Nearly 26 million Americans could be eligible for health insurance subsidies next year, but most don't know it.
That's because relatively few people are familiar with provisions in the Affordable Care Act, aka "Obamacare," that will provide tax credits to low- and middle-income consumers to help them purchase health coverage through state-run insurance exchanges.
Most of those who will be able to claim the subsidies are in working families with annual earnings between $47,100and $94,200, according to a recent analysis by Families USA, a consumer advocacy group. More than a third of those eligible will be young adults between ages 18 and 34.
"There's a huge number of people who can get coverage this way and can get significant help," said Ron Pollack, executive director of Families USA. "It's not just for the poor. It reaches deeply into the middle class."
Here's how the subsidies will work:
Starting in October, those looking to buy individual health insurance can enroll in plans offered through state-based exchanges, with coverage beginning in January. Consumers buying individual plans will be able to choose between four levels of coverage: platinum, gold, silver and bronze. The plans will differ in their premiums and out-of-pocket expense burdens.
People who are not in a government health insurance program, such as Medicaid or Medicare, and do not have access to an affordable plan at work may be eligible for help paying their premiums. The assistance is available to those with incomes of up to four times the federal poverty level -- this year, that's $45,960 for an individual or $94,200 for a family of four -- and will be scaled to ensure that folks don't pay more than a designated percentage (the exact target varies by income level) of their earnings toward the premium. The subsidy will be paid directly to the insurance company.
The federal subsidies will be pegged to the cost of a "silver" plan, which will vary depending on where consumers live. Insurers will soon submit to the states and federal government details of the plans they'll offer in the exchanges, including the premium costs, but consumers may not learn the specifics until open enrollment starts in October.
Families USA crunched the numbers for a few different scenarios. By its estimates, a family of four earning $94,200 and purchasing a silver-level plan carrying a $12,500 annual premium will get a subsidy worth $3,550, which limits the cost of the premium to 9.5% of the family's income.
The government hasn't yet released its own estimates on how many Americans will be eligible for the subsidies, but Families USA believes that up to 26 million citizens will meet the criteria.
Not everyone eligible for those subsidies will actually sign up, though. The Congressional Budget Office is forecasting that only 6 million people will receive subsidized coverage through an exchange next year. It expects that number to grow to 22 million by 2017.
Many Americans are still in the dark about Obamacare provisions that could help them, said Matthew Buettgens, senior research analyst at the Urban Institute.
"Outreach is going to be crucial to creating viable exchanges in the early years," he said.
It will be a heavy lift. Only 62% of Americans are aware that subsidy assistance is available to individuals under the health reform law, according to a March Kaiser Family Foundation poll. And about two-thirds of the uninsured say they don't understand how Obamacare will affect them.
All Americans are required to carry health insurance as Jan. 1, 2014, or face financial penalties, but if enrolling in coverage through the state exchanges is too expensive or too confusing, uninsured individuals might choose to skip it and pay the fines instead. That could lead to fewer healthy people enrolling -- which would make coverage in the exchanges more costly for everyone, since they would become populated primarily by people with greater medical needs.
"You want a broad range of people to enroll," Buettgens said.
Millions Eligible for Obamacare Subsidies, but Most Don't Know It
Myth 1: Obamacare is being partially funded by a $500 billion cut to Medicare.
Reality: Funding for Medicare will actually increase over the next 10 years. However, the rate of increase will drop, partially due to more aggressive prosecution of fraud and a reduction in overpayments to insurance companies.
In fact, the ACA has already increased funding to Medicare in some ways. It has increased the minimum rebate on drugs, extended coverage to smaller hospitals, set up public health screenings for Medicare recipients, and it introduced a discount to help cover the Medicare "doughnut hole" on prescriptions. The plan is to eliminate the doughnut hole by 2020.
Myth 2: Obamacare will introduce "death panels" that will severely ration care and will force elderly patients to commit suicide or submit to euthanasia.
Reality: Introduced by Sarah Palin in 2009, the idea that health care reform will lead to euthanasia is one of the most persistent lies myths surrounding Obamacare. There have been several versions of this claim; the most recent is that the Independent Payment Advisory Board will ration care and will make end-of-life decisions for patients.
In truth, the IPAB is basically powerless. It will make health care policy recommendations to Congress, which will then have the ability to pass or reject those suggestions. The president, in turn, will have the power to veto Congress' decisions -- as he can with any other piece of legislation.
Ironically, death panels already existed before health care reform -- but they were run by your insurance company. Insurers have regularly denied coverage for pre-existing conditions, canceled policies on sick patients, refused to pay for vital, life-saving operations, and otherwise made financially-based decisions about who would get to live and who would be left to die.
According to one congressional report, three insurance companies -- UnitedHealth (UNH), WellPoint (WLP) and Assurant (AIZ) -- saved $300 million by canceling policies on over 20,000 sick people over a five-year period. The new health care law will make many of these practices illegal. In other words, rather than creating death panels, Obamacare will actually abolish them.
Myth 3: Obamacare will force the middle class to pay for health care for poor people and illegal immigrants.
Reality:Many health care reform critics have argued that America already has a universal health care option: emergency rooms. After all, the argument goes, when people without insurance find themselves in desperate need of medical attention, they can always find help in ERs, which are required by law to open their doors to anyone in need of care. Consequently, critics claim, poor people can get health care without passing the charges on to the middle class.
But this health care isn't free -- in fact, standard treatment through a primary care physician is far cheaper than crisis care in an ER. Many hospitals aggressively bill emergency patients -- and their insurers -- to recoup the inflated costs of such care. Even so, they come up short.
So who covers the shortfalls? Well, a significant source of hospital funding is taxes. For the rest, hospitals make up their ER losses by inflating the prices that insured customers pay -- and according to the Center for American Progress, this amounts to a $1,100 yearly "hidden tax" on health insurance. Put simply, emergency room care is already funded by taxpayers and the insured middle class.
Granted, Obamacare will extend Medicaid to lower income families, and will subsidize health insurance for people who make up to 400% of the poverty line. On the other hand, it will also require people who can pay for health insurance do so, and will more aggressively prosecute Medicare fraud. More to the point, it will levy a 0.9% tax on households making more than $200,000 per year, and will increase taxes on medical machinery manufacturers, pharmaceutical companies, and insurers. Thus, it will, in all likelihood, actually reduce the burden on middle class families.
Myth 4: Obamacare is a socialist program.
Reality: Socialism is a system under which the government directly runs a nation's industries. Under this standard, New Deal programs like the Works Progress Administration and the Tennessee Valley Authority could, arguably, be considered socialist. After all, they represented instances in which the government directly employed people to build and administer power plants and other public works that generated income.
Obamacare, on the other hand, will work through private companies. Rather than directly providing health insurance, either through a national program or through some sort of public option, the government will require that people deal with private insurers. Far from competing with private industry, the health care law will likely give it a lot of new customers.
Myth 5: Obamacare will bankrupt small businesses by making them pay for their employees' health insurance.
Reality: The basis of this claim is a requirement that companies with more than 50 "full-time equivalent" employees must offer affordable health insurance to their workers. The insurance in question must not cost more than 9.5% of the employee's annual salary and must pay for at least 60% of covered health care costs.
A big part of the disagreement over the impact of this requirement lies in how you define a "small business." According to the government, the cutoff line between a small and a large business is 50 "full-time equivalent" employees. In other words, if a company's weekly work load totals more than 1500 hours -- the equivalent of 50 employees working for 30 hours per week -- then it is, officially, a large business, and is required to provide a competitive health insurance option.
As a side note, Obamacare contains a pretty significant tax break for businesses with up to 25 employees that offer health insurance.