By Kathy Rallings
The Affordable Care Act (ACA), sometimes called Obamacare, moves this country’s health care system forward by expanding health care coverage and protecting health care consumers. The statute and its regulations are complex and may not be perfect, but health care reform is an important step in the right direction.
Over the last several years, portions of the law have been fulfilled, but the largest system overhaul is under way right now with the implementation of the Exchanges/Market Places. Our state runs its own Exchange called Covered California (www.coveredca.com). It offers various private health plans to the uninsured and people with individual health policies. No one can be denied coverage or charged more due to pre-existing conditions or gender. For those whose household income is up to 400 percent of the federal poverty level, Covered California can help with subsidies for premiums and out-of-pocket costs, such as co-pays and deductibles. Open enrollment this year is Oct. 1, 2013, to March 31, 2014. Coverage begins Jan. 1, 2014.
Many CTA members received a notice from their school districts required by the ACA, providing information about the Market Places. These notices have raised questions from our members. Here are answers to some of those questions.
How will the changes in the ACA impact me as a CTA member?
Some small districts, with 50 or fewer full-time employees, may look at health benefits options with Covered California, but overall people with employer-based health care should not see any specific changes due to the opening of the Market Places. For our members who are not eligible for employer-sponsored health benefits, the law offers the new promise of affordable quality coverage.
Employer-based health insurance covers 85 percent of Americans. Most CTA members fall into this category. CTA members have already experienced positive changes to their health benefits under ACA regulations. For example, parents can keep adult children up to age 26 on their health plans, regulations provide a refund if insurance companies servicing large employers spend more than 15 percent of premiums on administrative costs (Medical Loss Ratio Refund), and lifetime limits for essential benefits were eliminated.
As a single person, what should I know about the changes?
The ACA requires employers to provide “affordable” health insurance to its full-time employees (more than 30 hours a week) to avoid a penalty. The penalty was postponed for employers, but not for individuals, until Jan. 1, 2015. Employer-based health insurance is considered affordable when no more than 9.5 percent of household income is paid toward the employee’s premium contribution for the lowest-cost employee-only medical plan option. If your school district does not offer affordable health insurance as defined by the law, there may be additional choices available in Covered California.
As a married person or parent, what I should be aware of?
The only way the ACA can expand access to health insurance is to require everyone to have coverage before illness or injury occurs. Therefore, individuals must not only have coverage for themselves but also their dependents, or face a penalty beginning Jan. 1, 2014. Since the affordability threshold is based on employee-only coverage, parents of adult children may want to help them explore options on Covered California and decide if the plan through the district is the best choice.
As local chapters plan for bargaining, what should negotiators be aware of?
Unfortunately, some politicians and employers want to take advantage of the ACA to undermine the health benefits for which our members have worked hard and sacrificed for decades. CTA is working with other unions, work centers and NEA affiliates to ensure that the ACA’s promise is kept and our members’ health benefits are strengthened. Therefore, each chapter will need to analyze its particular situation to ensure its members are able to continue access to affordable quality health care.
How can I help my chapter?
CTA staff and leaders have access to resources to ensure they are negotiating health benefits based on facts and not some of the misinformation that has been circulating around the ACA. It is important for members to support organizing efforts when asked by the local leadership and bargaining teams around this issue.
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