This is the final segment on our series on health insurance.  Our first two segments discussed How We Pay for Health Care and Understanding Health Insurance Coverage.  In this segment we discuss The Patient Protection Affordable Care Act (“PPACA”) signed by President Obama in 2010. 

Understanding Health Insurance Coverage

The PPACA has been the subject of much controversy. There has been a lot of confusion about what the Act does, when it does it, and how it was enacted. Adding still more confusion, the United States Supreme Court is now considering the Act’s Constitutionality with a decision expected sometime this summer.

Truckers, like everyone else, have a lot of questions about the PPACA.  The PPACA has many provisions that are popular.  These provisions are intended to increase access to health care, while lowering costs for the sick and injured.  The trade off for insurance companies to provide this expanded coverage and lower cost is the so called “individual mandate”.  The individual mandate provisions require that everyone purchase insurance, or pay a penalty.

The individual mandate has caused a firestorm of controversy.  We do not take a position on whether the mandate is right or wrong, constitutional or unconstitutional.  We will explain the rational behind the mandate.

First, health insurance works most effectively and efficiently when everyone (sick, healthy, young and old) pay for insurance.  The young and healthy pay premiums, but use very little health care.  In contrast, the sick and old receive far more in health care than they pay in premiums.  If the young and healthy are not paying for insurance, the cost of insurance for everyone else goes way up.

Second, the young and healthy eventually get old and/or sick.  When they do, and they don’t have insurance, they get health care from emergency rooms and other providers without paying.  This cost of unpaid health care is distributed to the rest of society that does pay for insurance and health care in the form of higher costs. 

The proponents of the individual mandate argue that the mandate is justified to (1) lower the cost of insurance for everyone and (2) make sure that everyone pays for the health care they will eventually consume.

The following is a summary of some of the PPACA’s popular provisions and when they take effect:

PROVISIONS ALREADY IN EFFECT:

Cheaper drugs for people on Medicare.  Seniors get a 50 percent discount when buying brand-name drugs and a 7 percent discount on generic drugs (14 percent in 2012) that are covered by Part D.

More young adults with insurance.  Young adults 25 or younger can stay on their parents’ health-insurance plan unless they’re covered on their own through an employer.

No lifetime and annual limits. Health insurers can’t set lifetime limits on your coverage or cancel it if you get sick. Annual limits on coverage will be phased out over the next few years for most insurance plans.

Help for small businesses. Businesses with fewer than 25 full-time workers can apply for tax credits to help them provide health insurance for their workers.

PROVISIONS COMING SOON

Rebates.  Insurers will have to give rebates if they spend too much of their revenue on administrative or other business costs instead of medical claims.

Guaranteed coverage for people with pre-existing conditions.  Insurers must sell individual or group coverage to any person or business that wants it, regardless of pre-existing conditions or any other aspect of their health status. And they can’t charge people more, or limit coverage, based on their health status.

Insurance “exchanges” will open. States will open health-insurance “exchanges” where individuals and small businesses can compare and buy health insurance.

Insurance subsidies. In the exchanges, families and individuals who meet certain income requirements will get subsidies in the form of reduced premiums and out-of-pocket costs.

Large employers will have to offer health insurance. Companies with more than 50 full-time workers who don’t offer coverage and have workers that qualify for a health-insurance subsidy in the exchanges will have to pay a penalty.

Expanded Medicaid coverage.  People younger than 65 with income less than 133 percent of the federal poverty level will be eligible for Medicaid.

Health insurance is critically important to hurt truck drivers.  When the Supreme Court makes a decision on the Constitutionality of the PPACA, we will let you know.  If the Supreme Court strikes down the PPACA, let’s hope lawmakers put politics aside and find real solutions to the many problems in our health care system. 

We don’t just handle our client’s personal injury and workers’ compensation lawsuits.  We make sure our hurt trucker clients are informed about all of the options available to pay their bills and get medical care while their lawsuit is pending.  

If you have been injured, we would be happy to speak with you about free of charge. You can contact us at 855-4-HURT-TRUCKER (855-448-7887) or email us at [email protected] or contact us on Facebook or Twitter.