COLUMBIA, SC (WIS) -
The kinks of the Affordable Care Act are still being worked out.
But the bottom line is: in 2014, medicaid will expand, there will be a marketplace where insurance companies compete for your business, and a tax if you choose not to have insurance.
"Instead of a requirement that you buy health insurance, we're saying you can buy health insurance or you can pay a tax" said USC Political Science professor Mark Tompkins. "It's up to you. It's your choice."
While it does seem like a mandate, Tompkins says the Affordable Care Act is designed to let people put their health care under their own control.
"When you're healthy, you don't think you need care," said Tompkins. "Most of us, sooner later do need it. So instead of free-riding, pay a little bit now so when you do need the care, you'll be able to have somebody else pay for it."
First, Medicaid grows. And the federal government covers all of cost up front.
Then in 2020 it covers 90 percent of Medicaid costs, making states responsible for 10 percent.
"The program currently mostly covers women, children and very poor people," said Tompkins. "We're going to expand that program dramatically. In some cases for those who are working and poor and working and near poor and subsidizing their insurance."
A new marketplace exchange is created where health professionals are rated on their coverage and insurance companies compete for your dollars.
"Because there's a marketplace for insurance, presumably they'll be pressure on insurance companies to give affordable care," said Tompkins. "And because we'll have a mechanism for providing them with a report card to decide which insurance company to sign up with. They're going to put pressure on insurance companies to put pressure on doctors and hospitals to do their best."
Tompkins says it will be difficult to repeal the law in part because democrats can stop it and the Congressional Budget Office has predicted hundreds of billions of dollars in savings.
"We have 18 months to do it now," he said. "And the current legislation says in 2014 if South Carolina doesn't do it for ourselves, the federal government is going to come in and do it for us."
The Supreme Court justices effectively took the health care issue out of the judicial spotlight. The role of government and how it should or should not govern health care is now back in the political arena.
The next issue is the growing deficit as congress tackles how to pay for these new changes.
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