Is it a coincidence that the Supreme Court decision on the Affordable Care Act (ACA) was announced on what happens to be the hottest day of the year? Perhaps, but I choose to see the steamy outdoor conditions as a portent to the fiery battles that are sure to ensue now that the ACA has been upheld on almost all parts of the law.
I will be perfectly honest with you – I still don’t know how I feel about the ACA. What I do know is that there’s a lot to the act that hasn't always been made clear in the news. If my sister-in-law hadn’t sent me a cool summary of the ACA and its potential consequences compiled by the Poynter Center, my usually pithy blog would have probably have looked something like this:
“Affordable Care Act. Dude.”
(c) Architect of the Capitol
So, now that I have a slightly better idea of what to expect from this monumental decision, I have a couple of my own thoughts to share, particularly on the implications for caregivers. But first, for those of you who chose to ignore this health care issue until now (and I can’t blame you), here’s a brief summary:
The Supreme Court upheld the ACA after it was challenged by Republican state officials and the National Federation of Independent Business.
Why was it challenged?
The Obama Administration put forth the ACA as a proposal to make healthcare more affordable and accessible to all Americans while also holding insurance companies accountable for their practices. A major component of the ACA is what is being called an “individual mandate” that will require nearly everyone to have healthcare coverage by the year 2014 or else pay a fine.
Republicans and the National Federation of Independent Business challenged the constitutionality of this mandate, saying that the federal government does not have the power to force Americans to purchase what is essentially a private product.
So now I have to buy health insurance even though I can’t afford it?
Not necessarily. Here’s when some of that rarely-reported information is useful. According to the mandate, the following folks would not have to buy coverage:
- Those who obtain an exemption for religious reasons
- Incarcerated individuals
- Undocumented immigrants (who would not be covered by the ACA)
- Those who would need to pay more than 8% of their household income in order to obtain healthcare coverage
- Individuals whose incomes are so low that they are not required to file a federal tax return, and
- Members of Indian tribes.
The Urban Institute estimates that according to these parameters, approximately 18.2 million Americans (6% of the total population) who currently do not have health insurance will have to buy it or else pay a fine. Of those people, about 10.9 million will be eligible for federal subsidies to help cover the costs of insurance.
That leaves 7.3 million people – or about 2% of the population – who will actually end up having to buy health insurance under the ACA’s mandate.
Interestingly, instead of using the word “fines” to describe what will be imposed on those who do not buy health insurance, the Supreme Court has reconceptualized them as “tax penalties.”
What else should I know about the ACA?
The ACA is more than the individual mandate. It also contains ten titles addressing issues such as improving the quality of healthcare, transparency and program integrity, and improving access to innovative medical therapies. To see the whole thing (brew some coffee, please), click here.
Title II (The Role of Public Programs) includes a requirement for states to significantly expand their Medicaid programs. However, the Supreme Court indicated in its decision that this required expansion violates states’ rights and may be unconstitutional. This may be the one component of the ACA that the Obama Administration cannot claim as a victory.
What does this mean for me as a caregiver?
It depends on whether you currently have healthcare insurance as well as whether the person you are caring for has some form of coverage. If you’re caring for an older person, chances are that he or she at least has Medicare. Still, we know all too well that Medicare doesn’t come close to covering all of the expenses associated with caregiving. And if your family member is younger, he or she might not have any coverage at all.
The cost of caring for a family member can become prohibitive if the caregiver is younger (i.e., not on Medicare) and cannot afford health insurance because any extra income goes toward caregiving. If you are now forced to buy health insurance, will you be able to afford it? Or will you opt for the tax penalty?
In essence, the ACA affects caregivers in a unique way because you have more than yourself to consider in this story-yet-to-unfold. You have more financial affairs to evaluate, manage, and make choices about. You may have more and harder decisions to make. And you will undoubtedly encounter more life changes in the areas of health and finances than the average person.
That’s why it’s so important to take stock of your financial situation now – as well as that of your loved one – to ensure that you are in the strongest position possible to pay for the care that is needed now and will be necessary later. If you have not already, seek the guidance of a financial advisor, and refer to these documents for assistance:
- Money Matters by the Alzheimer’s Association
- Caring Today, Planning for Tomorrow by the National Alliance for Caregiving
Almost one thousand words later, I still don’t know how I feel about this. But I know what I am seeing inside my tired mind. I see Democrats reveling on the hot White House lawn with cocktails, a grill, and perhaps a slip ‘n slide, while Republicans vow revenge, repeals, and a good dose of carcinogens in the Democrats barbecue.
And both sides fervently proclaiming, "Affordable Care Act. Dude."
Meanwhile, caregivers will continue their daily toil, hoping that some semblance of fairness and true assistance will grace their lives amidst these roiling political battles.