The Affordable Care Act ("ACA") was signed into law by President Barack Obama on March 23, 2010. It has taken two years, but now that the U.S. Supreme Court has found the law to be constitutional, Brooklynites can look forward to improved access to health care coverage, enjoy new protections if they suffer from pre-existing conditions or need treatment that exceeds plan coverage. ACA will also require insurance companies to expand coverage of preventive screening services such as colonoscopies and mammograms without a deductible or co-pay for these and other wellness visits.
Implementation of the ACA rests with individual states and so it helps that Governor Cuomo is supportive of the bill and won't have to be dragged kicking and screaming (like governors in some states) to build the health insurance exchanges that will provide competition between insurers and make it easier for freelancers and other New Yorkers to purchase affordable health insurance. Under the ACA New York State has received $5.5 million to fight unreasonable premium increases and $86.7 million to implement the new health exchanges.
Beginning in 2014, people without health insurance will have the option of purchasing insurance through health insurance exchanges, basically internet-based markets for insurance. Plans participating in these exchanges must provide comprehensive coverage and cannot exclude pre-existing conditions. They cannot reject a person simply because they are high risk (although they can make some adjustments based on age, location and smoking status). Moreover, if your income is between 100-400 percent of the federal poverty limit, you will be eligible for subsidies that will help pay for insurance subsidies. Individuals who do not get health insurance will pay a tax that will ultimately rise to as much as 2.5% of their income. Arguably, the most popular provision of the ACA is the requirement that health plans permit parents to keep adult aged children under the age of 26 on their plans (as long as they do not have coverage on their jobs).
Under the ACA, Brooklynites will no longer need to worry about losing coverage if they are laid off, change jobs or face bankruptcy because of an annual or lifetime limit on treatment. While the exact number of freelance workers is difficult to pinpoint, some estimate that there are over 42 million independent workers in the U.S. or as high as 30% of all workers. Anecdotal evidence suggest that even full-time employees are supplementing their incomes with activities in the independent economy. Therefore, as NY begins to develop and implement health insurance exchanges, it will be important for Brooklyn residents to continue to make their voices heard, so that we adopt a new health care system that is truly affordable, accessible and responsive to local needs.