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Affordable Care Act Exchanges Make Their October 1 Debut

October 1, 2013

Today the Affordable Care Act (ACA) enters a new phase with the opening of the enrollment period for the health care exchanges. The federal government has also shut down today for the first time since 1995, but the roll-out of the exchanges will continue because this provision of the ACA is largely funded through mandatory appropriations rather than annual spending bills.

The exchanges are the centerpiece of the ACA’s effort to cover more of the 48 million uninsured Americans by creating online marketplaces in each state where individuals and small businesses can compare health insurance plans and buy coverage. All plans are required to at least provide the same set of essential benefits but plans may offer additional benefits as well. The cost structures of the plans will vary and consumers will be able to compare prices of the different plans, which are described as bronze, silver, gold, and in some cases platinum. In addition, consumers who are between 100 and 400 percent of the poverty line are eligible for tax credits to defray monthly premium costs.

The District of Columbia and 16 states have opted to run their own exchanges, while the remaining 34 states decided to let the federal government run all or part of their marketplaces. The enrollment period for 2014 coverage starts today and ends March 31, 2014; however, in order to be covered starting January 1, 2014, the deadline for enrollment is December 15, 2013. The ACA requires most people to have health insurance, but exceptions to this rule exist. Those who do not meet an exception in 2014 will be required to pay a $95 penalty or 1 percent of their household income, whichever is greater. People who have insurance through their jobs or through Medicare are automatically in compliance with the health insurance mandate.

The success of the health insurance marketplaces depends on whether the exchanges will function as expected, whether sufficient numbers of healthy, young Americans will sign up for coverage, and whether patients will be able to have adequate access to doctors and specialists. The program has already faced technical glitches and delays including a delay until November of the ability of small businesses to buy coverage online in the 34 federally run exchanges and a delay of the Spanish language version of the federal website until mid-October.

Visit http://www.healthcare.gov for links to each state’s exchanges and for more information.

NASABA Health Law Section

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