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Health Care Reform:

Health Insurance & Affordable Care Act

Who Gets Covered Under Health Reform?

As the debate rages over 'Obamacare,' here's a look at what the changes will mean.

Fate of Medicaid Expansion in States' Hands

Medicaid is a government program that helps the poorest Americans get health care. One in four people insured under Medicaid are children.

"The Medicaid program is financed as a partnership between the federal government and the states," says Andrew Bindman, MD, a professor of medicine, health policy, epidemiology and biostatistics at the University of California, San Francisco. Bindman helped to draft the ACA, and he worked on the Medicaid expansion plan.

According to a report by the Kaiser Family Foundation, the federal government pays an average of 57% of the cost of Medicaid. States pick up the rest of the tab.

As it stands, the income cut-offs for Medicaid are very restrictive. Many people fail to qualify if they earn minimum wage.

The Medicaid expansion increases the income cut-off to 133% of the federal poverty level. The level is adjusted each year. But in 2012, for a family of four, the level is $23,050. The new law would bump that up to $30,657.

Currently, an estimated 50% of people who don't have health insurance would qualify for the Medicaid expansion under the ACA.

But only if the state you live in decides to participate.

"The good news is that we're expanding coverage for the uninsured. Concern remains for some of the most vulnerable, because the Medicaid provisions of the law could be interpreted differently from state to state. It's possible that states may choose to opt out of the program with a negative impact on poor people," says Rachel Garfield, a senior researcher with the nonprofit private foundation Kaiser Family Foundation.

What About Preexisting Conditions?

In the past, many people who have tried to buy their own health insurance on the open market have been dealt disappointment: Based on something in their past medical history, the insurance company declined to cover them.

In some cases, these so-called "preexisting conditions" are chronic diseases that need lifelong care, like diabetes, rheumatoid arthritis, allergies, or asthma.

In other instances, though, preexisting conditions don't seem quite as serious. They can be anything from a past bout of sinusitis to an old sports injury.

People deemed to have a preexisting condition can sometimes buy health insurance, but any doctor's visit related to the condition may not be covered under the plan they are offered.

The ACA blocks insurance companies from denying anyone coverage on the basis of a preexisting condition, and it prevents insurance companies from charging sick people more.

"That goes away in 2014. Everybody's premiums will be the same," says Sara Collins, PhD, vice president for Affordable Health Insurance at the Commonwealth Fund.

In fact, it's already gone away. If you need health insurance, but you've been turned down because of a preexisting condition, the ACA has already established insurance plans that will cover you.

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