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ObamaCare: a wide door to healthcare

Additional provisions come into play in 2014

Molly Young | 6/26/2013, 7:20 p.m.

• With most job-based health insurance plans, your employer pays a portion of your premiums. If you choose a marketplace plan instead, your employer does not need to make a contribution to your premiums. You should consider this carefully before comparing marketplace plans.

• If you decide to check out marketplace plans, be aware that you may not qualify for lower costs on your monthly premiums and out-of-pocket costs, even if your income would qualify you otherwise.

• Whether you qualify will depend on what kind of coverage your employer offers. If your job-based coverage is considered affordable and meets minimum value, you won’t be able to get lower costs on premiums or out-of-pocket costs in the marketplace. This is true no matter what your income and family size are.

• Your employer can tell you whether the insurance plan it offers meets minimum value and can provide you with information to determine if the plan is considered affordable to you.

• If you do not qualify for lower costs in the marketplace, and your employer does not pay part of your premiums on the marketplace, be sure you take these things into account before you consider choosing a plan other than your employer’s.

Starting in 2014, the tax credit increases to 50 percent and is available for two consecutive years. The Small Business Health Options Program (SHOP), also offers plans to small business owners, which can be purchased directly, or by using an insurance broker. (More information can be found at www.HealthCare.gov) Employers that have more than 200 employees must enroll new full-time employees in medical coverage.

An employer that has more than 50 employees and offers coverage that is unaffordable or doesn’t meet the minimum essential coverage and is found to have an employee who receives the premium assistance tax credit because their coverage is unaffordable or does not cover 60 percent of the total cost, then the employer will be fined the lesser of either $3,000 for each of the employees receiving a credit, or $750 for each of their full-time employees. Also, to qualify for any tax credit, an employer must pay at least 50 percent of the employee premium costs.

When the next phase of the program begins in 2014, and more people are able to sign up for and take advantage of better healthcare coverage, there is a concern that there could be a shortage of medical personnel, both doctors, and mid-level health professionals, such as nurse practitioners and physician’s assistants, to cover the increased number of patients.

According to Jim Mangia, president and CEO of St. John’s Well Child and Family Center in Los Angeles, “The big issue that we have to tackle is: how are we going to train and bring more primary-care providers to South Los Angeles? There is a shortage of providers and there is a concern that in 2014 it will be exacerbated by the increasing numbers of folks with pre-existing conditions who are eligible for health insurance.

“We are on an intensive recruitment; we are gearing up for ObamaCare. The issue is, are there enough providers out there? Certainly it’s a very competitive hiring environment. There really is nobody addressing the question of recruiting primary-care providers. There is a law being proposed by Sen. (Ed) Hernandez that would allow mid-level practitioners, such as nurse practitioners and physician assistants to provide more services.”