The White House on Tuesday abruptly announced a one-year delay, until 2015, in his health care law’s mandate that larger employers provide coverage for their workers or pay penalties. The decision postpones the effective date beyond next year’s midterm elections. The 2010 Affordable Care Act required employers with more than 50 full-time workers to offer them affordable health insurance starting next year or face fines. Some companies with payrolls just above that threshold said they would cut jobs or switch some full-time workers to part-time employment so that they could avoid providing coverage. Under the provision to set up state-based marketplaces, subsidies are supposed to be available to many lower- and middle-income people who do not have access to coverage from employers or other sources. It may be difficult, however, for officials running the exchanges to know who is entitled to subsidies if employers do not report information on the coverage they provide to workers.
Health Care Law
Public Health in the National News – On June 28, 2012, the Supreme Court upheld the Affordable Care Act, with the majority opinion that Congress has the authority to use the taxing power endowed by the Constitution to impose the individual mandate. Another key ruling from the Court was that a provision of the ACA to expand the Medicaid program for individuals from 100% of the federal poverty level to 133% of the federal poverty level is optional, rather than required of state governments. You can read the Supreme Court’s decision here.
The Supreme Court’s ruling clears the way for the law’s implementation (Timeline of the ACA implementation). States, like Nebraska, that have been waiting for a decision from the Supreme Court before acting on implementation of key pieces of the legislation will now need to hurry to meet federal deadlines. For example, states need to submit a “readiness review” for a state-run health insurance exchange by January 2013. States that fail to submit a readiness plan will either have a health insurance exchange run entirely by the federal government or in partnership with the state government. Governor Heineman recently stated that Nebraska should wait on further planning efforts on implementing health insurance exchanges.
A recent report profiling health insurance in Nebraska by the UNMC Center for Health Policy (Health Insurance Coverage in Nebraska) found that there are more than 217,000 uninsured Nebraskans. Several key provisions in the Affordable Care Act will help many uninsured Nebraskans find and be able to afford health insurance coverage, including establishment of health insurance exchanges, guaranteed issue of insurance regardless of pre-existing conditions, and allowing children to stay on their parent’s health insurance up to age 26, and expansion of Medicaid coverage.
Even though the law has been upheld, the outcome of the November elections could impact the implementation of the law. For example, Congress could pass legislation to repeal the law or attempt to defund it through the budget reconciliation process before major provisions take effect in 2014. The following are some selected benefits of the Affordable Care Act for Nebraska after two years of implementation. More details are available at HealthCare.gov.
- 18,000 young adults in Nebraska gained insurance coverage.
- 359,000 Nebraskans with private health insurance gained preventive service coverage with no cost-sharing.
- Nebraska has received $7.3 million in grants from the Prevention and Public Health Fund created by the Affordable Care Act.
- Health centers in Nebraska have received $19.4 million to create new health center sites in medically underserved areas and expand preventive and primary health care services.
This article was written by Jim Stimpson, PhD, associate professor in the UNMC COPH Department of Health Services Research and Administration.