The Star-Ledger

Obamacare Confusion: New Health Care Choices For Workers, With Or Without Insurance

The Star-Ledger — Wednesday, September 25, 2013

By Ted Sherman / The Star-Ledger

"There's a lack of awareness"

While studies show nearly 98 percent of large companies in New Jersey offer health care coverage, and 67 percent of small ones do, there are still more than 1 million uninsured residents in the Garden State.

And many do not have a clue about how the new health care law will affect them.

"There's a lack of awareness," said Maura Collinsgru, health policy advocate for New Jersey Citizen Action.

A poll earlier this year by the Kaiser Family Foundation found that even as community organizations and advocates gear up to provide assistance in preparation for the open enrollment of the health insurance exchanges created under the Affordable Care Act, much of the public remains confused about the status of the health law.

The law requires those who can afford it to obtain coverage or pay a penalty. In 2014, the penalty is $95 per person or 1 percent of your income. The penalty increases in 2015 and 2016.

The act, though, gives new choices to those employed with no insurance, as well as workers not satisfied with the options they may be offered on the job.

Most people with health insurance coverage they like can keep it — and any job-based health plan qualifies as minimum essential coverage — avoiding the penalties that may be assessed on uninsured people in 2014.

If someone does not like the coverage being offered through their job, they can go to the exchange — the virtual marketplace people will use to shop for insurance policies. The exchanges are meant to drive down costs by pooling thousands of consumers together online, where they would be able to negotiate better prices with insurance providers as a group.

But that may not be the wisest option, said Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute and a former insurance executive.

"If your company is offering insurance coverage, it's most likely the way to go," she said. "If the coverage meets all the minimum standards under the act, an employee is not going to be able to get a subsidy on the exchange — no matter what their income."

In addition, an employer offering health care does not need to make a contribution to premiums for marketplace plans. Experts say whether someone qualifies for lower premium costs and out-of-pocket costs will depend on what kind of coverage an employer offers, no matter what a person's income and family size. If a person does not have an option for insurance coverage, or no longer has coverage, they are eligible to go through the exchange.


The new law is expected to have a big impact on those who have lost their jobs and rely on temporary coverage through COBRA, which gives workers and their families who lose health benefits the right to pay for continued group health benefits for limited periods of time.

Those on continuation health coverage can keep it, or buy a marketplace insurance plan instead at any time after Jan. 1. In the long run, though, the health care act may render COBRA meaningless.

"People will still have the option to pick up coverage through COBRA, but if you are able to get a subsidy through the exchange, then you're going to get more affordable health insurance," said Collinsgru. "The exchange may be a better option."

The cost of the plans that will soon be available through the exchange are still an unknown. Gov. Chris Christie opted not to set up a state-run exchange, so the federal government is running it, and the plans proposed by those companies seeking to participate are still under review. However, limits set forward in the Affordable Care Act will restrict just how high those premiums can go.

For now, Schwimmer said, people still may not be focused on the issue of health care insurance because most need not be making any decisions right away. Still, she said it may not be a bad idea to do some research on sites such as as the plan enrollment period approaches.

"There is a tremendous amount of easily digestible information in the public domain and a lot of resources out there," she said.

Copyright 2013 The Star-Ledger

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