Here’s how health mandate will work in Wisconsin
Some of the health law—sometimes called Obamacare—has already started. This includes protecting kids with pre-existing conditions, giving discounts to seniors hitting the prescription drug doughnut hole, letting young adults stay on parents’ insurance, and preventive care without cost-sharing to get a handle on the preventable chronic diseases causing 75 percent of our health costs.
The bulk of the law will start in 2014, though, and many aren’t aware of how these parts work—including the “individual mandate.” A key point to understand is that if you already have insurance—through your employer, Medicare, the Veterans Administration, etc.—you’re not subject to the mandate. A recent Urban Institute study found that only 2 percent to 5 percent of Americans will be.
Many also think you’re just on your own, forced to buy insurance, but it’s important to understand that the mandate takes effect only when other interconnected parts of the law kick in to help uninsured people afford insurance.
The first “interconnected” part is creation of Affordable Insurance Exchanges, or marketplaces, in each state. These marketplaces will offer various levels of private insurance plans with quality coverage. They will allow small businesses and uninsured middle class people to pool together to get the leverage big companies already have—and let people compare “apples to apples” online similar to booking hotel rooms.
The second part is the individual tax credit to help uninsured middle class people buy insurance within these marketplaces. A family of four making between roughly $31,800 and $92,200 would qualify. The credits will be “advanceable,” meaning they can lower premium payments each month rather than just once a year.
The third part is the small-business tax credit. Under the law, many small businesses, including nearly 63,000 in Wisconsin, are already eligible for tax credits up to 35 percent to help provide health insurance for their employees. In 2014, the maximum credit increases to 50 percent.
The fourth part is that Medicaid, called BadgerCare here, is offered extra federal funding to help cover low-income folks. It will be up to state government to decide whether to accept the money.
Finally, while kids with pre-existing conditions are already protected, adults will be protected in 2014. The idea is if you require folks to be part of the insurance pool, you also have to make it illegal for insurance companies to drop coverage.
If someone still doesn’t want to get insurance even with these options, they can choose to pay a penalty to pick up the costs the rest of us pay, for them, because they don’t have insurance when they go to the emergency room. The penalty will be $695, or 2.5 percent of taxable income, whichever is greater (though it’ll be less in 2014 and 2015).
This is what’s ahead now that the Supreme Court has affirmed Obamacare. You can visit www.healthcare.gov for more, or send me an email if you have questions or a story about how you’ve been impacted already.
Doug Hill is director of Know Your Care Wisconsin, a nonprofit group devoted to educating citizens about how the health care law impacts them. Readers can reach him at firstname.lastname@example.org or (715) 581-5730.