Obamacare: The Winners – Jeff Penso, M.D., FAAP

When patients ask me what I think about Obama care, I pause before answering. The law is new, complex and will take time to work out. However, it is clear that some people will benefit rapidly under the ACA –Accountable Care Act, the law’s more accurate name.

The first to benefit were young adults, under 26 years old, whose parents have health insurance. Those young adults are now covered by their parents’ plan.

The next winners comprise an often overlooked group. They are some of the parents of the pediatric patients I see at my office: Self-employed adults. The self-employed, often in tech or media fields, are the entrepreneurs of the 21st century. They may be single or married, with or without children. Historically these individuals have been treated rather poorly by the insurance market; subject to high rates and often denied coverage because of pre-existing conditions, like asthma. Under ACA they are guaranteed insurance coverage, with reduced cost if they qualify.

How to get coverage? Under ACA states set up web based marketplaces, called ‘Exchanges.’ California has already created its Exchange, called ‘Covered California.’ Covered California will offer online shopping for private health plans, starting in October 2013, and patient coverage will begin in January 2014.

Consumers will be able to compare insurance plans online. All plans are required to cover essential benefits such as hospital, emergency and doctor care as well as preventive services. You will be able to choose among 4 basic levels of coverage- platinum, gold, silver and bronze. You can get increased coverage for a higher premium, or pay more out of pocket for lower monthly cost.

At Covered California, consumers may sign up family members who need health coverage. Health plan premium costs are based on family size and ages of family members. There are tax credits and cost-sharing subsidies to lower costs for qualified individuals or families.

For more information I suggest you visit the excellent Covered California site:

www.coveredca.com

www.culvercitysymphony.org

2 Comments

  1. Thank you Dr. Penso for a reasonable explanation of a good law.

    Whenever I encounter someone who thinks that ACA will ruin American healthcare, I wonder what planet they’ve been living on. My husband and I now have excellent company-sponsored health insurance, but for several years while our daughter was in elementary school, he was self-employed and we had private insurance through Anthem Blue Cross. While the plan was never what you would consider affordable, the last 2 years were the worst–4 rate increases in 2 years paired with increased deductibles (and other attempted rate increases put on hold by the state of California during this period), only 1 annual check-up allowed every TWO years for kids 7 years and older,”pre-existing” this and pre-existing that, and adoption of what I call the “first-try rejection mode” for every claim.

    Who are these Americans that conservatives claim are happy with their existing plans? Their doctors, yes, but the assertion that most Americans want to continue the status quo with health insurance to be laughable. These people should take a ride with Anthem Blue Cross for a year.

  2. Without the ACA my children would have had no cover! Why because every job they had included no benefits! And not hardly enough to pay insurance premiums or co-pays! My cousin is self employed and Kasier premiums where killing him! Healthcare is a human right not only for those of us that can afford to pay the over-inflated premiums

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