There's been a lot of confusion about misinformation about the recent health insurance reform legislation. We'd like to clear some things up for the benefit of the arts community.
The Reform Law Holds Insurance Companies Accountable
When the law goes into full effect in 2014, insurance companies won't be allowed to:
- Discriminate or charge you a higher rate based on your gender or health status
- Deny you coverage because of a pre-existing condition
- Cancel your coverage when you get sick and need it the most
- Set an annual or lifetime limit on benefits
Most employer-sponsored plans already provided these protections, but individuals have been left to fend for themselves. That makes these new rules especially important for independent workers (such as artists), who now make up 30% of the total US workforce.
Accountability Goes Both Ways
If we're going to hold insurance companies accountable, then we must also ensure a stable risk pool with full participation by the US workforce. We are all players in the system, and our actions (and inactions) impact its economic balance.
That's why the law includes an individual mandate, which requires that all Americans have health insurance or face tax penalties. The only way to prevent a death spiral of ever-increasing premiums is to ensure that there are no "free riders" and that we've all got some skin in this game.
Freedom is Alive and Well
In the long journey towards reform, there have been plenty of histrionics about how the
law would mean the death of American freedoms and the destruction of our economy. This
tactic is not new. In the 1960s, many on the right, notably the future
President Reagan,
insisted that the creation of Medicare amounted to socialized medicine and would be
catastrophic for our way of life. Needless to say, this hasn't happened. In fact, Medicare
has helped millions of Americans access vital health care when they've needed it most.
Does it limit our freedom to insist that we all participate in the health insurance system? A little bit, perhaps. But is health care really so different from fire departments, public libraries, or schools? Does it limit your freedom to insist that you pay your fair share for highway maintenance or food safety? These are public goods, and part of living in a civilized society is chipping in for things that benefit us all. To do otherwise isn't freedom; it's anarchy.
The Fat Lady Hasn't Sung Yet
The passing of the health reform bill is a big win and represents real progress in the US healthcare system. It's not a panacea, however. There are still inequities in the system. There are still plenty of ways in which artists and other independent workers get a raw deal. Fractured Atlas has been advocating for health insurance reform since 2002, and we'll continue to push for a system that works for our whole community. We're in this for the long haul.
The Health Care Law: What's in it for you now, and later?
The changes in the health care law will be phased in gradually over a four-year period. Some of the most popular provisions, those that will truly transform the current system, will not come into effect until 2014. The individual profiles below can help guide you in learning how reform may affect you now, or later. Also, to get a better idea as to when all the bits and pieces will be coming into effect, check out our timeline.
An uninsured young adult under the age of 26
Within 6 months you can get coverage under your parents' plan until your 26th birthday, unless you get a job with coverage before then. The plan cannot drop you if you get sick. No annual or lifetime benefit caps can be imposed.
Starting in 2014, if your income is below $43,320, the government will help pay your premiums in the form of a subsidy from a state run health insurance exchange. The exchange will offer a menu of plans with a minimum set of standardized benefits for easy, transparent, apples-to-apples comparison shopping.
If you are offered coverage through an employer, you can still buy insurance through the exchange if the employer's plan costs too much. Your employer may also give you a voucher to buy insurance through the exchange.
An uninsured individual with a pre-existing condition
Within 3 months, you can get subsidized coverage through a new national high risk insurance program until 2014. Premiums will be based on the standard population and not on health status. No annual or lifetime benefit caps can be imposed.
UPDATE (July 2010): The national high risk insurance program is up and running! You can apply for coverage online.
Starting in 2014, if your income is below $43,320, the government will help pay your premiums in the form of a subsidy from a state run health insurance exchange. The exchange will offer a menu of plans with a minimum set of standardized benefits for easy, transparent, apples-to-apples comparison shopping.
A small organization or business
The government provides a tax credit as a serious incentive to offer healthcare for your employees. To be eligible for these credits you must contribute at least 50% of the total premium. If you have fewer than 25 employees, with average annual wages of $50,000 or less, you qualify for a 35% tax credit effective immediately.
On Jan. 1, 2014, the tax credit increases to 50%.
If you have 10 or fewer employees with average annual wages of $25,000 or less, you qualify for the full tax credit of 35% effective immediately and increasing to 50% in 2014.
If you are a nonprofit organization, a tax credit of 25% is effective immediately, increasing to 35% in 2014.
If you employ fewer than 50 employees, you will not be required to provide health insurance. You are exempt from the mandate to contribute or pay a fine.
An uninsured healthy individual
You can qualify for affordable quality health insurance now! What are you waiting for?
Starting in 2014, if your income is below $43,320, the government will help pay your premiums in the form of a subsidy from a state run health insurance exchange. The exchange will offer a menu of plans with a minimum set of standardized benefits for easy, transparent, apples-to-apples comparison shopping.
Insured through Medicare
Starting in 2010, you will receive a rebate of $250 for prescription drugs if you've hit the coverage gap known as the donut hole. No annual or lifetime caps can be imposed.
Starting in 2011, you will pay nothing for recommended, preventive medical care. The government will begin phasing in discounts for generic and brand name prescriptions purchased in the gap (the donut hole).
We've also highlighted some of the more interesting aspects that will apply to everyone. This list is not exhaustive:
- Free preventive care. Insurers are required to provide coverage in full for recommended preventive benefits, e.g., an annual physical. This will take effect within 6 months and applies to all plans.
- No annual or lifetime limits on benefits.
- Transparency: starting in 2011, insurance companies must report the percentage spent towards items other than healthcare costs (like marketing, bureaucracy in administration, and executive compensation). The law stipulates that no more than 20% can be allocated to those expenses. Anything greater than 20% and policyholders will receive rebates. This means that 80% of every dollar paid in premiums must go exclusively towards medical costs.
Later in 2014...
- Insurance companies can't refuse to sell or renew coverage due to a pre-existing condition.
- Coverage for pre-existing conditions can't be excluded.
- Insurance companies can't discriminate and charge premiums based on health status or gender. Rates may only differ due to age (no more than 3:1), geographic area, family size, and whether or not you're a smoker.
- It is expected that everyone get insured. The government will provide support in the form of subsidies for qualifying individuals to ensure affordability.
- The government provides subsidies to qualifying individuals, families, and small businesses to help pay premiums for coverage.
- The government will set up shop and establish state-run health insurance exchanges for individuals and small businesses. The exchange will provide access to quality, low cost standardized plans for easy comparison. It will also assist in issuing subsidies and facilitating enrollments.
- Insurers must provide clear, easy to understand summaries outlining coverage without the fine print.
- Insurance companies must provide a valid reason for any premium increase, prior to it taking effect. Insurers that jack up prices without legitimate justification will be banned from participating in the state exchange.


