ABC's of Health Care Reform and You

Access

In June 2013, the healthcare.gov website was re-vamped and is now more consumer-focused and offers a 24/7 consumer call center 1-800-318-2596/TTY: 1-855-889-4325. Also offers online CHAT feature. (Updated 6/18/14)

In July 2013, New York State notified the Nassau-Suffolk Hospital Council (NSHC) that it was selected as a Navigator Agency for the marketplace for the Long Island region - Nassau and Suffolk counties. The NSHC has state trained and certified enrollers ready to assist individuals, families, and businesses in understanding the insurance options offered on the marketplace and in purchasing insurance. The navigators screen individuals via their income for eligibility for subsidies that will help them afford insurance or whether their income places them in the Medicaid insurance program. The navigators also help small business owners determine if they are eligible for any tax credits. For enrollment dates and sites go to www.coverage4healthcare.com (Update added 11/5/14)

The marketplace re-opens November 16, 2016 for 2017 enrollment and closes January 31, 2017. However, enrollment in Medicaid and Child Health Plus continues throughout the year. Individuals, families, and small businesses (less than 50 employees) can shop for insurance in the marketplace. Insurance purchased by December 15, 2016 is effective January 1, 2017. Enrollment entails choosing a health plan and paying the first month’s premium payment. (Update added 8/5/16).

Uninsured

  • In 2010, 47 million Americans lacked health insurance. With the individual mandate for coverage that began in 2014, roughly 32 million more Americans will eventually have some level of health insurance. (Undocumented immigrants are excluded from the law.) By 2014, policy analysts estimated that the ACA reduced the nation’s uninsured rate by 4.5 percent. However, because the Supreme Court did not uphold the mandate that states expand their Medicaid programs, the number of newly insured will not increase as much as was originally anticipated. (Updated 8/25/14)
  • There are approximately 190,078 uninsured individuals on Long Island, according to the Small Area Health Insurance Estimates from the U.S. Census Bureau. (Updated 8/5/16)
  • By current federal law, hospitals cannot deny care to anyone who comes to the emergency room. This means the cost of emergency room care is not fully covered and, in some cases, is never covered, which creates a loss for the hospital. Taxpayers and insured consumers help subsidize the cost of this care.
  • On Long Island, individuals and families without health insurance can apply for one of the public insurance programs offered by the state – Child Health Plus and Medicaid. Eligibility depends on income. Uninsured individuals whose income exceeds eligibility thresholds for public insurance programs can shop the marketplace. The Nassau-Suffolk Hospital Council is a state appointed Navigator Agency for the New York State of Health insurance marketplace. It offers application assistance for these programs and commercial plans sold on the exchange. Go to www.coverage4healthcare.com.
  • The law provides for navigators to help Americans understand and purchase the appropriate insurance. (See information above about approved navigator agency. Update added 11/22/13.)
  • Two-year increase (2013 – 2014) in Medicaid fee paid to physicians will help improve access. (Update added 1/14/13)

Young Adults

  • In September 2010, the federal law required insurers to cover adult children up to the age of 26 on parents’ health insurance. In New York it is age 29. (This age limit was put into effect by the New York State Legislature in 2009 and it differs slightly from the federal law.)
  • Approximately 4.8 million more young adults (19 to 25 year olds) now have health insurance as a result of this policy in the Affordable Care Act. This is according to the National Health Interview Survey (National Center for Health Statistics, Centers for Disease Control and Prevention). (Updated 8/5/16)
  • Two-year increase (2013 – 2014) in Medicaid fee paid to physicians will help improve access. (Update added 1/14/13)
  • In December 2013, the U.S. Department of Health and Human Services said consumers whose coverage cancelled because it did not meet minimum federal requirements could buy catastrophic level coverage if all other coverage on the marketplace is determined to be too expensive. This level coverage had been available only to those aged 30 and under. (Update added 2/26/14)

Seniors/Disabled

  • The law does not change Medicare eligibility or access to care. Whether seniors/disabled persons have traditional Medicare coverage or opt for coverage by a Medicare Advantage plan (a private insurance plan contracted by Medicare) their access to current physicians and hospitals remains the same, as outlined in their chosen coverage plan – traditional Medicare or Medicare Advantage.
  • Two-year increase (2013 – 2014) in Medicaid fee paid to physicians will help improve access. (Update added 1/14/13)

Chronic Disease Sufferers

  • Those who are diabetic, obese, suffer from high blood pressure or high cholesterol, asthma and other chronic conditions will be able to access more educational and clinical services geared to helping them control and/or overcome their conditions. Adults with pre-existing conditions also now have access to coverage through the high-risk pool. In New York, the Bridge Plan provides affordable coverage for these high-risk individuals. This plan ended in 2014, when exchanges went live.
  • Two-year increase (2013 – 2014) in Medicaid fee paid to physicians will help improve access. (Update added 1/14/13)
  • In December 2013, the U.S. Department of Health and Human Services said consumers whose coverage cancelled because it did not meet minimum federal requirements could buy catastrophic level coverage if all other coverage on the marketplace is determined to be too expensive. This level coverage had been available only to those aged 30 and under. (Update added 2/26/14)

Children

  • As of September 2010, the law no longer allows insurers to deny insurance coverage to children with pre-existing conditions.
  • Two-year increase (2013 – 2014) in Medicaid fee paid to physicians will help improve access. (Update added 1/14/13)

Adults Under 65

  • Adults with pre-existing conditions also now have access to coverage. In New York, the Bridge Plan provides affordable coverage for these high-risk individuals.
  • The Bridge Plan is temporary until the State Insurance Exchanges become active in 2014.
  • Two-year increase (2013 – 2014) in Medicaid fee paid to physicians will help improve access. (Update added 1/14/13)
  • In December 2013, the U.S. Department of Health and Human Services said consumers whose coverage cancelled because it did not meet minimum federal requirements could buy catastrophic level coverage if all other coverage on the marketplace is determined to be too expensive. This level coverage had been available only to those aged 30 and under. (Update added 2/26/14)

Businesses

  • Small businesses, since 2014, began offering their employees options for purchasing affordable health insurance. These include referring employees to the exchange and/or deciding to purchase affordable group insurance for their employees, subsidized partly by tax credits, if certain criteria are met.
  • Two-year increase (2013 – 2014) in Medicaid fee paid to physicians will help improve access. (Update added 1/14/13)
  • On July 2, 2013, the Department of the Treasury announced that it would delay for one year, until January 2015, the Affordable Care Act mandate that employers (50+ employees) provide coverage for their workers or pay penalties. (Update added 7/23/13)
  • Delay of employer mandate for businesses with between 50 and 100 employees took effect in 2016. This follows an initial change announced in 2013 that delayed the employer mandate for all employers until 2015. The administration essentially allowed for a phase in of the employer mandate over a two-year period, based on the size of the firm. The administration says it made these changes to help businesses adjust to the law. (Update added 8/5/16)
  • In December 2013, the U.S. Department of Health and Human Services said consumers whose coverage cancelled because it did not meet minimum federal requirements could buy catastrophic level coverage if all other coverage on the marketplace is determined to be too expensive. This level coverage had been available only to those aged 30 and under. (Update added 2/26/14

Back to Top

Affordable Care Act Conference Calls

You're invited to:

Interactive Conference Calls on the Health Care Law
Hosted by the HHS Center for Faith-Based and Neighborhood Partnerships