Five things you need to know about the Affordable Care Act

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Editor's note: We are proud to introduce a new contributor, Sarah O’Leary, who will write the “Insurance Essentials” blog covering health insurance and healthcare issues. O’Leary is CEO and founder of ExHale Health, which helps consumers across the country successfully manage their health insurance and healthcare provider relationships. The company’s mission is to save consumers time and money on their healthcare through policy/plan selection, claim filing and tracking, reimbursements, insurance-plan transitions and more. We know you’ll find this new blog interesting and helpful.

We’ve all heard a great deal about the Affordable Care Act (ACA) and how it will adversely affect Americans. As a company that represents consumers across the country, we encourage you to see how the ACA affects you and then decide how you feel about it. You deserve the best care possible at a fair price, and that’s all that should matter. Keep these five things in mind as you consider your options:

  1. Don’t fear needlessly! If you look back to the decades leading up to the passage of Medicare, you’ll see many of the same groups are engaged in the fight against this latest healthcare reform. People over the age of 64 can’t imagine life without Medicare. No system is perfect, but no system at all is dangerous. Many facets of the Affordable Care Act have already been enacted, and it’s already helping insure millions who would have gone without insurance otherwise. The federal web site,, is a good place to find information about the Affordable Care Act and how it may affect you. Millions of Americans who have insurance through their employer might not even notice a difference.
  2. Open enrollment for 2104 begins Oct. 1. The term “open enrollment” can be confusing for the average person who hasn’t purchased health insurance before. Essentially, it is a time period in which people can enroll into an insurance program or make changes to an existing insurance policy without risking a delay in their coverage or financial penalties. Individuals and small businesses owners who want to get health insurance through the Affordable Care Act can begin to enroll on-line through state (and potentially federal) insurance exchanges beginning Oct. 1. The open enrollment period continues through the first months of 2014. If you enroll by December 2013 (barring any unforeseen processing issues by the insurance company you choose), you will be covered by Jan. 1, 2014. Insurers can no longer refuse care based on their assessments of pre-existing conditions, so the enrollment process should be easier than in the past for individuals.
  3. Transparent pricing and competition is good for consumers. States such as California made health insurance companies bid on the opportunity to sell individual and small-business insurance policies through the ACA state exchange. This is a “cards on the table” approach to health insurance that can only help drive prices down for average consumers. The 13 insurers participating in Covered California, the name for the state’s exchange, will have to reveal their pricing-structures policy details up front, allowing consumers to shop around for the best policy. This means insurance companies will have to work harder to win an individual’s business. Many experts predict that the competition and transparency will mean that those who have been insured individually in the past may get better coverage for less than they pay now.
  4. Millions of consumers won’t be denied health insurance because of pre-existing medical conditions. This is an enormous change for individual/small business policy holders. Most Americans who have coverage through their employers (a group plan that isn’t based on an individual’s medical history) aren’t aware that small businesses and individuals have been subjected to higher insurance rates, insurance denial and termination of coverage based on how insurers judged their health. Prior to 2014, private insurers were allowed to decide what individuals they would approve or deny for insurance coverage based on pre-existing medical conditions.  Each insurance company had its own – often somewhat arbitrary – list. A major PPO in Michigan, for example, counted acne and erectile dysfunction as potential reasons to deny coverage. Once you’ve been denied individual coverage, it is almost impossible to get it anywhere else. (Major insurers ask if you have been denied coverage by any other insurer because of a pre-existing condition on the application). If you could afford it and it was available, you could end up in your state’s high-risk insurance pool, potentially paying hundreds of dollars more a month than your neighbor for the coverage. The government is also requiring that insurers include an expanded number of tests, exams, procedures and life events (such as pregnancy) in their policies. Coverage of certain mental wellness services will also be made available to individuals under their insurance plans.
  5. Individuals and small businesses can receive tax credits for participating. Those who qualify can receive tax credits designed to offset the price of the insurance. If you do not get insurance before the deadline, you may be required to pay a nominal fine when you file your taxes. See for more information.

Insurance Essentials is written by Sarah O’Leary, CEO and Founder of ExHale Health. The opinions expressed here are exclusively those of the author. If you or someone you know needs help with health insurance questions or information, go to, or call 1-800.381.4741.

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iowa  |  September, 24, 2013 at 09:02 AM

I read Sarah OLearys story on Exhales website--- business was founded in 2012 and she never dreamed of being in the health care industry until then?? Cmon... we want someone with a non bias view to do editorials and give us real facts, not a CEO with no experience in the industry and looking to make sales for her company. If we want a slanted view of issues we can turn on the TV and listen to politicians. Very disappointed in Pork Magazine now if they feel she is a expert in the heath care industry

Paul Meers    
Mo  |  September, 24, 2013 at 10:52 AM

I too read Sarah O'Learys' story on her website. I am impressed with her intestinal fortitude for starting a company based solely on her friends $88k cancer bill. It appears she has surrounded herself with professionals in this field. Her company will survive only thru profits via results just like all in America. ( except GM possibly ) I am a Blog writer for Pork Network and provide articles for publication without pay. I assume O'Learys' is free as well. For that we are allowed to provide a web site or contact info with the opportunity to further interact with readers. My web site has had > 1000 hits since spring and I have been contacted by people from 7 states. Read the articles or delete them. Everyone's choice. Exhale Health won't be around long without profits via results.

NW Indiana  |  September, 24, 2013 at 09:48 AM

#1; "People over the age of 64 can’t imagine life without Medicare" What ! Uncounted millions of us can't imagine a sick life with it's costs, it's doctors and their pills 'n ills.

Iowa  |  September, 24, 2013 at 11:42 AM

Thanks for your comment, Steve. Paul is right - we don't compensate any of our blog contributors. We feel insurance is an important topic, particularly since so many farmers are self-employed. I think Sarah will be a good contributor because she isn't deeply entrenched in the insurance business, rather than in spite of the fact. She can look at the industry and accompanying options/solutions with a fresh approach. This isn't a commercial message - it's meant to offer information and insights on the topic. Thanks again for writing.

Arizona  |  September, 24, 2013 at 12:25 PM

The OLeary comments are all "pro". Balanced???

Wa  |  September, 24, 2013 at 12:51 PM

"You'll get to keep your plan." I and several others got the notice our current plans are discontinued or illegal. My offered replacement goes from $262 to $416. Deductable from $2750 to $4000. The only improvement is prescription coverage (I don't have any, never have) and pregnancy (as a male, whole lot of good in that one.) That there are subsidies and tax credits available is Nothing to be Proud of. That just leads to more market distortion and political gamesmanship. Down the road, let's say I pay the higher premium, and have a claim, but the insurance company is no longer solvent. Don't say the federal gov't will pick up the tab. That's just shoving more on to the Tax Payer. We already saw an adjustment to the field in Washington back in the '90's when the state required broader coverage for more special interests. About half the companies left the state, and the rest easily doubled their rates just to keep going. 3. "Many experts predict ... may get better coverage for less than they pay now." Total BS. Yugo, Chevy and BMW may all be cars, but they come at different prices for a reason. What we now get to experience is paying premium prices for Yugo or Beetle service. Eventually even those will break down, because the politicians destroyed the industries (both medical and insurance).

NC  |  September, 24, 2013 at 03:40 PM

I agree all you have done is shown the "Pros" you need to keep it fair and balanced. With the IRS in charge of healthcare is kinda scary to me. I hope the editors of this magazine will ensure that all subjects unbiased. This article IS NOT

September, 24, 2013 at 09:34 PM

it is to bad we have to read this. we get enough of this left wing stuff on tv. you guys can do better.

kansas  |  September, 25, 2013 at 01:05 AM

I do not doubt Pork or Ms. O'Leary's intent and good will. However, there are many pure Risk Management firms who have NO conflict of interest, that would be far superior choices. Whether intentional or no, Ms. O'Leary cannot help but be biased towards the Sellers end of insurance, not the Buyers. That is her business and we should think her a fool if she did not. This column's information should be presented 100% from the Buyers perspective. That is what Risk Management Cos. do - represent the interests of the Buyer. I would imagine Pork's corporate parent retains these services and the editors should ask for recommendations there. Please.

October, 03, 2013 at 07:02 AM

No mention of the tax increases assessed on the "rich" to pay for this program. I don't think those whose federal top marginal tax rate went from 35% to 43.4% (a 24% increase) on 1/1/13 have such a favorable assessment of this latest acceleration into federal bankruptcy. A program that subsidizes some at the expense of others is usually going to be viewed as a good thing by the takers, unless they care what this gift to them is eventually going to do to this country, which has 17 trillion dollars of debt on the books abd who knows how many hundreds of trillions of unfunded liabilities for such "good" programs as medicare, social security, and on and on.

Bo Burgess    
Resaca, Ga. 30735  |  October, 09, 2013 at 08:45 AM I just visited this site and looked over the first eight pages of provisions. It is scary to look at how far reaching this act will be to the US economy. This thing is massive. No wonder Nancy said we have to pass this thing to find out what's in it...away from the fog of controversy. How can they come up with this, but not a way to address a plausible budget and address debt reduction. I keep hearing, "passed on to our children..." and it finally hit me that this will come in the form of increased taxes and provisions to pay for what was done before they even fall under the act. I'm sick at the thought of what the future brings from this endeavor.

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