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Health Care Reform:

Health Insurance & Affordable Care Act

Supreme Court Upholds Health Reform Law

What will happen in 2014, when the so-called "individual mandate" takes effect?

Almost all individuals will be required to buy insurance beginning in 2014. Those who have insurance will be able to keep it. Those who don't have insurance through an employer can buy it through the state-based health insurance markets.

What will happen to those who don't buy insurance?

People without insurance will face tax penalties that will be phased in and increased over several years, starting with the 2014 tax filing. The penalty for the 2014 tax year will be $95 or 1% of taxable income (whichever is greater).

What if I can't afford insurance?

Tax credits will be available for people with incomes that are between 133% and 400% of the poverty level (up to $92,200 annually for a family of four in 2012).The law will also expand the number of people who qualify for Medicaid, the state and federal health insurance program for people with low incomes. An individual that makes less than $14,856 or a family of four that earns less than $30,657 will be eligible. 

It's not clear yet whether these funds will be available to everyone, however. The court's ruling allows the states to decide whether they want to accept additional federal money to help cover these costs.

How many additional people are expected to get insurance?

About 32 million Americans were expected to gain health insurance under the law, starting in 2014 when it takes full effect. They would do so as a result of the law putting an end to discrimination against people with pre-existing health conditions, and in some cases by qualifying either for Medicaid or for financial assistance from the federal government to buy coverage in the new health exchanges. 

The ruling from the court has possibly limited the Medicaid expansion by taking away a penalty for states that don't want to accept the extra funds, so the ultimate number of people who will gain insurance may not meet the initial estimate of 32 million.

What will the states do? Are many of them likely to refuse the money to expand Medicaid coverage?

The answer to this question won't be immediately known.

Marc K. Siegel, MD, a clinical associate professor of medicine at NYU Langone Medical Center in New York, says many states are already struggling to pay for Medicaid costs.

"I think states will turn it down. I don’t know how many out of the 26, but I think they will," Siegel says. "California is in a lot of trouble right now. Florida is in trouble. New York is in some trouble. In New York, it's a billion dollars or more to administer the Medicaid expansion. So a key problem here is not in terms of Medicaid, which the feds are picking up the cost of for the most part, but the administration of the additional Medicaid patients."

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