Supreme Court upholds health care reform: what it means for Montana

6-28-12

Yesterday the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act. 

 

This means more than 105 million Americans will continue to benefit from the elimination of lifetime limits and the coverage of preventive services without cost-sharing.

 

Six million young adults will remain covered by their parents’ health care plans. 

 

Seniors will continue to save money on prescription drugs as the Part D donut hole" closes over the next eight years. 

 

Insurance companies will not be able to deny coverage due to pre-existing conditions, charge women more, or drop coverage for those who get sick.

 

Here's an analysis by Montana reporter Mike Dennison on how the ruling will affect us in Montana:

What’s next for Montana after ruling on health care

By MIKE DENNISON IR State Bureau | Posted: Friday, June 29, 2012 12:13 am

 

The U.S. Supreme Court ruling Thursday upholding the Affordable Care Act (ACA) means

many things for Montana, from pending expanded coverage for tens of thousands of Montana, to higher taxes for some, to multimillion-dollar grants for others.

 

Here’s a look at the status and effect of ACA’s major components in Montana:

 

Medicaid expansion: The law requires states to expand Medicaid, the program that pays medical bills for the poor, to cover everyone up to 133 percent of the federal poverty level (about $14,500 income for one person), starting in 2014.

 

However, the U. S. Supreme Court said states could reject this expansion, without losing funding for existing Medicaid programs.

 

That means the 2013 Montana Legislature and the next governor must decide whether to expand Medicaid in Montana, and provide coverage for an estimated 70,000 additional Montanans (on top of the approximate 100,000 Montanans already covered by the program). Under ACA, the federal government will cover the entire cost of the expansion through 2016. By 2019, the feds will cover 90 percent of the expansion cost.

 

Subsidized health coverage in 2014: Right now, about 175,000 or 18 percent of Montanans are without health insurance. Those not covered by the Medicaid expansion in 2014 will be required to buy insurance, but will receive subsidies if they’re earning less than 400 percent of the federal poverty level ($43,500 for one person). If they don’t buy insurance, they’ll pay a tax penalty of $95 that year, escalating to 2.5 percent of their income by 2016.

 

Young adult coverage: Young adults can remain on their parents’ health insurance until age 26, affecting an estimated 12,000 people in Montana.

 

Tax increases and tax credits: Most businesses with 25 employees or less can take tax credits to help them buy health insurance for employees. However, the law imposes new taxes this year on drug manufacturers, next year on medical-device manufacturers, and in 2014 on health insurers.

 

Starting next year, the very wealthy — the top 1 percent of the taxpayers in Montana – will pay higher payroll taxes to support Medicare, the government health coverage program for the elderly.

 

Business penalties: Starting in 2014, a business employing more than 50 people will pay a $2,000 per employee fine, if any of its workers are getting subsidies to help them buy health insurance on their own. They probably will pay no fines if they offer affordable insurance to their workers.

 

Community health centers: Three community health clinics in Missoula, Helena and Havre received $5 million through the ACA each this spring to expand their services to mostly lower-income clients.

 

Health care cooperative: A group of Montanans has established a health insurance cooperative with a $60 million federal loan guarantee through the ACA. The nonprofit co-op will offer insurance to compete with the state’s major insurers, starting in 2014.

 

Health insurance exchanges: Each state is required to set up an exchange, which is an Internet marketplace to buy health insurance, by 2014. The Montana Legislature refused to give authority to create the exchange, so the federal government is doing it for Montana.

 

Health insurance changes: No lifetime limits on health-insurance benefits, no rescission of coverage unless the insured commits fraud, no denial of coverage for pre-existing conditions (for children, immediately, and for adults starting in 2014).

 

Health insurance rebates: If insurers pay less than 85 percent of premium dollars on medical claims, that amount must be rebated to customers (80 percent for small-group or individual policies). In Montana, rebates this year estimated at $2.6 million.
 

 

 

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