Last year, most of the debate that took place in Congress was about health care reform.  Despite the flaws, this bill is a significant accomplishment that will benefit thirty million individuals. The legislation will impact individuals and families differently. This document seeks to answer some of the most common questions that people may have about the new health care reform law.    

When is health care reform going to be implemented?   

Health care expenditure accounts for 17.3% of the nation’s gross domestic product, and it is a very complex system. The implementation of the health care reform passed by Congress and signed by President Barack Obama will take about a decade to be fully implemented. 

In 2010, the following provisions of the health care bill will be implemented.

• Regulatory reforms to private health insurance providers:

• Provide tax credits to small businesses with no more than 25 employees to purchase employee health care coverage.
• Create a temporary insurance program for uninsured individuals with pre-existing conditions. The program will be in place until 2014, when the Exchanges are established.   
• Increase funding for community health centers starting in the 2011 fiscal year and continuing over the next five years. Most of these community health centers are located in underserved communities and provide medical treatment to all residents regardless of immigration status or ability to pay.

The following provisions will take effect between 2011 and 2014:

• States receive federal funds to create health care ‘Exchanges.’ These Exchanges are composed of different private health insurance providers that will offer policies at a low cost with comparable benefits to the uninsured.  States will decide what type of Exchange should be created to serve its residents; depending on the state, the Exchanges will be administered either by a non-profit organization or government agency. These Exchanges will be established in 2014.
• Premium tax credits are available to eligible individuals and families with incomes between 133% - 400% above the Federal Poverty Level (FPL) to help with the cost of health care.
• Cost-sharing subsidies are available to eligible individuals and families with incomes between 100%-400% above the FPL to help with the cost of health care.
• Public programs' income eligibility criteria and services are expanded.  

• While employers technically will not be required to provide health insurance to their employees, beginning in 2014 large employers with more than 50 full-time employees that do not offer health care coverage will pay a penalty of $2,000 per year for each full-time worker in their payroll. Employers with less than 50 employees are exempt from the penalty.   

If I am currently insured, do I have to change my health care coverage?

No.

If you are currently insured through your employer or in the individual market, you don’t have to change your coverage. However, due to new regulations, you may be eligible for public programs or receive either tax credit or subsidies for the cost of health care.  There may be some changes for individuals that work for companies with fewer than 100 employees if their employers decide to offer coverage via the Exchanges that will be established in 2014. For individuals that will continue to be insured through the individual market, insurance companies will be prohibited from denying coverage because of pre-existing conditions and limiting or canceling coverage to individuals that are sick. 

If I am uninsured, what health care plans would be available for me? 

It is estimated that about 30 million persons will have access to health care coverage.  The main vehicles that will be used to provide health coverage are employer coverage, expansion of public programs, and creation of Exchanges.  Exchanges are composed of different private health insurance providers that will provide policies at a low cost with comparable benefits to the uninsured and offer tax credits or subsidies to eligible individuals or families.  Most of the expansion and creation of the Exchanges are set to be implemented in 2014.

If I have a pre-existing condition (diabetes, high blood pressure, etc.), would I be eligible for health care coverage?

Yes.

At the end of this year, a high-risk pool will be established to offer coverage to people with pre-existing conditions with the same rates that are offered to individuals without pre-existing conditions. This high-risk pool will be in place until 2014, when the Exchanges are set to be ready.   In addition, starting in September 2010 private insurance companies are prohibited from denying coverage to children with pre-existing conditions. Once the Exchanges are established in 2014, all the private insurance companies that want to participate in the Exchanges will be prohibited from denying coverage to all individuals with pre-existing conditions. This will also be extended to small group markets outside the Exchanges.  

Do I need to be a full-time worker to qualify for health coverage via my employer? 

Yes.

Employers will not be required to offer coverage to part-time workers. However, two part-time workers will be considered one full time worker for the purposes of determining if a company is covered by the employer requirement.

What type of coverage would employers offer?

Employers must offer a minimum essential coverage that is also affordable. Employees of companies with more than 50 workers that are charged more than 9.5% of their income for the employee-share premium may be eligible to receive premium credits to be able to afford insurance coverage. Those employers will pay a penalty if any of their employees obtain a subsidy to help pay for insurance.  The penalty equals $3,000 per worker who uses the subsidy. The employer will then be required to provide a voucher to the employee for the percentage that the employer would have paid had the employee chosen to continue with the employer-sponsored plan.

Is my information going to be shared with other government agencies?

For verification purposes in the Exchange, the immigration status of immigrants that are legal permanent residents will be verified by the Department of Homeland Security database and citizenship verification will be verified by the Social Security Administration. This verification will only affect individuals that are uninsured and applying for individual insurance in the Exchange. Employers can only inquire information that is strictly necessary and this should not be used as a vehicle to re-verify the employment eligibility of their workers.   

Am I going to be penalized if I don’t have a health care plan? If so, what’s the penalty?

Yes, but there are exceptions to the individual mandate.

The legislation that was signed into law included an individual mandate. Thus, starting in 2014, all U.S citizens and legal permanent residents are required to obtain health coverage. There are exceptions to the individual mandate based on religious objections and financial hardships. Unauthorized immigrants are exempt from this mandate because they are not eligible for public programs, buying unsubsidized coverage in the Exchanges, or tax credits and subsidies. The penalty for not having coverage for a family could start at $95 in 2014 and go up to $605 by 2016.

Is there going to be financial assistance to help with the cost of private coverage?

Yes, but the assistance is dependent upon the income of an individual or family.

An individual or family whose income is above the level needed to qualify for public programs but is below 400% of the FPL could be eligible for tax credits or subsidies. These two types of subsidies will be available for people with incomes between 133% and 400% above the FPL.  A family of four with an income below $88,200 could be eligible for subsidies.  However, families or individuals with incomes between 300% and 400% above the FLP would only be eligible to receive subsidies if the premiums exceed 9.5% of their income. Thus, the maximum someone would have to pay for health insurance premiums before subsidies is $8,379. Tax credits and subsidies will take effect starting in 2014 and are only available to citizens and legal residents.   

My children are U.S citizens or legal permanent residents, but I am not. Would they be able to qualify for coverage?

Yes.

Children that are either legal residents or citizens but whose parents are undocumented immigrants qualify to enter into the Exchanges or public programs depending on the income of their families.

I am a legal permanent resident. Do I qualify for assistance to purchase health care coverage?

Yes.

Legal residents will be eligible to participate in the Exchanges as well as tax credits and subsidies. While this new law does not remove the five-year waiting-period for legal immigrants before they can access Medicaid, it provides them with subsidies or tax credits to purchase private coverage in the Exchange.

If I receive assistance to purchase my health care coverage, is that going to affect my chances of becoming a naturalized citizen?

No. Applying for subsidies would not jeopardize the naturalization process of a legal immigrant.

If I am an undocumented immigrant, am I eligible for health care coverage?  

Undocumented immigrants will not be able to purchase unsubsidized coverage in the Exchanges with their own money. In addition, they are not eligible for premium tax credits or subsidies. As a result of this restriction, undocumented immigrants are exempt from the individual mandate.  However, they are still eligible to receive emergency medical services and non-emergency services that are offered at public hospitals or community health centers.  The funding for community health centers will increase, including funding for construction and renovation.

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