Access to Care
HEALTH CARE REFORM: IMPACT ON COVERAGE AND ACCESS TO CARE On March 23, 2010, President Obama signed into law legislation that will change the health care landscape in many important ways. Most of the major reforms will begin in 2014, although there will be other important changes in advance of 2014. While the new law has many provisions that impact a wide range of health care-related issues, such as insurance reforms, increased funding for prevention and Medicare payment reform, this report will focus on the broadest reforms that will dramatically impact health insurance coverage options, particularly for low-income individuals.
2010 Mecklenburg Community Health Assessment
Major Coverage Changes: January 2014 Starting in 2014, most individuals will be required to purchase health insurance or face a tax penalty that will be phased in over several years. Exemptions from this requirement will be granted for financial hardship, religious objection, people without coverage for less than three months or for whom the lowest cost plan option exceeds 8% of income, undocumented immigrants, incarcerated individuals and American Indians.
For detailed information on the new law’s provisions, as well as an implementation timeline, see resources from the Kaiser Family Foundation (http://www.kff.org).
Two of the most significant insurance coverage changes to begin in January 2014 are an expansion of Medicaid and the creation of state-based insurance exchanges in which certain individuals and families can purchase coverage. Sliding scale federal subsidies will be available to help those making up to 400% FPL with the cost of coverage purchased in the exchange.
A Sample of Pre-2014 Reforms
Medicaid Eligibility Changes
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After September 23, 2010 (as new health plan years begin), young adults under age 26 will be permitted to stay on their parents’ coverage even if they are not students. This will impact many young adults who, particularly in the economic downturn, have taken jobs that do not offer benefits and/or lose their health insurance upon graduation.
Eligibility for Medicaid will change dramatically under health care reform, expanding coverage to many previously ineligible for Medicaid and reducing the number of low-income uninsured adults substantially. Eligibility for full Medicaid coverage will increase to 133% FPL, with children’s Medicaid and NC Health Choice eligibility levels maintained. See below:
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Beginning in summer 2010, North Carolina will establish a new high risk pool intended to provide immediate access to insurance for those with preexisting conditions that have been uninsured for six months or more. The federal government has allocated $5 billion in funding for this program. In May 2010, Families USA released a report that, using MEPS 2007 Medical Conditions data, extrapolated that 23.7% of the population in NC has a pre-existing condition that could make individual insurance cost prohibitive.
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After September 23, 2010 (as new plan years begin), children can no longer be denied coverage for pre-existing conditions and insurance plans cannot impose lifetime caps or rescind coverage when people become sick, except in cases of fraud. In 2014, adults will no longer be subject to pre-existing conditions exclusions either.
Jan. 2014 Pregnant Women Children 0-18* Working Parents Non-working Parents Childless Adults Disabled Elderly
185% 200% 133% 133% 133% 133% 100%
Max Income** (family of four) $40,792 $44,100 $29,326 $29,326 $29,326 $29,326 $22,050
* Under health care reform, children ages 6-18 will be eligible for Medicaid up to 133% FPL and NC Health Choice between 133-200% FPL. Children under age six will continue to be eligible for full Medicaid coverage up to 200% FPL. NC is required to maintain current eligibility for NC Health Choice through 2019.
Prepared by: Mecklenburg County Health Department (MCHD), Epidemiology Program
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