What is the Affordable Heath Care Act?

Most provisions of the law take effect Jan. 1, 2014. But many people with Medicare or employer-sponsored health plans are eligible for free preventive and wellness benefits under the law, such as annual health exams, immunizations, mammograms and other screenings for diseases including diabetes and certain cancers.

Health exchanges created under the Affordable Care Act are online marketplaces, where consumers can compare health plans and buy subsidized insurance. The exchanges will also help consumers find out if they qualify for tax credits or other government health benefits. Each state will have an exchange, operated by either the federal government — as in Ohio — or by the state. Each state’s exchange must offer coverage beginning next year, and will begin accepting enrollment on Oct. 1. Consumers can now create a user account at HealthCare.gov, the government’s main health care reform website, where they can find out more about the health exchanges in their state and actually purchase insurance online. Small businesses with less than 50 employees can buy insurance for their workers on separate Small Business Health Options Program, or SHOP, exchanges. But SHOP coverage is not subsidized.

The Affordable Care Act was originally intended to expand Medicaid health coverage to all those who couldn’t afford basic coverage on state-based health exchanges. But the Supreme Court ruled last year that states could decide whether to expand Medicaid coverage, and Ohio has so far resisted expansion, despite the pleas of Gov. John Kaisch. Consequently, more than 300,000 Ohioans who would have qualified for Medicaid coverage under an expansion are expected to remain uninsured.

Community health centers across the state were recently awarded nearly $4 million in federal grants for patient outreach under the health care law. The government is also preparing to award an additional $2.3 million in grants to community groups in Ohio to become so-called “health navigators” that will be trained to help people sign up for insurance on the exchange. However, the Ohio Department of Insurance won’t actively promote the exchange. Lt. Governor Mary Taylor, who heads the insurance department, is a vocal opponent of the health care law.

Essential health benefits are a package of items and services required under the health care law that must be included in insurance policies sold on state-based health exchanges set to go online next year. Essential benefits are required in 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

The impact of the law on people with employer-sponsored insurance is complicated, and people with different types of coverage will likely see a range of outcomes. At least some larger employer-sponsored plans will be “grandfathered” in and exempt from Affordable Care Act requirements. In 2015, the government will start enforcing the recently-postponed employer mandate under the health care law that requires companies with 50 or more full-time employees to offer health insurance or pay fines. Some companies may find it cheaper to drop insurance they now offer, which can costs five times the penalty of $2,000 to $3,000 per full-time worker.