The Affordable Care Act and You

Published: November 20, 2013


You’ve likely heard that the Affordable Care Act (often referred to as Obamacare) has begun to roll out across the country. This new law may affect you in a variety of ways (or not at all).

As a resident of the United States, you will likely be required to enroll in a health insurance plan. This is not news to residents of Massachusetts, as we have been subject to the Individual Mandate for several years.

However, there may be some changes in your plan, to comply with the mandatory minimums of coverage required by the ACA. We checked in with Midge Rose, our insurance expert and guide from Bryden and Sullivan Insurance Agencies, and here’s what she said

  • Whether you purchase Health Insurance through an employer or you purchase it as self-employed there are many changes coming up January 1, 2013. There are new benefits, a more enhanced Pediatric Dental for those with children, and enhancing some benefits like Physical and Occupational Therapy and Chiropractic Care. Also, restrictions on deductibles and out of pocket maximums.
  • If you have a deductible on your plan now greater than $2,000 at renewal in 2014 your plan will change. The new maximum deductible will be $2,000. Out Of Pocket maximums must remain below a combined $6,350 for medical, prescription, and dental ($12,700 family). All costs (copays, deductible, etc.) must apply to Out Of Pocket maximum.

Midge was quick to point out that some of these details may change over the next few months, and beyond, as the law is enacted and executed. Also, some residents may qualify for subsidized plans, you can visit https://www.mahealthconnector.org/ for more information on plans and eligibility.

As a business owner, you should be aware of how the ACA may affect you. Some businesses are eligible to use the SHOP (Small Business Health Options Plan) Marketplace to simplify the process of buying health insurance for your business.

If you are self-employed with no employees, you are not considered an “employer” and you may use the regular Marketplace. If you own a business with fewer than 50 employees, you are not required to offer health coverage, but you may use the SHOP Marketplace if you choose to do so. If you own a business with 50 or more employees, you are considered a “large business” and it would be wise to thoroughly examine the requirements of the ACA and their application to your business.

Detailed information for business owners is available at https://www.healthcare.gov/businesses/ and you may find this information from Associated industrias of Massachusetts health cost expert Russ Sullivan useful in learning about the new laws.

As a wellness provider, the ACA may eventually allow for massage to be covered by health insurance plans. Section 2706, titled the Nondiscrimination Provision states.

“A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.”

What does that mean? It means patients will have a right to see the health care provider of their choice, and insurance must cover that care.

Section 2706 does not mean that every massage therapists will be required to accept insurance. If you do not wish to be involved in insurance and billing, you do not have to. It is a decision each practitioner should carefully weigh and decide on their own.

But let’s dig a little deeper. Each state will determine how the ACA is interpreted and enacted in their jurisdiction. Some organizations, like the American Medical Association, oppose Section 2706 and are forcefully lobbying states as well as the federal government to repeal the provision. You can read more about the ACA and its opponents (and supporters) at the Integrative Healthcare Policy Consortium website here.

The Hon.Deborah Senn explains the provision beautifully in the video below, even using the example of a patient with back pain, and describing the array of practitioners the patient may see for care.