The ACA IS Alive and Well in New York

David R. Jones, The Urban Agenda

“I am going to have health insurance for the first time in my life.  I can now sleep at night.  It is the constant worry that gets you.  What if I get sick?  How will I get the care I need or pay for my medicine?  Now I don’t have that worry.  The enrollment process was very smooth.  Hannah, my CSS Navigator, was wonderful and made things much easier for me.  I could not have done it alone.”

This is a quote from a client of ours.  The Community Service Society (CSS) was selected by the New York State Department of Health to take the lead as a Navigator network to help New Yorkers and small businesses shop for and enroll in health coverage through the NY State of Health, the official health plan marketplace.  CSS is partnering with 38 community-based organizations and small business-serving groups to serve 61 of New York’s 62 counties, with over 250 locations around the state where consumers can meet with a Navigator one-on-one. 

Individuals and small employers who would like to meet with a Navigator in the CSS Navigator network can contact CSS at enroll@cssny.org or phone toll-free at 888-614-5400.

There has been a lot of news lately about the problems people are having getting health insurance through the new Affordable Care Act (ACA), or “ObamaCare.”  This may be true in other states, but health coverage under the ACA is proceeding on track in New York State. 

The ACA was signed into law in March 2010.  It has been phased in over the past three years.  Insurance marketplaces opened on October 1, 2013, for coverage that begins on January 1, 2014. 

A new, online New York State health insurance marketplace was created under the ACA – the NY State of Health.  This is a health consumer assistance program for New York’s families, individuals, and small businesses.

Compare Costs and Benefits

The marketplace makes comparing health plan costs and benefits easy, and it gives New Yorkers access to free insurance coverage or financial help to buy their own if they cannot afford to pay for their insurance.   As a result, insurance prices are 53 percent cheaper on average than before.

Why does New York need the ACA?  About 2.6 million New Yorkers are uninsured.  Half of uninsured adults work full time.  Insurance prices have outpaced wages.  Between 2000 and 2009, health insurance premiums in New York increased by 92 percent, while median income rose by only 14 percent.  And employers were cutting back on health care benefits or dropping them.

Here are a few examples that illustrate how the ACA can help New Yorkers get good affordable health care.

Angie from Queens recently graduated from college and started a new job, but her employer doesn’t offer health insurance.  She makes $28,750 per year.  At her level of income, she receives a monthly premium subsidy of $172.26 to defray the expense of the insurance.

Angie chose a Bronze MetroPlus plan for $334.44 per month.  She chose to take her premium subsidy in advance, and in full.   Final monthly cost for Angie: $334.44 - $172.26 = $162.18.

Temitope Okafur from Brooklyn is a freelance photographer.  Her husband was recently laid-off and is now a stay-at-home dad for their two boys.  They lost their coverage through his job.

Their household income is $47,100 per year.  Their monthly premium subsidy is $483.  The Okafurs chose a Silver-level Emblem Health plan for themselves, and they enrolled their sons in Child Health Plus.  They chose to take the full subsidy in advance.  Monthly cost for the Okafurs: $770.60 - $483 = $287.  Child Health Plus: $9 per child = $18.  $287 + $18 = $305 for health insurance for the whole family.

Bob runs his own auto shop in Manhattan where he has seven full-time mechanics.  Bob pays his employees an average of $24,000 annually.  He decided to pay for 50 percent of his employees’ premiums.  Bob chose to offer MetroPlus’s silver level plan for $387.23 per month per employee.

The cost of covering his employees is $1,355.31 per month or $16,263.66 per year.  The tax credit available – 50 percent of Bob’s portion of the costs – is $8,131.83.

Final cost to Bob is $16,263.66 - $8,131.83 = $8,131.83.  Bob can then deduct the remaining $8,131.83 to reduce his total tax liability. 

About 81 percent of small businesses in New York State (285,000 firms) are eligible for tax credits like Bob received.  But many eligible businesses don’t know about the credits.  ACA tax credits have already benefited 360,000 small businesses in the U.S. covering two million workers.

Navigator Assistance

New Yorkers can sign up for insurance through a local insurance assistor called a Navigator.  Navigators provide in person application assistance at initial enrollment, and they remove barriers to the application process by providing assistance in multiple languages and in community based settings.

You can call the CSS Navigator network or NY State of Health direct toll-free at 855-355-5777 or go online.

Issues Covered

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