Q: What is the individual mandate?
A: In a nutshell, the law “mandates” that every American have health insurance coverage. Most people will already have coverage through their jobs, so they don’t need to do anything about that aspect of the law. But more than four million Texans who are uninsured will have to find coverage and enroll in a plan.
Q: Why is this necessary?
A: Uninsured people suffer because they can’t obtain healthcare when they need it. They get sicker, and they often go bankrupt because of medical bills.
Q: I have health insurance, so how does this affect me?
A: Everyone is affected because uninsured people often end up in the emergency room, and the cost of their care gets passed on through hospital costs, resulting in higher insurance premiums for all of us. Ron Cookston of the local collaborative Gateway to Care says insurance premiums in the Houston region are $1,200 higher than they would be if everyone was covered.
The insured also pay through their property taxes. Those taxes help fund public health systems for every Texas county, like Harris Health System’s clinics and Ben Taub and LBJ hospitals. Those taxpayer-funded facilities provide treatment for many uninsured Harris County residents who have nowhere else to go.
Q: How do I get insurance if I don’t have any now?
A: The simplest way will be to go online and comparison shop on a so-called “health insurance exchange.” There isn’t one set up in Texas yet, but it should be active by Oct. 1st. Everyone is supposed to be insured starting January 1st.
Q: Where do I go?
A: The exchange for Texans is not ready yet. Governor Rick Perry decided to “opt out” of setting up a state-operated exchange, which means Texans must wait for the federal government to set one up. It will probably get going this summer.
Q: How much will a policy cost me?
A: That depends. If you have a very low income, you or your children may qualify for Medicaid. There will also be sliding-scale subsidies for private insurance on the exchanges (for residents who earn up to 400 percent of the poverty level, about $44,680 for one person.)
We won’t know the price tag on the actual policies until insurers start setting up their plans. Premiums can vary by type of plan and location.
But the national law does include some rules. For example: Insurers won't be able to charge more if you are a woman or if you have a pre-existing condition. But they will be able to charge older people up to three times more than younger ones.
Q: Will anyone be allowed to buy from the exchanges?
No. For now, exchanges are for people who need to buy their own coverage, and for small companies who want to cover 100 or fewer workers (50 or fewer in some states). Also, undocumented immigrants are not allowed to use the exchange.
Q: Where can I find out more?
Enroll America Information on a state-by-state basis
Healthcare.gov The official federal website for the Affordable Care Act includes information about exchanges and also how to find an affordable clinic or doctor right now.
Gateway to Care (Harris County and 12 surrounding counties)
“Be Covered Texas” An outreach website from Blue Cross Blue Shield Texas
Carrie’s on-air interview with Ron Cookston of the local nonprofit Gateway to Care, click here.