The Affordable Care Act

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You or someone you know who lacks access to affordable health insurance can, thanks to the Affordable Care Act, sign up for coverage with no questions asked about preexisting health conditions.  Your family may gain significant health and financial security through this new opportunity to obtain health insurance. But with the troubled website rollout and obstructionism at the state level, there is still much misinformation and confusion.  


The Affordable Care Act does not provide government insurance or provide for the government to hire doctors and open hospitals as we do for our veterans.  Rather it relies upon competition among private insurance companies. 


You can now comparison shop for private insurance coverage among qualified health plans in the Health Insurance Marketplace. To ensure that the fine print of an insurance policy does not deny you the coverage you thought that you were purchasing, each policy offered on the Marketplace must meet minimum federal standards, such as the inclusion of benefits for doctor’s visits, hospitalization, and lab services.  Most people who are currently uninsured can receive premium tax credits to keep premiums and out-of-pocket costs affordable. 


What will insurance cost?  The exact monthly price will depend on where you live, which plan you choose, your age, and how many people are in your family.  A 27-year old woman in San Marcos who makes $25,000 per year will be eligible to receive a $720 annual federal tax credit to pay for monthly premiums.  For a San Antonio family of four with family income of $50,000 a year, the annual tax credit would be worth $5,136.


With this tax relief, the young woman or family can choose among the available plans to find the one that works best for their particular health care needs andbudget.   The uninsured young woman could get health coverage for as little as $85 per month.  With perhaps greater overall health care needs, the family may choose a plan that covers more of its health care costs for $282 a month.  If that doesn’t work for their budget, they can choose a plan for as low as $73 a month.  Overall, it is estimated that nearly half of those shopping for coverage in the Marketplace can pay $100 or less a month for quality health care coverage.


How do you sign up?  The initial “Open Enrollment Period” for coverage through the new Health Insurance Marketplace ended earlier this spring, and the next time that most people will be able to sign up for coverage will begin November 15, 2014, with coverage beginning as early as January 1, 2015.   You may be eligible to sign up for health coverage before November if you experience a significant life event—like getting married, having a child, or losing health insurance coverage due to a change in your job, a move, or other circumstances.  You have 60 days to sign up for coverage after one of these events.  You can sign up online at, by phone at 1-800-318-2596, or go to a number of places in our community for in-person assistance completing the application.  No matter the method of enrollment, consumers are now able to compare plan benefits and prices, determine what the costs to them will be after tax credits, and sign up for insurance, all in one place. 


What if you already have health insurance?  If you receive insurance from your employer, Medicare, or TRICARE, you are not required to buy additional coverage.  In fact, if you have Medicare or TRICARE, you are not eligible for coverage through the Marketplace at all since you already have coverage.  Those who rely upon Medicare are already benefiting in several ways:  an annual wellness visit and preventative services like mammograms and colonoscopies are now free, prescription drug costs have been reduced with the gradual closing of the “donut hole” in coverage, and the solvency of the Medicare Trust Fund has been extended by almost another decade.  


You are insured.  Now what?  Many people may be getting health insurance coverage for the first time.  There are helpful resources available on what to do after you buy health insurance in the Marketplace, how to keep your Marketplace health insurance, how to use your health insurance, and a roadmap on From Coverage to Care.     

I hope that the information I provide here is helpful to you. I also encourage you to get information about the Affordable Care Act from objective sources like the AARP, American Heart Association, American Diabetes Association, and American Cancer Society. Armed with the facts, you will be able to make informed health care decisions for you and your family.

How does the Affordable Care Act impact the 35th District and Texas?