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Are ObGyns getting “bumped” out of deserved Medicaid reimbursement?
The Medicaid expansion covered approximately 7 million more women in 2014, but not all of them were able to find a doctor. Here’s why, and how...
How premium subsidies work
Premium subsidies are actually tax credits. Individuals and families can qualify for them to purchase any type of health insurance offered on an exchange, except catastrophic coverage. To receive the premium tax credit for coverage starting in 2015, a marketplace enrollee must:
- have a household income that is 1 to4 times the federal poverty level. In 2015, the range of incomes that qualify for subsidies is $11,670 for an individual and $23,850 for a family of 4 at 100% of the federal poverty level. At 400% of the federal poverty level, it is $46,680 for an individual and $95,400 for a family of 4.
- lack access to affordable coverage through an employer (including a family member’s employer)
- be ineligible for coverage through Medicare, Medicaid, the Children’s Health Insurance Program, or other forms of public assistance
- have US citizenship or proof of legal residency
- file taxes jointly if married.
The premium tax credit caps the amount that an individual or family must spend on their monthly payments for health insurance. The cap depends on the family’s income; lower-income families have a lower cap. The amount of the tax credit remains the same, so a person who purchases a more expensive plan pays the cost difference (TABLE 2).
The ruling’s effect on women’s health
On June 26, American College of Obstetricians and Gynecologists President Mark S. DeFrancesco, MD, MBA, hailed the Supreme Court decision, saying, “Importantly, recent data have shown that newly insured adults under the ACA were more likely to be women. Those who did gain coverage through the ACA reported better access to health care and better financial security from medical costs.”
“Without question, many women enrollees were able to purchase health insurance coverage due, in part, to the ACA subsidies that helped make this purchase affordable. In fact, government data have suggested that roughly 85% of health exchange enrollees received subsidies,” Dr. DeFrancesco said.
“If the Supreme Court had overturned this important assistance, approximately 4.8 million women would have been unable to afford the coverage that they need. The impact also would have been widespread; as these women were forced to leave the insurance marketplace, it is likely that premiums throughout the marketplace would have risen dramatically,” he continued.
“Instead, patients—especially the low- and moderate-income American women who have particularly benefited from ACA subsidies—will continue to have the peace of mind that comes with insurance coverage.”
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