What will it mean to disabled individuals when health insurance will be available to all United State Citizens in 2014?

facebook twitter

The Patient Protection and Affordable Care Act of 2010 (ACA) enacted many reforms of the health insurance industry in the United States.  The kingpin, or crown jewel, of the ACA is access to health insurance for everyone.  As of 2014, everyone will be required to have health insurance in the United States.  As a corollary, no one can be denied coverage by health insurance companies, regardless of age, preexisting conditions, or the amount of coverage that may be subsequently needed.  The rationale for this reform is that everyone is required to be a member of the pool of the insured, and thus the risk for insurance companies will be spread across a larger pool.

In 2014, health insurance exchanges are created through the ACA to provide a mechanism for access to health insurance with sufficient coverage, that is, hospitalization, prescription drug coverage, rehabilitation, mental health services, substance abuse treatment, preventative and wellness health coverage, chronic disease management, pediatric coverage (including dental and vision for children) and maternity coverage.   In 2014, all individuals in the United States who do not have health insurance coverage will pay an income tax penalty.  There is a sliding scale of assistance and premium credits to make health insurance affordable.  The term “affordable” means that the premiums shall not exceed 8% of the family’s annual income.  If an individual refuses to obtain health insurance, a penalty of the greater of $95 or 1% of the annual taxable income will be charged in 2014.

There will be a uniform enrollment form for health coverage through the exchanges.  The exchanges can be a clearing house to determine eligibility for Medicaid, CHIPs or premium credits using this uniform enrollment form.  Additionally, the exchanges can screen for families that may be exempt from tax penalties.

Because the ACA eliminates the option for health insurance companies to deny coverage for a preexisting condition, all of a sudden an additional option opens up for some folks with disabilities.  As of September 23, 2010, health insurers were no longer able to deny coverage to children with preexisting conditions.  Depending on the disability, a disabled child who has recovered a personal injury settlement does not necessarily have to plan exclusively for continuing eligibility for Medicaid.  Parents who have health insurance through employers can now add a disabled child to their coverage.  Children up to age 26 can remain on their parents’ health insurance as well.  So, there is some relief here.

While the ACA provides universal access to health insurance in 2014, what is does not do is expand the services available for the long term care needs of people with disabilities or long term chronic diseases.  It is still the case that these types of services are available only through private resources, or through Medicaid.