The Supreme Court ruled 5-4 in favor of the individual mandate on June 28th, in effect providing tens of millions of low income people with health insurance. In addition to the current benefits the Affordable Health Care Act provides such as children being able to stay on their parents policy until age 26, insurers not being able to turn away children with pre-existing conditions, discounts on prescription drugs for Medicare patients, and the uninsured who are sick being able to buy their coverage through high-risk pools set up by the government, many additional changes will take place in 2014 to the American healthcare system.
In 2014 the act will require states to set up their own health exchanges, Americans will be required to buy their own insurance coverage if they don't already have insurance (e.g. through an employer plan or Medicare) or pay a penalty of 1% of their income or $95 a year whichever is greater, Medicaid will be expanded by an estimated 16 million low income people, and employers with more than 50 employees will also face a penalty if they don't offer insurance to their employees.
The Urban Institute estimates that only about 6% of the U.S. population will actually be required to purchase health insurance or be hit with the penalty under this new mandate, as most people already have coverage, including through a company plan or through Medicare.
The battle over the individual mandate has been intense between the Republicans and the Democrats and 26 states have sued over the law arguing that requiring people to purchase health insurance or face a fine is unconstitutional. The republican congress and their presidential candidate Mitt Romney have promised to try to repeal the entire law. The democrats including the senate will unlikely allow this to happen. However, if the republicans are able to take control of the senate and the presidency, they could overturn the act.
This program is expected to help tens of millions of Americans, including the poorest Americans who currently don't have health insurance, many potential employees in large companies who aren't currently offered health insurance, seniors who should expect to see lower premiums, and those who have been denied coverage based on a pre-existing condition. The plan is also expected to help millions of people by covering more preventative services rather than charging out-of-pocket costs for preventative care, which should ultimately save the insurance companies more money over the long run by treating a condition early before it requires more costly treatment later.
Insurance companies will now be required to sell insurance coverage to everyone, regardless of their medical history. It is expected that consumers will continue to see increases with their premiums and co-payments, especially as the cost of healthcare continues to rise. Older people should see their premiums come down because of the age rules for the insurance policies. People who purchase their own policies without going through an employer should see their rates reduce as they will be able to better compare plans through the exchanges.
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