Good Explanation of the Affordable Care Act

I recently received a fairly good explanation of the new Affordable Care Act from the Virginia Consumer Voices for Healthcare. I thought you all may be interested in this information.

Health Benefits Exchange:

What is it?

The Affordable Care Act (ACA) created a Health Benefits Exchange. The Exchange is an online marketplace, with a paper form option, where individuals and families can go online and enter information about them and select a health plan from options that fit their needs. States can decide to have a state-based Exchange run from within the state or can join the Exchange that the federal government is starting.

How Do I Use It?

  • The Exchange is for people who do not get health insurance through work.
  • Navigators (people trained to help) will be available to help people sign up for the Exchange and make sure they get what they are eligible for (for example Medicaid or a subsidy). Hopefully, these Navigators will be located in places like churches and community centers like the YMCA, as well as the Department of Social Services.
  • If you go to one place with a Navigator to sign up for the Exchange, that Navigator should be able to help you no matter what you qualify for. There will be no wrong place for you to go.
  • A special Exchange will be set up for small business owners who employ fewer than 50 workers to help them get health insurance for their employees and a tax credit from the government.

Medicaid Expansion

What is it?

Medicaid is the state and Federal partnership that provides medical coverage to eligible persons who might otherwise go without medical care for themselves and their children.

What are today’s requirements in Virginia?

You must be:

  • A resident of the state
  • A U.S. citizen or qualified legal immigrant
  • In need of health care/insurance assistance with low/very low income. The Medicaid income eligibility limits are different, depending on which group you fall into.

You must also be either:

  • Pregnant
  • The parent or relative caretaker of a dependent child(ren) under age 19
  • Under age 21 and in foster care
  • In a nursing facility
  • Blind or disabled
  • 65 years of age or older

ACA Medicaid Expansion

Beginning in January 2014, Medicaid will increase its national eligibility limits for adults to 133 percent of the Federal Poverty Level. (Note from Dave: Currently, the Federal Poverty Level for a family of four is $23,050. The ACA makes a family of four making less than $30,725 eligible for Medicaid. This doesn’t include the other assistance that people may receive from the government.) The June 2012 Supreme Court decision on the Affordable Care Act (ACA) essentially gives state the option of whether or not to participate in the Medicaid expansion.

Note from Dave:

Virginia has one of the most restrictive Medicaid programs in the country.  It currently only covers parents who make below 30% of the poverty line, so if a family of 4 makes more than $10,000 a year, the parents can’t qualify for this program. By implementing this provision of the Affordable Care Act, individuals who make $15,000 and families of four who make $31,000 a year would qualify.


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