Despite the lofty goals of the health care reform championed by President Barack Obama, approximately 5.2 million Americans will fall through the cracks of system. Since the Affordable Care Act was designed as a build-on to the existing system — filling in the gaps left by Medicare and Medicaid to expand health care coverage to America’s millions of uninsured — the reform is “a complex and somewhat ugly patch on a complex and somewhat ugly system,” according to Princeton University’s Uwe Reinhardt.
The Affordable Care Act was designed to make affordable health insurance accessible to most all Americans via a two-part system: the expansion of Medicaid and the creation of insurance exchanges where individuals will be able to comparison-shop for health insurance policies in online marketplaces where their collective bargaining power will theoretically foster competition and drive down prices.
Subsidies in the form of tax credits were also included to make coverage more affordable for the exchange enrollees who earn between 138 percent and 400 percent of the poverty level. The expansion essentially sets a national Medicaid income eligibility level of 138 percent of the federal poverty level, or about $27,000 for a family of three for adults. Historically, Medicaid eligibility was restricted generally to low income individuals in a specified category, such as children, their parents, the aged, or individuals with disabilities.