#blackhealthmatters ACA health healthcare

ACA is Here to Stay

As many of you know by now the Affordable Health Care Act (ACA) was again saved by the Supreme Court of the United States in late June. In a 6-3 decision the Supreme Court saved the controversial health care law that has been at the top of Republicans repeal list since its inception in 2011. Republicans have tried to appeal or undermine this law 56 times.

Can we just let it go? We’ve been paying for it and more people have healthcare that is affordable. The latest issue was the fact that the ACA authorized federal tax credits for eligible Americans living not only in states with their own exchanges but also in the 34 states with federal marketplaces. Sounds fair to me.

Do I like the ACA? Yes. Do I support it? Yes. Why? Because although I have always had great health insurance, I know many people who haven’t had health insurance due to the premium cost. In some cases, health insurance on a job where they’ve worked five or more years is more than my monthly premiums for medical, prescription, dental and vision for me and munch. That’s not affordable.

You may be asking, “But, T why should the government force us to have insurance if we don’t want it?” I will tell you that I agree with your logic. If you don’t want health insurance, you shouldn’t have to get it. However, you should know that you are putting yourself and your family at risk should they need medical care. But, on the flip side if you want health insurance, you should be able to get health insurance at an affordable rate with no disregard to your prior health conditions. I mean why should you be excluded because you were asthmatic or diabetic?

I remember when my cousin was diagnosed with cancer and could no longer work. I felt helpless trying to navigate his benefits in Tennessee. He worked a great job for a great company, but when he went on long-term disability they allowed him to keep his benefits paying COBRA. COBRA is 102% the cost of the premiums that both you and your employer pay and the 2% administration cost. How is that affordable for someone now getting 60% of their paycheck to pay bills, buy your cancer medications, eat or take care of your children? It’s not.

However, when he went to court to adjust his child support his children’s mothers were understanding that he was dying and that he couldn’t afford to pay them child support and they were okay with receiving social security. His Medicaid agent told him that under no circumstances should he ever stop paying COBRA because until he’s approved for state benefits he would be disqualified for his cancer treatments and medications if he has a break in coverage. It would be considered a pre-existing condition and they wouldn’t pay. He called me and asked me to confirm this.

It broke my heart to say yes this is true. He was 33. He died. He had Medicaid maybe 6 months before his death. His story like many others is heartbreaking if you care about humanity. No, I’m not in his situation or anyone else’s but my frame of reference is not from a rich person either with no compassion. You shouldn’t have to choose between medication and food.

So, this ruling was again an exciting win for those who are uninsured. But, what happens next? Well, next year you will receive a 1095-B from your employer. This form will confirm that you and your dependents had health insurance for 2015. This is part of the individual shared responsibility provision of the ACA which states:

The individual shared responsibility provision requires you and each member of your family to do one of the following:

  • Have qualifying health coverage called minimum essential coverage;
  • Qualify for a health coverage exemption, or
  • Make a shared responsibility payment when you file your 2015 federal income tax return in 2016.

What is minimum essential coverage? 

You are considered to have minimum essential coverage for the entire month as long as you are enrolled in and entitled to receive benefits under a plan or program that is minimum essential coverage for at least one day during that month. For example, if you start a new job on June 26 and are covered under your employer’s health coverage starting on that day, you’re treated as having coverage for the entire month of June. Similarly, if you’re eligible for a coverage exemption for any one day of a month, you’re treated as exempt for the entire month. For any month that you do not have minimum essential coverage you will need to qualify for an exemption or make a shared responsibility payment.

Minimum essential coverage includes:

  • Most health insurance coverage provided by your employer,
  • Health insurance purchased through the Health Insurance Marketplace in the area where you live, where you may qualify for financial assistance,
  • Coverage provided under a government-sponsored program for which you are eligible (including Medicare, Medicaid, and health care programs for veterans),
  • Health insurance purchased directly from an insurance company, and
  • Other health insurance coverage that is recognized by the Department of Health & Human Services as minimum essential coverage

So, what happens if I or my dependents didn’t have minimum essential coverage for any period in 2015? 

You’re going to have to pay. For any month during the year that you or any of your dependents don’t have minimum essential coverage and don’t qualify for a coverage exemption, you will need to make an individual shared responsibility payment with your tax return.

How much will it cost you?

In general, the annual payment amount is the greater of a percentage of your household income or a flat dollar amount, but is capped at the national average premium for a bronze level health plan available through the Marketplace. You will owe 1/12th of the annual payment for each month you or your dependent(s) don’t have either coverage or an exemption.

By January 31, 2016 (February 1st because January 31st is a Sunday), your employer should provide you with form 1095-B which you will file with your taxes to confirm that you and your dependents had health care coverage that met the minimum essential coverage requirement. If you didn’t have health coverage for you or your dependents, then you will be responsible for paying the premium.


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