ACA 2018 Data and Thoughts Marketplaces Exchanges Health

ACA – 2018 Data and Thoughts

Marketplaces – Exchanges • Health Insurance Marketplaces (also known as Exchanges) are organizations set up to create more organized and competitive markets for buying health insurance. They offer a choice of different health plans, certify plans that participate, and provide information and in-person assistance to help consumers understand their options and apply for coverage. • Through the Marketplace, individuals and families can shop for coverage if they need to buy health insurance on their own. Premium and cost sharing subsidies based on income are available through the Marketplace to make coverage affordable for individuals and families. People with very low incomes can also find out at the Marketplace if they are eligible for coverage through Medicaid and CHIP. Finally, small businesses can buy coverage for their employees through Small Business Health Options Program (SHOP) Marketplace plans.

Table 1: Examples of Declinable Conditions In the Medically Underwritten Individual Market, Before the Affordable Care Act Condition AIDS/HIV Lupus Alcohol abuse/ Drug abuse with recent treatment Mental disorders (severe, e. g. bipolar, eating disorder) Alzheimer’s/dementia Multiple sclerosis Arthritis (rheumatoid), fibromyalgia, other inflammatory joint disease Muscular dystrophy Cancer within some period of time (e. g. 10 years, often other than basal skin cancer) Obesity, severe Cerebral palsy Organ transplant Congestive heart failure Paraplegia Coronary artery/heart disease, bypass surgery Paralysis Crohn’s disease/ ulcerative colitis Parkinson’s disease Chronic obstructive pulmonary disease (COPD)/emphysema Pending surgery or hospitalization Diabetes mellitus Pneumocystic pneumonia Epilepsy Pregnancy or expectant parent Hemophilia Sleep apnea Hepatitis (Hep C) Stroke Kidney disease, renal failure Transsexualism

Table 1: Examples of Declinable Conditions In the Medically Underwritten Individual Market, Before the Affordable Care Act Condition AIDS/HIV Lupus Alcohol abuse/ Drug abuse with recent treatment Mental disorders (severe, e. g. bipolar, eating disorder) Alzheimer’s/dementia Multiple sclerosis Arthritis (rheumatoid), fibromyalgia, other inflammatory joint disease Muscular dystrophy Cancer within some period of time (e. g. 10 years, often other than basal skin cancer) Obesity, severe Cerebral palsy Organ transplant Congestive heart failure Paraplegia Coronary artery/heart disease, bypass surgery Paralysis Crohn’s disease/ ulcerative colitis Parkinson’s disease Chronic obstructive pulmonary disease (COPD)/emphysema Pending surgery or hospitalization Diabetes mellitus Pneumocystic pneumonia Epilepsy Pregnancy or expectant parent Hemophilia Sleep apnea Hepatitis (Hep C) Stroke Kidney disease, renal failure Transsexualism

Source: Kaiser Family Foundation analysis of 2015 BRFSS SMART data. For more information on methods, see: https: //www. kff. org/health-reform/issue-brief/mapping-preexisting-conditions-across-the-u-s Pre-existing Econditions MMSA_number MMSA_name Preexisting_ conditions_rate 40340 Rochester, MN, Metropolitan Statistical Area 20% 41884 San Francisco-Redwood City-South San Francisco, CA, Metropolitan Division 21% 12060 Atlanta-Sandy Springs-Roswell, GA, Metropolitan Statistical Area 23% 31080 Los Angeles-Long Beach-Anaheim, CA, Metropolitan Statistical Area 23% 35614 New York-Jersey City-White Plains, NY-NJ, Metropolitan Division 23% 47664 Warren-Troy-Farmington Hills, MI, Metropolitan Division 26% 37964 Philadelphia, PA, Metropolitan Division 26% 17460 Cleveland-Elyria, OH, Metropolitan Statistical Area 26% 16980 Chicago-Naperville-Elgin, IL-IN-WI, Metropolitan Statistical Area 26% 38300 Pittsburgh, PA, Metropolitan Statistical Area 27% 15380 Buffalo-Cheektowaga-Niagara Falls, NY, Metropolitan Statistical Area 31% 31140 Louisville/Jefferson County, KY-IN, Metropolitan Statistical Area 32% 28700 Kingsport-Bristol, TN-VA, Metropolitan Statistical Area 41%

Individual Mandate • Congress eliminated the federal tax penalty for not having health insurance, effective January 1, 2019. • For 2018, everyone is required to have health insurance coverage – or more precisely, “minimum essential coverage” – or else pay a tax penalty, unless they qualify for an exemption. This requirement is called the individual responsibility requirement, or sometimes called the individual mandate. • While the federal tax penalty still applies for 2018, recent changes will make it easier for people to claim a hardship exemption, and so owe no penalty, when they file their 2018 federal income tax return. • Several states have adopted individual mandates with state tax penalties for not having health insurance. These include Massachusetts, New Jersey, and the District of Columbia, effective for the 2019 calendar year. Vermont will impose a tax penalty for not having coverage starting in 2020. Other states are considering individual mandates; California, Connecticut, Hawaii, Maryland, Minnesota, Rhode Island.