Federal Health Care Reform

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In March of 2010, Congress finished their work on the historic health care reform bill. Thanks to the tireless work of Colorado Progressive's members and countless others across the United States, Congress has enacted the biggest piece of social legislation since the Civil Rights Act in 1965. Together we made over 15,000 phone calls to members of Congress and President Barack Obama, hosted 166 successful events, and had 188 meetings with members of Congress and Congressional staff. Because of the work of so many dedicated activists, 31 million people who are currently uninsured will have access to coverage and health care - 500,000 of those right here in Colorado. Not only does this piece of legislation extend coverage to millions of people, it also prohibits insurance companies from denying people with pre-existing conditions, stops the practice of recission and bans the practice of lifetime caps. In short, this bill is a first and important step towards the kind of health care system we all want for this country.

• March 23rd marks the second anniversary of the passage of health care reform! Click here to read more about what the Affordable Care Act has done for Colorado in the two years it has been law!

• On March 26th, the Supreme Court will begin hearing arguments about the Affordable Care Act. Want more information about what's being decided, what the process looks like, and what a ruling will mean? Check out our ACA and the Supreme Court page here!

You can follow this link to Colorado's official state website that explains how the federal health care reform law will affect our state.

What health care reform means to you.

I'm an uninsured adult...

If you’ve been uninsured for six months or more and been rejected for private insurance because of a pre-existing condition, you may be able to buy your insurance from Colorado’s newly expanded high risk pool. This program is called Getting Us Covered and was created for the specific purpose of insuring people with pre-existing and chronic conditions. Purchasing insurance in this way can be expensive, but is a good option for people who can afford private insurance but cannot get coverage because of a chronic condition.

By 2014 you may be eligible to receive a subsidy to help you purchase health insurance. About a million people in Colorado will receive some sort of premium assistance either in the form of a subsidy or tax credit (or a combination of the two) beginning in 2014. You will be able to use this subsidy to purchase private insurance or to keep paying your Getting Us Covered premium.

If you are newly uninsured or have exhausted your COBRA benefits, you may be eligible for Cover Colorado, which is another state run insurance plan designed to provide insurance for people with chronic conditions under the age of 65. Like Getting Us Covered, this option can be expensive but may be cost effective for people managing chronic conditions and serious illnesses.

My child is uninsured…

If your child is uninsured because of a pre-existing condition, insurers across the nation are now required to provide coverage to kids with pre-existing conditions either through family or stand alone plans. You do need to be aware that stand alone policies for kids with pre-existing conditions can only be purchased during open enrollment. The first enrollment period begins on January 1st and runs through January 31st. The second enrollment period begins July 1st and runs through July 31st. This means that you will only be able to purchase private child only plans for kids with pre-existing conditions during these two thirty day windows. If you are trying to insure your child with a pre-existing condition as part of a family plan, you should be able to purchase that at any time during the year.

If you cannot afford to purchase private health insurance for your child (whether or not she has a pre-existing condition), she might be eligible for CHP+, which is a low cost health insurance program for children and pregnant women. To be eligible for this program you will need to determine your family size and household income. Once you’ve done this, you can consult the eligibility chart on the CHP+ website. If you are eligible you must fill out the application and follow the instructions for submitting it.

I am a young adult…
If you are under the age of 26 and your parents have insurance, health care reform means that you are now able to stay on your parents’ private health insurance plan until the age of 26. Previously, some insurers allowed college students to stay on their parents’ plans up to the age of 24, but the new health care reform law does not allow insurance companies to create that kind of criteria. You are eligible to stay on your parents’ insurance whether or not you are enrolled in college.

If you are between the ages of 18 and 26 and your parents’ do not have insurance or cannot cover you under their plan, you may be eligible for Cover Colorado, Getting Us Covered, the Colorado Indigent Care Program, or Medicaid. In 2014 you may be eligible for a subsidy to help you purchase health insurance on the private market.

I am over 65 and on Medicare…
Health care reform won’t drastically change your benefits, but it will improve them! Under the new law, the Medicare part D donut hole will slowly be phased out. People on this plan began receiving reimbursement checks as soon as they hit the donut hole. While these reimbursements will probably not be enough to cover all out of pocket medical expenses, they are an important step towards closing the donut hole entirely and can help you alleviate some of your out of pocket costs for prescription drugs. In addition to closing the Medicare donut hole, the new law also mandates that all preventative care will be covered under all Medicare plans with no out of pocket expenses for you. The new law places a premium on preventative care and recognizes that cost savings can be found in the system by catching problems before people become seriously ill. You will see these new benefits slowly phased in between now and 2018. You may have heard that health care reform will harm, and even cut, Medicare, but this is not true. The projected cost savings for Medicare in the law will come from increased efficiencies including a streamlining of record keeping and a utilization of new technologies to cut down on administrative costs.

I am a Small Business Owner…
If you provide health insurance for your employees, you may be eligible for a tax credit right now. To qualify you must employ the equivalent of 25 full time employees or less. This means that someone employing 50 part time employees would be eligible for the tax credit because those 50 part time employees equal 25 full time employees. You must also be paying at least 50 percent of your employees’ premium costs to be eligible for the credit. Currently, the tax credit is up to 35% of the amount of money you as an employer spend on premium costs for your employees. In 2014 that tax credit will jump to 50% of your business’ premium costs. The IRS has developed a worksheet (http://www.irs.gov/pub/irs-utl/3_simple_steps.pdf) that can help you determine whether or not your business is eligible for the credit and how much the credit is worth if you do qualify. The website also includes instructions you can follow to claim the credit.

Beginning in 2014 you will be eligible to purchase health insurance through Colorado’s Health Benefits Exchange. The Exchange will be a one stop shopping place to compare plans and help you make more informed decisions about the kind of policies you’re purchasing. The Exchange will also help lower the cost of health insurance because it will expand the risk pool, which will help spread the risk out among more people and that helps to drive down cost.

I have private insurance that I like or I get coverage through my employer…
You probably won’t notice a change in your coverage, but it will be strengthened thanks to health care reform. As of this year, health insurance companies are required to spend 80% of your premium dollars providing actual medical care. They are also no longer allowed to drop your coverage because you get sick and by 2014 they will not be able to deny you coverage because of a pre-existing condition. By 2014 insurance companies will not be able to impose limits on coverage or institute lifetime spending caps, which will allow you to actually count on your coverage if you become seriously ill or injured. In addition to implementing insurance industry reform, health care reform will also require insurance companies to provide comprehensive preventative care in all plans they sell.