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Questions, controversy permeate mandate

Published: Sun, September 22, 2013 @ 12:05 a.m.

By Burton Speakman



Here’s how the Affordable Care Act works:

After Jan. 1, 2014, you either must have health insurance or you must be prepared to pay a fine when tax day comes in April 2015.

Despite a nearly three-year buildup, many people are confused about the so-called individual mandate and how the insurance exchanges will work.

Republicans in Congress have pushed for a delay in the individual mandate in the ACA to mirror the one given to businesses. On Friday, the House voted to defund the ACA altogether.

U.S. Rep. Tim Ryan of Niles, D-13th, said he doesn’t know enough about the progress that the administration is making in setting up the national insurance exchange to know if a delay in the individual mandate will be necessary.

It isn’t fair to the public that the individual mandate remains in effect while the business mandate was delayed by a year, said U.S. Rep. Bill Johnson of Marietta, R-6th. Johnson voted Friday to defund ACA.

It isn’t reasonable to expect a member of the public to understand everything included in the ACA, Johnson said. Bureaucrats in Washington are still determining elements of the law.

Though employers expressed relief that the business mandate was delayed, individuals have received no such delay and will soon be faced with a barrage of options when open enrollment in the exchanges begins Oct. 1.

A large number of people would qualify for some type of subsidy on insurance through the exchanges. Anyone who makes between 100 percent and 400 percent of the federal poverty level would qualify for a tax-credit subsidy.

The federal poverty thresholds are currently $11,490 for a single person, $15,510 for a couple, $19,530 for a family of three, and $23,550 for a family of four. This means that a single person who makes up to $45,960 or a family of four that earns up to $94,200 would receive some level of subsidy.

Those who earn less than 100 percent of the poverty level could be eligible for Medicaid — the government’s health-care program for the poor, disabled and children — if Ohio chooses to expand coverage to some 275,000 people. Until the General Assembly votes to expand the program, some of the state’s poorest will receive no help and not be eligible for subsidies on the exchanges.

Last year, the U.S. Supreme Court voted to uphold the individual mandate, but it overturned the requirement that all states expand Medicaid coverage, leaving each state to decide what was once a major provision of the law before it was struck down.

In Mahoning County, the typical family, which has just more than two people, makes $40,570, according to the U.S. Census Bureau. This family would receive a tax subsidy of $132 a month and pay an estimated $284 a month for a mid-level health insurance plan, according to information from the University of California at Berkeley Labor Center.

“Almost one-third of the population will be eligible to receive some type of discount on their health insurance,” Ryan said.

In Massachusetts, the only state that has an operating exchange, a single person who is 30 pays between $246 a month and $412 a month on the exchange. Meanwhile, 60-year-olds would pay between $436 per month and $761 a month if they make more than $34,476 per year and are not eligible for a subsidized plan. For a family of four, the income level to qualify for a subsidized plan increases to $70,656 per year. The Massachusetts plan provides subsidies only for those at 300 percent of the federal poverty levels or less. The subsidized plans range from no cost to a high of $182 per month and are dependent upon income. The numbers will be different in Ohio, and subsidy thresholds are more under the ACA.

Costs could leave some to consider paying the fine instead of buying insurance.

In the law’s first year, the fine would be about $90 and would progress from there to $695 a year when the fine is fully implemented in 2016, said George P. Millich Jr., an attorney with Harrington, Hoppe & Mitchell in Youngstown.

Things might not improve for the public in 2015 when companies with more than 50 employes have to offer insurance to employees or start paying a fine.

A number of companies are considering reducing workers’ hours to stay below the 50 full-time employee requirement to be a large employer that has to offer insurance, Millich said.

“There are also companies that are looking at it solely as a financial decision and consider the fine to be a fixed cost,” he said. “There will also be a lot of employees who currently opt out of their employers’ health insurance who will now want to opt in.”

Employees also won’t be able to rely on their employers for information because, in a lot of cases, the employers aren’t sure exactly what will happen, Millich said.

The positive aspect of the act is that it is expected to greatly increase the number of people who carry insurance, though educating them about the exchanges and what options are available remains a challenge.

The U.S. Department of Health and Human Services has estimated that the law will provide an additional 97,000 of Ohio’s young adults with health insurance.

The public also won’t be able to rely on their family doctor to tell them about how the exchanges work.

Most doctors don’t know enough about the exchanges to provide any information to the public about plans, said Dr. Dominic Conti, who practices in Youngstown.

Part of the issue is also going to be patient choice, including how long people are locked into the health plans they chose, he said

“Hopefully, there will be some option for people to change plans and maneuver within the system,” Dr. Conti said.

Navigating the exchanges could be challenging for people who are not familiar with using the Internet, Millich said.

“There are a lot of filters and other things on the side of the [web] page that could be confusing for some people,” he said.


1Ytownnative(1121 comments)posted 2 years, 10 months ago

U.S. Rep. Tim Ryan of Niles, D-13th, said he doesn’t know enough about the progress that the administration is making in setting up the national insurance exchange to know if a delay in the individual mandate will be necessary.

He doesn't have a clue. It was a demoncrat plan he voted blindly for and now they are passing bills that say he doesn't fall under the plan. Its good enough for us but not good enough for him

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2bmanresident(607 comments)posted 2 years, 10 months ago

It seems no one really knows how this law is supposed to be implemented. Doctors will soon be forced out of business, under employment will rise, and this country will receive the one-two knock out punch that the globalists are looking for. Obama has proven his incompetency.

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3drpautot(70 comments)posted 2 years, 10 months ago

Parleyhenry, your correct on so many levels. I find it staggering the level of idiocy i hear from people about the affordable care act. Never mind the fact that both times, in the last 2 elections; both candidates were running on a platform that was primarily about healthcare reform, And both times we elected the president that came up with the plan. So where are the Americans who do not want healthcare reform. Strangely, I've heard the argument to have it repealed from people who live below the poverty level, and from some seniors who are less informed than congress The bill will have virtual no effect on the healthcare that is already there except for the fact it will cut insurance corporations profit margin. And lets not forget that since we have had this bill introduced, republicans have tried to repeal it 42 times, That Is 41 long debacles of an argument that would have been better spent using that same energy fixing real problems in the country. Congress is simply acting like spoiled brat kids whose parents wont buy them candy at the store and throw themselves to the ground crying and going limp, simply because they are not getting what they want.

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4studdabubba(2 comments)posted 2 years, 10 months ago

True health care reform did not have to be this difficult. This is just another hidden agenda driven towards socialism.

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5drpautot(70 comments)posted 2 years, 10 months ago

Studdabubba, socialized healthcare isnt necessarily bad. Canada, as well as most of the EU have had it for years, and doctors make considerably less there, than their American counterparts. Thee services in some cases are far better too. In France for example, if you are having a stoke or heart attack, real time telemetry is sent from the ambulance to the hospital directly, so when you arrive at the ER, the room is ready for you to get the required surgery, and they do not have to page doctor so and so from his corner office at the back nine of some country club to come and do his job, saving lives. And now we have a hostage situation in Washington. I surely hope our President keeps his stance on terrorism, and refuses to negotiate with the Congressional Boehner regime. Good healthcare for everyone is not Socialism, its just common sense.

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6ricnsherri(41 comments)posted 2 years, 10 months ago

Just make it fair for everyone. If businesses can wait a tear then let individuals wait a year. During that time have some educational plans for folks to learn.

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7Benice(4 comments)posted 2 years, 10 months ago

Parlayhenry, please, your original post IS the definition of "playing the race card". Most Americans that disagree with this program could not care less which color our president is or isn't.

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8Benice(4 comments)posted 2 years, 10 months ago

"'What we have now is untenable over time,' said Warren Buffett, an early supporter of President Obama. 'That kind of a cost compared to the rest of the world is really like a tapeworm eating, you know, at our economic body.'

"Buffett does not believe that providing insurance for everyone is the first step to take in correcting our nation's healthcare system.

"'Attack the costs first, and then worry about expanding coverage,' he said. 'I would much rather see another plan that really attacks costs. And I think that's what the American public wants to see. I mean, the American public is not behind this bill.'"

That is what a "dumb white guy" suggests and who IS a supporter of President Obama, who oddly enough has a different color skin pigmentation.

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9msweetwood(179 comments)posted 2 years, 10 months ago

Hey everyone:

Instead of the typical back-and-forth here, I have a different idea: Read this week's newspaper and arm your self with the facts.

For the next six days, we are devoting extra space to items that you won't see here on the web. Page A9 today is a blueprint for what you need to know plus it has links to various websites for more information.

We have grown tired of the pro/con debate which does little to illuminate what the act might mean to real people in coming months. Now we want to arm you with as many facts as we can find from resources to experts, to even a glossary of ACA terms (see Monday).

For everyone posting that they don't know enough, run out and get today's newspaper and stick through the series until Friday. Then come back and share what you've learned.


Mark Sweetwood
Managing Editor

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10ricnsherri(41 comments)posted 2 years, 10 months ago

Will you PLEASE included a list of all the companies/groups that are exempt.

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11redeye1(5675 comments)posted 2 years, 10 months ago

I guess by many of these posters GDOG, PARLAY HENRY ,that the so-called educated voters of this valley really aren't . They are as CLUELESS as their congressman Timmy Ryan. If any of you had really looked into this mess you would have seen that the rates for OHIOANS will raise about 45% to help cut the costs of New Yorkers , who right now pay one of the highest rates in the country. If you think that 's fair then you really are CLUELESS. If also think that major companies aren't going to cut out your insurance programs you are CLUELESS If you belong to a union and think you will be exempt from the mess , you are CLUELESS !!! it's only a matter of time before you are enroll in the MESS. Because OBAMMY will screw your union sooner then you think. You heard it first here !!!!

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1276Ytown(1371 comments)posted 2 years, 10 months ago

Our health care costs are so far out of reach for anyone with or without insurance. Gone are the $100 deductible per person, $200 per family, 80/20 plan of years ago. Gone are employer sponsored health plans with small payroll deductions.

Fact: My individual plan has a $5,500 calendar year deductible per person, 2 family maximum That is $11,000 if 2 people have a catastrophic illness in a calendar year in addition to $508 per month/ $6096 yr for the insurance premiums for my 3 member family. The plan pays for preventive care but does not pay for any other expenses until I am out of pocket for $5500 per person at which point it will cover 100% for the remainder of the year.

According to SHRM (Society for Human Resource Management):
"For 2013, average health plan premium costs per employee are projected to jump to $11,188, of which average employee contributions to the health plan premium would be $2,385. In addition, average employee out-of-pocket costs (co-pays, co-insurance and deductibles) would be $2,429.

Over the last five years, employees’ share of health care costs—including employee premium contributions and out-of-pocket costs—have increased more than 50 percent from $3,199 in 2008 to $4,814 in 2013, according to the analysis."


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13southsidedave(5199 comments)posted 2 years, 10 months ago

no one knows anything except that health care costs continue spiral ever higher and the average person cannot afford to become ill...

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14redeye1(5675 comments)posted 2 years, 10 months ago

Ytown and Dave There is NOTHING in OBAMMY CARE that will stabilize any costs . The liberals keep saying that the more people who get insurance the lower the costs will be. .That's a LIE! You see insurance companies are already raising their rates to cover those people who haven't had any insurance because they know these same people will be using it like crazy to get better at great costs to everyone. It doesn't take a take rocket sciencetist to figure that out. There is a simpler way to help all and that is to repeal the bill that says the hospital has to take care of everyone who doesn't have any insurance or the money to pay for it. That would get rid of a lot of the illegals in this country too. They wouldn't have FREE medical care without paying for it.

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15paulydel(1607 comments)posted 2 years, 10 months ago

Lets call a spade a spade. Not one of you that claim Obumacare is a good thing can show any of us anything that the govt. has involved itself in that has made any money. I don't want the govt to tell me what covers me and what don't. This is exactly why businesses are not hiring fulltime workers and cutting benifits. Then you have our elustrious congress who says lets pass it then we'll read whats in it. I'd venture to say that those of you who want this stupid illplanned insurance with huge fines didn't sign a contract you didn't read first. If you support Obumacare then you must have your head up your butt.

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1676Ytown(1371 comments)posted 2 years, 10 months ago

“But we have to pass the [health care] bill so that you can find out what’s in it....” Nancy Pelosi (3/9/10)

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17paulydel(1607 comments)posted 2 years, 10 months ago

76Ytown I was coming back to make that same point. If Congress thought that Obumacare was so great then why did they make it a point to exempt themselves from having to take it also? This insurance would rob us all not only dipping into our pockets for money we don't have but of being covered by insurance the way we should be. Obuma says he is bringing th economy back up I don't see it. There are more jobs being lost than created. If the economy was strong this wouldn't even be an issue and Obumacare would be where it should be flushed down the toilet.

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18Aware(255 comments)posted 2 years, 10 months ago

Parlay....you give me hope that there is intelligent life.....well-written posts. Thank you.

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19Benice(4 comments)posted 2 years, 10 months ago

so sad

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2076Ytown(1371 comments)posted 2 years, 10 months ago

parlayhenry: What part of out of control health care costs do you not see? Having the government take over health care is going to reduce costs? Nothing in life is Free. Those in favor of ACA seem to think that it will be.

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21Benice(4 comments)posted 2 years, 10 months ago

You cannot defeat racism with racism.

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2276Ytown(1371 comments)posted 2 years, 10 months ago

Emergency rooms have been abused by patients for years. Insured folks go there after hours and weekends when they can't visit their doctor and the uninsured go there because they know they can't be turned away. Years ago, insurance plans implemented a higher co-pay to deter ER use.

The ACA will not eliminate the uninsured population since for example, Ohio has not elected the Medicaid expansion and the undocumented won't be covered by ACA either.

A common sense approach to lower hospital costs would be for more urgent care centers to open nights and weekends for non-emergency doctor visits. They have popped up in recent years as stand-alones and even in drug stores but again, they are not always open when you need them.

Have you noticed that there is a major paradigm shift going on? Companies are reducing hours to limit benefits to employees. Yes, that would mean that the "pool" is increasing but it also means that employees are getting less hours but will be forced to pay for coverage on their own.

Lower income earners and unemployed will resort to paying the $90 penalty instead of joining the pool.

What is unsustainable is the rising cost of health care for all services not just the ER.

Medicare is for over age 65 and is paid for by FICA payroll taxes by the employee 7.65% and the employer 7.65% = 15.3% of your paycheck An additional premium deduction is paid through your monthly Social Security check.

Medicaid is for the for people with low income of all ages and is funded by the federal government and state.

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2376Ytown(1371 comments)posted 2 years, 10 months ago

parlayhenry...Take Mr. Sweetwood's advice (#13 above). In the meantime, go for a walk and cool off before you blow a fuse!

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2476Ytown(1371 comments)posted 2 years, 10 months ago


Canadian healthcare = single payer system paid for by taxes and free at point of use.

Obamacare = requires every to buy insurance and if you don't you pay a penalty. Govt will subsidize your premiums based on income by putting you into the Medicaid expansion.

Insurance coverage purchased can be the bronze, silver or gold plans. They pay 70%, 80% or 90% after deductible.

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25andersonathan(687 comments)posted 2 years, 9 months ago


ObumaCare same people that delivers your mail, collects your taxes, sells weapons to the Muslim Brotherhood, and did not know what to do about Benghazi, but knows how to shut a national park service down that costs more to keep it closed than to leave it open LMAO

And check out the UK Daily on the real health care numbers not millions by far in fact those logged on about 2% actually complete the sign up and buy into it.

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26andersonathan(687 comments)posted 2 years, 9 months ago


ObumaCare= Job Killer

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27kk80586(229 comments)posted 2 years, 9 months ago

henry-you posted that plagiarized drivel on another board. Why don't you quit posting other peoples opinions and come up with one of your own? OH, that's right...you are a demoKKKrat (which means your opinion is what your master tells you it is). you are a good bot :)

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