A Q&A on the health care ruling

We took questions and comments from readers Thursday after the Supreme Court ruled on health care at tampabay.com, on Facebook and via email. Here's an edited transcript.

So now what? Does this mean I have to go out and find health care for my four employees?

Employers with fewer than 50 employees are not required to provide insurance, nor are there any fines for not providing insurance. The employer rules for coverage affect companies with 50 employees or more.

Do you see a drop in rates offered by private companies? Even at the current rates, health care is unaffordable for my income.

Overall, most analysts are not expecting price drops for health insurance. For people who have insurance through work, analysis from the nonpartisan Congressional Budget Office showed small increases in premiums — $100 to $200 a year.

Having said that, there are significant changes for people who have to buy insurance on their own. The Congressional Budget Office projects prices will go up overall in this area, because the law requires that all policies provide comprehensive coverage. People of modest income will receive credits to buy coverage, which means their out-of-pocket costs go down. Insurance companies will not be able to charge people more if they have pre-existing conditions, so those people will likely find more affordable policies.

The court said the federal government cannot force me to have health care. A $95 tax is levied instead. So why buy insurance at all when health care cannot be denied? The tax is a lot cheaper than full coverage.

You're correct that the penalty is $95 in 2014. (Most people would notice it on their tax returns in 2015.) Some people will find it cheaper to pay the tax penalty than to buy insurance. The fines do get bigger each year, though, up to 2.5 percent of income in 2016.

The people who pay the tax will be those who don't have insurance, meaning those who can least afford the tax will be forced to pay it.

There is a "hardship" exemption on the mandate for people who can't find an affordable policy. People don't have to pay the tax penalty if the only policies they can find exceed 8 percent of their income. They also don't have to pay the tax penalty if they make too little income to file taxes, if they're incarcerated, have religious objections, or are illegal immigrants. However, paying the tax penalty does not mean you get insurance. People who pay the penalty remain uninsured.

My monthly health insurance contribution increased by $88. What is my recourse when I no longer have the same health care that President Obama promised that I would have?

Obama likes to say, "If you like your health care plan, you can keep your health care plan." This is partially accurate but leaves out important information.

People who get insurance through work or Medicare will not see many changes. But as you probably know, those plans typically have had annual changes on premiums and coverage. Some of those changes will still happen under the new law.

If you get comprehensive coverage through work right now, the law's intention is that you'll stay in that plan.

What happens to Medicaid if states can opt out of the program? Will states start dropping people from Medicaid?

The court said the federal government can't take current Medicaid funding away from states if they don't want to expand their programs. What that means in practice is still being analyzed and digested. We'll have to wait and see. Medicaid is a joint federal-state venture that provides health insurance to the very poor, and the rules are complicated. Technically, it's a voluntary program right now, but every state participates.

A Q&A on the health care ruling 06/28/12 [Last modified: Friday, June 29, 2012 12:11am]

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