For millions of Americans, Tuesday is significant not because of threats of a government shutdown or because of the lingering debate about raising the debt ceiling. It's a watershed moment because for the first time they can start shopping for health insurance, something 48 million Americans — including more than 72,500 in Sonoma County — are without.
Beginning next month, people who have been prevented from getting insurance, because of pre-existing conditions or other obstacles, will be able to buy coverage through health insurance marketplaces known as exchanges. Some may qualify for government financial assistance — tax breaks and subsidies — in paying for those plans. In fact, assistance will be available for those with incomes up to four times the federal poverty level. (That's $45,960 for individuals and $94,200 for a family of four.)
Open enrollment will run until March 31. Any plans that are purchased through the exchanges won't start until Jan 1. For those who wait until January or February to sign up, they will have to wait until the following month for their coverage to begin.
Given all the hyperbole offered in recent days by those in Congress trying to defund so-called Obamacare, here are some issues that need clarifying.
First, not all Americans who are without coverage will be allowed to obtain coverage. For example, roughly 20,000 of Sonoma County's uninsured are illegal immigrants who are ineligible for coverage under the Affordable Care Act.
Meanwhile, many others are not expected to take advantage of the new services, even though it may expose them to a fine next year of up to $285 per family or 1 percent of income, whichever is higher. (The fine goes up from there to 2.5 percent of income in 2016). In fact, the county is just hoping to insure about 25,500 Sonoma County residents during 2014.
County officials project that about 13,500 of those residents will be enrolled in Medi-Cal, where the eligibility requirements have been increased from 100 percent of the poverty line to 138 percent. (The federal poverty level is $11,490 for an individual or $23,550 for a family of four.) Meanwhile, officials hope to get another 12,000 residents signed up for insurance through the state exchange.