Tim Jost + the Affordable Care Act

With the Patient Protection and Affordable Care Act (ACA) rolling out the health insurance enrollment period tomorrow, Tim Jost, law professor and one of the top experts on the Affordable Care Act, spoke to Harrisonburg City Council.

  • 60% of bankruptcies have some form of medical cause
  • Most admit to have only a vague notion of how the law works – read The Onion article for a sad depiction
  • 81% people get information about the law from the media but only 8% trust the media
  • Supports it but it is not the law he would have written had he been in charge; “imperfect should not be the enemy of the good”
  • 5 steps:
    • Expand Medicaid
      • Virginia is not moving forward right now
      • Would bring $3.9billion in revenue
      • Would actually save the state money by paying for similar care that already occurs but the expansion would use federal funds instead of state funds
      • 300-400k Virginians will remain uninsured by not expanding
    • Employer responsibility tax on large employers (generally over 50 employees)
      • Coverage if you work more than 30 hours per week
      • Some locations are cutting back employees and citing ACA as reason
    • Make Individual Market work
      • 29 million people in this pool
      • Deductibles can be $10-100k
      • Abolish pre-existing condition
      • Requires to cover 10 essential health benefits
      • Coverage will be available January 1
Approximate Harrisonburg rates
Age Bronze level insurance Silver level insurance
21 $161.64 $213.75
40 $206.58 $273.21
60 $438.69 $580.20
    • many of these aren’t the actual prices people would pay; instead, this is tied to tax credits developed on sliding scale based on income (as estimated below)

Premium Tax Credits and Cost-Sharing Protections Under the Affordable Care Act

    • 80% of Americans are likely to benefit from advanced tax credit
    • 27 year old earning $25k – would pay $145 (silver); $80 (bronze)
    • Family of 4 earning $50k – would pay $282 (silver); $48 (bronze)
    • Find health insurance to cost less than 8% of income
    • Penalty: starts at $95 or 1% of income and eventually moving up to 2.5% of income – “don’t freeload on others, provide for yourself and your family”

Already Implemented Pieces

  • Insurance reforms (private, Medicaid, Medicare) under ACA
  • Outlawed lifetime limits – affects few but devastating when it did
  • Internal and external review of health claims
  • Guarantees access to preventative health care without cost sharing
  • 80% of premiums must be towards care in the market or provide rebate


Community Questions

  • What is the most common misperception?  It will ruin the economy.  5-9% of employers are considering changes to their environment; this is significant but not 75%, as sometimes cited in the media.
  • How will VA be affected by current procedure?  What happens if we elect a governor who supports the ACA? McDonnell administration has been pretty straight with people but he regrets that we don’t have a plan yet.  We haven’t seen the purposeful obstructionism as there are in other states.
  • What provision(s) do you wish were different of ACA?  That if your employer offers any form of service they would get a $2,000 fine.  Employers don’t offer insurance to avoid fines; they offer it to recruit and retain employees.
  • Concerns regarding scams? Yes – don’t give out your social security number over the phone and be wary of other URLs.  Be certain to use official Healthcare.gov or a certified Navigator
  • Who are the winners and users?  The Republican party in 2010.  They took over a lot of seats.  The losers were the blue dog Democrats who lost their seats.  Winners = low income Americans; women (they’ve historically had to pay more).  Losers = higher income individuals not in the group market; also, younger folks.
  • All members of Congress and their employees have to buy their insurance through the District of Columbia exchange.  Otherwise, local, federal, and state employees are exempt.

To get more information from the man himself, check out his blog (social media rocks!)


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