What is Healthcare Reform: Affordable Care Act (ACA)

The ultimate goal of healthcare reform was to increase the number of insured people and families and the quality of care by adding preventive services while trying to stabilize or reduce costs. 

As inflation, technology, drugs and advancements drive up the total costs of health care, premiums increase with it.

  The safety net of society was already established with Medicaid, and our own California version of MediCal. People without much in the way of assets and income had government health care in place already. The American system says that you can get benefits that are better by paying premiums for your own coverage, or having coverage through your employment.

The effects of the landmark 2010 Patient Protection and Affordable Care Act were phased in over several years as the expansion of coverage took effect. On June 28, 2012, the Supreme Court confirmed the constitutionality of the individual mandate. The Court also held that states may opt out of the Medicaid expansion for adults. States now have the option to expand Medicaid or not. California has opted to expand Medicaid, which is our Medi-CAL. What did your State do?

Do you feel better already? Your new preventive benefits covered at 100% took effect with the plan year that started after September 2010. Coverage for dependent children was also extended until they turn 26, so some of the user friendly features are already helping clients.

The initial ACA open enrollment ran from October 1, 2013 to March 31, 2014, whereby guarantee issue individual insurance was offered by insurance companies and California Exchange, the Covered CA. If you’re not in Open Enrollment, you will not be able to get coverage unless you experience a Qualifying Event. OPEN ENROLLMENT for 2024 will re-open November 1, 2023 and will end on December 31, 2023 For January 1, 2024 effective dates. The program remains open through 1/31/2024 for February 1st 2024 effective dates. Dental applications may continue to be submitted after Open Enrollment ends.

Even the government wants you to take healthcare into your own hands. Learn more about the healthcare law and you at https://www.healthcare.gov/law/timeline/index.html.


The year ACA was established

23 million+

People covered under ACA

Your income determines which health coverage you need.

“Modified Adjusted Gross Income” (MAGI) This calculation applies to the FAMILY HOUSEHOLD applying for insurance coverage. Add the INCOME of the relevant household members, applying the income modifications as required. Use the calculator at www.CoveredCA.com to help you.

Income less than about $20,385 for an individual indicates you are better served by Medi-Cal or Medicaid, as would a family of four making less than $41,625.

In order to make insurance less of a burden to a family, we look to the Federal Poverty Level (FPL) to see where your income indicates you are. If your income falls between zero and 138% of the FLP, then you should take advantage of the new and improved Medi-Cal system (the Federal Medicaid system).

Medicaid Expansion for Adults

In the ACA, Congress required states to expand Medicaid to all adults, including parents and adults without children, up to 138 percent of the federal poverty line. To ease the fiscal impact on states, the federal government is covering 100 percent of the cost of the newly-eligible adults in the first years of implementation.

Over time, the federal government’s share of the cost of covering newly-eligible adults will taper down, but it never falls below 90 percent. As a result of the Supreme Court decision on the ACA, states can decide that they do not want to expand Medicaid. California has opted to implement the expansion to 138 percent of the federal poverty line for adults (previously the ceiling was up to 133 percent).

The ACA makes other notable changes to Medi-Cal including:

  • Requiring use of a simple, streamlined application for Medi-Cal and other insurance affordability programs
  • Eliminating asset tests for children, parents, pregnant women and non-disabled adults
  • Adopting new ways of defining income when evaluating eligibility in order to allow for better coordination with other insurance affordability programs
  • Creating a new requirement to cover former foster care children up to age 26

The Healthy Families program has helped a lot of children have coverage for healthcare and has been a good options for lower income families in the past.

Going forward into 2024, TLICP — Targeted Low Income Childrens Program —  will provide coverage for those who fall below 250% of the FPL.

With Medi-Cal you can have one plan for the entire family or each member on a different plan.

For 2024 the Federal Mandate is not in place but the State of California is enforcing the mandate that everyone have health insurance.

California has reinstated the individual mandate tax penalty if you chose not to buy qualified health insurance. The penalty is $850 per adult or 2.5% of their annual income. The best way to avoid this penalty is to be sure you have health insurance and purchase it during open enrollment for the 2024 coverage year.