Care 411


The Affordable Care Act: Marginally Affordable?

admin October 30, 2018

The Affordable Care Act is the largest change to health care in four decades, a huge coup for the lowest income individuals and families who currently put off going to the doctor or filling much needed prescriptions. For these folks, if you are at or below the poverty line, you may continue to receive Medicaid (in most states) or  tax credits for out-of-pocket expenses and premiums. People who are determined to be just above the government’s poverty level will receive the lowest out-of-pocket maximums–the lowest amount you will be responsible for regardless of incurred expenses.

Although the aim of the ACA is to make sure that no American is denied preventative and long-term healthcare based on income or preexisting conditions, like any new idea, it’s not without criticism. The ACA plans are, simply put, divided into different levels of coverage based on various income brackets.  Bronze plans are the cheapest plans– the coverage is basic– covering 60% with the individual being responsible for the rest. The others are Platinum, Gold, Silver, and the option of only carrying emergency coverage which provides for minimal benefits in the event of a sudden illness or catastrophic medical emergency.  However this plan is only made available to people under 30 or those who can’t find another plan for less than 8 percent of their income.

It sounds perfect if you consider yourself low-income. But the criticism from opponents is: does the government consider you low-income? Herein lies the “flawed part” of the Act or at least its opponents would say. One must understand the government’s determined “above the poverty” level is only a meager $29, 000. At this level, individuals are now responsible for bills that insurance does not cover. Also an individual is ineligible for Medicaid’s no premium coverage. Lastly, the minimal out-of-pocket costs and tax credits begin to significantly diminish.

If you happen to reside in certain parts of the country, you may be getting by on $29,000, but if you live in a city like New York or San Francisco, you are probably struggling. The Affordable Care Act doesn’t distinguish by area, except in that states can actually refuse to participate in Medicaid. Some people will incur big bills that they simply cannot afford. If you don’t get coverage, you will incur a tax penalty. Additionally, some folks who are truly deemed middle class, in the $40,000 range may struggle with much higher deductibles.

Historically, big changes in this country, while positive in the long run, come with growing pains in the early stages. However, the up side presently is that no American will go without necessary prescriptions. No American will be unable to see a doctor for a physical, denied coverage for a preexisting condition or remain uninsured. Proponents of the Affordable Care Act feel nationwide coverage is worth the growing pains. Those in support of the Act might say if it helps even some individuals to see a doctor sooner avoiding for example, a stroke ultimately or metastatic Cancer, the burden on insurance companies and states to provide long-term care may indeed be lessened. Then we, the tax payers, benefit. Clearly at this juncture, this “benefit for all” mentality may be merely speculation.  But if Republicans, Democrats, Libertarians, Tea Partiers, or let’s just say all Americans, don’t at some point take a leap of faith to change a broken healthcare system–a point agreed upon by most across party lines–will we ever know its benefits or pitfalls? I think most of us can agree on the need for action. Whether you support or despise Obama, are voting for or protesting against Romney or believe in or detest The Affordable Care Act, we all want good healthcare so at least we can start there.

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