WASHINGTON — The new year brings the big test of President Barack Obama’s beleaguered health care law: Will it work?
The heart of the law springs to life Wednesday. Patients will begin showing up at hospitals and pharmacies with insurance coverage bought through the nation’s new health care marketplaces.
Lots of Americans are nervous.
Will their new coverage be accepted? It’s a concern because insurers reported problems with the customer information they’ve gotten from the government, including missing data and duplication.
How many more people will see old individual plans they liked canceled? Will a flood of newly insured patients cause doctor shortages? Will businesses respond to the law by ditching their group plans or pushing more health costs onto workers?
The new year also launches the most contentious aspect of the law: the mandate that nearly everyone in the U.S. have health coverage, or pay a fine.
All this will unfold during the super-heated politics leading to November’s midterm elections.
These are some dates — and moving parts — to watch in 2014 when it comes to the Affordable Care Act implementation:
l Coverage begins. Many low-income Americans who didn’t qualify for Medicaid in the past can use it now. People who signed up for private insurance in a state or federal marketplace by Dec. 24 (or later in some states) and paid their first premium are now covered, too.
l Coverage begins for workers at companies that signed up for new small business plans through the marketplaces, also called health care exchanges.
l Coverage lapses for people whose existing plans were canceled, if they haven’t signed up for a replacement or received an extension. At least 4.7 million people got cancellation notices, despite Obama’s promise Americans with insurance they like could keep their old plans. Obama recently gave insurance companies the option of extending old plans for existing customers for a year, but only where state insurance commissioners give their OK.
l The clock starts on the “individual mandate.” Nearly all U.S. citizens and legal residents are required to have “minimum essential coverage” for most of 2014, or pay a penalty. Most people already are insured through their jobs, Medicare, Medicaid or military coverage and so don’t need to do anything.
l Insurance companies are no longer allowed to turn away people in poor health or kick customers out of plans when they get sick.
l Women and people with pre-existing conditions pay the same rates as healthy men in the new plans. The law also limits how much more insurers can charge older people.
l New insurance plans can’t put an annual dollar limit on care, or require individuals to pay more than $6,350 in out-of-pocket costs per year.
l Payment due. In most cases, marketplace customers who signed up by Dec. 24 have until now to pay the first month’s premium and get coverage for their January medical bills. Major national insurers agreed to accept payments 10 days into the month because of technical troubles plaguing online enrollment at HealthCare.gov. But buyers should check early with their insurance companies — some might not honor the grace period. A few states running their own marketplaces are granting even more time. Those who miss their deadline can get coverage starting Feb. 1.
l A temporary program for people denied coverage because of poor health ends. Tens of thousands of Americans with serious illnesses such as heart disease and cancer were in the special program and needed new coverage for 2014. The Pre-Existing Condition Insurance Plan, originally set to expire Dec. 31, was extended one month to help sick people whose enrollment was stymied by HealthCare.gov computer crashes.
l Some people could lose coverage for a prescription they’ve been taking. The Obama administration urged insurers to temporarily allow customers to keep filling prescriptions covered by a previous plan, but not their new one, through January.
l The patched-up health care website will face a major test if too many people rush to sign up in the final days of open enrollment. Watch for a possible return of rampant crashes and error messages.
l On the other hand, low enrollment signals another danger. The law’s design relies on younger, healthier enrollees to offset the cost of older and sicker consumers. If the numbers stay low, it’s likely enrollees will be disproportionately people with more expensive medical needs, putting a financial strain on insurers. The White House set a goal of 7 million sign-ups for private coverage. More than 1 million enrolled by Dec. 20, Obama said.
l Last chance for open enrollment through the federal marketplace or 14 states running their own exchanges.
l This is the deadline for most people to get coverage to avoid a fine. Those whose existing insurance was canceled because of the law will be exempt. People who lose coverage can go without for three months before facing a penalty.
l The deadline doesn’t apply to people signing up for Medicaid or the Children’s Health Insurance Program, based on income. People can apply for those programs at any time and coverage begins at once.
l The deadline also won’t stop those signing up later because of a “qualifying life event.” The events include things such as getting married or having a baby. Qualifying events trigger a special enrollment period lasting 60 days.