Simple answer is yes. NEXT BLOG PAGE PLEASE. . . . . .
But seriously - yes. ACA provided a net to allow, yet require, all citizens to be insured in one of a host of ways: medicaid; medicare; individual market place; small group employer or large group employer plans. Remember that risk pool I talked about? That risk pool that needs EVERYONE in the US to be insured in order to spread risk around? This is the reason we are penalized if we don't have the coverage. But the only way to attempt to manage rates is by having everyone participate. And when I say everyone, I also mean employers.
So as an individual, who does not have access to employer based healthcare, you have to get it through the individual market; Medicaid or Medicare. Oh - and for those that are scratching their heads about the millions of undocumented workers, or those who have not 'paid into it for just immigrating here' who are getting free healthcare through the system - it is NOT happening. in NYS, I have to provide numerous documents to the state to prove someone is eligible to receive healthcare that is under the Medicaid program or are offered a tax credit. If they want to purchase insurance directly from a carrier and pay for it themselves at rack rate, go for it, if they have a social security number. But if they want to get subsidized coverage, I need socials, citizenship documents, tax returns and a myriad of other proof before NYS will 'give' free or credited insurance to someone. Really - test me - comment below and I will show you the requirements to get healthcare in the NY State of Health. I sometimes have to provide that paperwork to get folks approved who were from the Mayflower landing and have an accent that only a New Yorker 5 generations back can have.
As an employer with over 50 employees - you have to offer access to affordable health care (it cannot cost more than 9.69% of the lowest cost single rate offered by your employer based on your monthly income - unless you qualify for Medicaid, then you are exempt and can enroll into Medicaid with no penalty to the employee or employer) and it has to have a threshold of coverage to meet minimum value (it has to cover at least 60% of the total cost of health care - think Bronze plan in metallic terms) - we will get back to that.
An employer with under 50 employees - you don't have to do anything. But your employees do.
So what happens if I don't comply? The individual as a sole proprietor or an employee in an employer under 50 employees will be fined. An employer with over 50 employees that doesn't make it affordable and of minimum value will also be fined.
Why all the fines you whine? (or, let me stop reading this blog and get my bottle of wine) Remember that pesky risk pool? We have to have EVERYONE enrolled to balance the system and have the health pay for the sick. And since everyone is not enrolled in healthcare, there are fines to balance that out.
Oh - and by the way, those that don't have healthcare coverage, in an emergency, they can't be turned away. The Emergency Medical and Treatment Labor Act (EMTLA) passed by Congress in 1986 forbids the denial of care due to lack of health insurance coverage because of a lack of an ability to pay. It doesn't keep them from asking if they can pay and under the ACA, they will attempt to enroll them in Medicaid if an option, but they cannot deny emergency care.
And some states still collect taxes and fees from insurance companies to cover the uninsured (in a world where we are supposed to be 100% insured). Where do you think those fees come from? Your insurance premiums as the state will insert surcharges on the insurance company that then feed them down to your premium costs.
If I have not lost you yet, let's get to later this week when we talk about how premiums are calculated and why is my insurance more expensive in one state than another - wait, the states STILL regulate my healthcare? Obamacare isn't just the law of the land?
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