healthcare for all Americans, freeing people to pursue their dreams without fear of not having health coverage when they need it most.

For the uninsured, the self-employed, small business employees, or those currently purchasing plans on the individual market, it is particularly important to learn how the federal marketplace works and what insurance choices will be made available.

The information on this page will help you get the full story on how the Affordable Care Act is going to benefit you and your family.  The slides prepared by HHS officials detail the positive impact healthcare reform will have on your coverage choices. The slides prepared by Legal Services of Northern Virginia,  just one of the Navigators in our area, explain how these organizations are going to help you find the best plan for you and your family.  After that you'll find a detailed list of Frequently Asked Questions, mapping out your options under the ACA and and dispelling some unfortunate rumors about the law.

 

Frequently Asked Questions

Congressman Moran moderates a question and answer session
at Navigating the Affordable Care Act: Making Health Reform Work for
You and Your Family.

Q:  What are the new online Marketplaces, starting in January, and who are they designed for?

Q:  If I need insurance, how will I be able to enroll in a health plan in the new Marketplace?

Q:  Starting in 2014, will it be easier for me to get coverage even if I have health problems?

Q:  I already have employer-provided coverage, how does the health care law affect me?

Q:  I have employer-provided coverage and I have heard that, beginning in 2014, large numbers of employers are going to drop their coverage and put their employees in the new Marketplaces.  Is that true?

Q:  I have been concerned premiums in Virginia seem to be going up rapidly and I’ve heard it’s because of the new health care law. Is that true?  And what can be done about rising premiums?

Q:  I am a senior enrolled in Medicare, how does the health care law affect me?

Q:  Isn’t it true that this expensive law is going to bankrupt the country and explode the deficit?

Q:  I am a young adult.  Is it true that, because of the new limits on age-based rating in the health care law, young adults like me will suffer “rate shock” and never be able to afford the premiums in the new Marketplaces?

Q:  I have heard that, since it was enacted in 2010, the health care law has caused health care costs and premiums to rise rapidly.  Is that true?

Q:  I am a veteran.  I served my country and I was promised VA health care for the rest of my life.  I am concerned that the health care law will take away the VA health care I have earned.

Q:  I am serving my country and I don’t want to see my family kicked out of TRICARE and I don’t want to lose my military health benefits either now or when I retire.  I am concerned that the Affordable Care Act can change or take away my benefits.

Q:  I have heard that, under the health care law, there is a panel that can order my doctor not to give me certain procedures, therapy or care.  Bureaucrats will decide whether I live or die.

Q:  What are the new online Marketplaces, starting in January, and who are they designed for?

A:  The new Marketplaces (also referred to as the Exchange) are designed for Americans who buy their own coverage or currently have no coverage at all.  Every health insurance plan in the Marketplace will offer comprehensive coverage, from doctors to medications to hospital visits. A significant majority of people in the new Marketplaces will pay the same or less than they do for their coverage right now.  One reason is that more than 80 percent of those buying coverage in the Marketplaces will qualify for premium tax credits, which will dramatically cut what an individual actually pays in premiums in many cases.  In addition, the advantage of being in a larger risk pool—as opposed to an individual or small group policy—will spread the risk and therefore lower the premiums.

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Q:  If I need insurance, how will I be able to enroll in a health plan in the new Marketplace?

A:  Individuals and families will be able to enroll in a health plan in the Marketplace online (www.healthcare.gov) , over the phone (1-800-318-2596 or (703)-647-4748),

 by mail, or in person.  Web sites, a toll free call center and community based organizations, Navigators, will be available to assist individuals and families choose the best private health plan for them.

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Q:  Starting in 2014, will it be easier for me to get coverage even if I have health problems?

A:  Yes, starting in 2014, having a health problem will no longer be a barrier to having access to affordable, quality health insurance.  Currently, millions of Americans who have health problems and do not have access to affordable insurance through their employer are locked out of access to affordable insurance.  Insurers systematically exclude people with pre-existing health conditions altogether or only offer them astronomical, unaffordable premiums.  In the new Marketplaces starting in January, Americans can no longer be denied coverage or charged higher rates for having a pre-existing health condition. Nor will they be dropped by their carrier if they develop a serious illness.

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Q:  I already have employer-provided coverage, how does the health care law affect me?

A:  If you have employer-provided coverage, you have already received numerous new protections and benefits under the health care law --  your insurer can’t drop you when you get sick, your insurer can no longer impose a lifetime limit on your coverage, adult children can stay on or join your employer-provided plan until they turn 26, insurers cannot discriminate against children with pre-existing conditions, your insurer must spend at least 80% of your premium dollar on health care, any double digit premium increase must be justified, and you have free coverage of key preventive services.

Furthermore, beginning in January 2014, you will receive additional protections and benefits under the health care law, including:

  • Your insurer cannot discriminate against you if you have or develop a pre-existing condition.
  • If you are a woman, insurers cannot charge you more than men for the same coverage.

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Q:  I have employer-provided coverage and I have heard that, beginning in 2014, large numbers of employers are going to drop their coverage and put their employees in the new Marketplaces.  Is that true?

A:  That is not true. CBO estimates that the health care law, after 2014, will continue the employer-based system that we have today.  There are 156 million Americans in employer-provided coverage today. CBO estimates that there will still be 159 million Americans in employer-provided coverage in 2019.

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Q:  I have been concerned premiums in Virginia seem to be going up rapidly and I’ve heard it’s because of the new health care law. Is that true?  And what can be done about rising premiums?

A: The provisions of the health care law over the last couple of years have not played a causative role in premium increases. There are actually key provisions in the Affordable Care Act that have been in effect for two years that limit rate increases. Increases of more than ten percent must be approved by a state agency. Individuals who have been subjected to significant premium increases are encouraged to file a complaint with the Virginia Insurance commission (http://www.scc.virginia.gov/boi/complaint.aspx#A7 )

No serious study has asserted that health care law will cause exorbitant premium increases. Headlines touting these rumors are about the individual market only – where only 3.5 percent of Americans currently buy insurance. The headlines are only about rates that insurance companies are proposing, not rates that have been approved by state regulators – rates that in many cases will be significantly lower.

All health care costs, including insurance will increase with normal inflation. In the past, however, increases in health costs have far surpassed average inflation rates. A primary  goal of the new law is to slow that growth to keep it more in line with other sectors of our economy. This is working. The increases over the past three years are the lowest in a generation.

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Q:  I am a senior enrolled in Medicare, how does the health care law affect me?

A:  The health care law is strengthening Medicare and providing you with better benefits. If you fall into the Rx drug ‘donut hole’ coverage gap, you are receiving more than a 50 percent discount on your brand-name Rx drugs.  Already, more than 6.3 million seniors who have fallen into the ‘donut hole’ have saved over $6.1 billion on their Rx drugs.  By 2020, the ‘donut hole’ will be completely closed.  You are now receiving free coverage of key preventive services, such as mammograms and colonoscopies.  Before the health care law, some services could have a co-pay as high as $160.  You are already receiving a free physical – or Annual Wellness Visit – each year.  Finally, the health care law strengthens Medicare and extends the solvency of the Medicare Trust Fund by 8 years – from 2016 to 2024.

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Q:  Isn’t it true that this expensive law is going to bankrupt the country and explode the deficit?

A:  The opposite is true.  According to the latest estimates from the nonpartisan Congressional Budget Office, the health care law reduces the deficit by $109 billion over the next 10 years and over $1 trillion over the following decade.

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Q:  I am a young adult.  Is it true that, because of the new limits on age-based rating in the health care law, young adults like me will suffer “rate shock” and never be able to afford the premiums in the new Marketplaces?

A:  That is not true.  Large majorities of young adults will not pay more for insurance because they will qualify for generous premium tax credits that will make insurance affordable.  Currently, about 29 percent of people in their 20s are uninsured (almost double the rate of the overall population) and the health care law will actually greatly improve their access to affordable coverage.  Eighty-eight percent of 18-to-20-year-olds projected to buy a plan in the Marketplaces are expected to have incomes less than 300% of the poverty level, so they also will be eligible for substantial tax credits to help pay premiums in the Marketplaces or for Medicaid. In addition, those under 30 may purchase a low  cost catastrophic plan.

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Q:  I have heard that, since it was enacted in 2010, the health care law has caused health care costs and premiums to rise rapidly.  Is that true?

A:  No, that is not true.  The opposite is true.  Since the enactment of the health care law, the growth in overall health care spending and Medicare spending has decreased to record lows.  In fact, U.S. health care spending grew at historic lows for a third consecutive year in 2011.

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 Q:  I am a veteran.  I served my country and I was promised VA health care for the rest of my life.  I am concerned that the health care law will take away the VA health care I have earned.

A:  You should not be concerned.  You stay in the VA health care system.  Nothing changes for you under the Affordable Care Act.  

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Q:  I am serving my country and I don’t want to see my family kicked out of TRICARE and I don’t want to lose my military health benefits either now or when I retire.  I am concerned that the Affordable Care Act can change or take away my benefits.

A:  Your family stays in TRICARE.  While you serve, all of your military health benefits continue.  And when you retire, you receive all of your military retirement health benefits.  Nothing changes for you under the Affordable Care Act.

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Q:  I have heard that, under the health care law, there is a panel that can order my doctor not to give me certain procedures, therapy or care.  Bureaucrats will decide whether I live or die.

A:  There is no such panel.  That is a blatant falsehood.

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