New Year, New Rules in Health Care

Wednesday was quietly one of the most monumental days ever in American health care. That’s because with the start of the new year, the biggest parts of the Affordable Care Act finally went into effect. Around the country, there is plenty to celebrate. Many more have good, affordable health coverage than a year ago. Even more – everyone, actually – can celebrate new health insurance protections. However, some find themselves in an unfortunate coverage gap.

A few months back, we explained all of the big health care changes that 2014 would bring, but since the new year is now here, we thought it would be a good time for a refresher.

First, two things are no longer allowed:

  • Sick people can’t be denied coverage: It still sounds crazy – the people who need insurance the most have routinely been denied coverage, with insurers refusing them due to “pre-existing conditions.” This term now goes out the window for everyone. (As of 2013, insurers couldn’t deny children due to pre-existing conditions). Insurers also won’t be able to charge you more just because you’re sick.

  • No more yearly limits: Insurers can no longer set a yearly limit on what it will spend on your coverage. Imagine facing a catastrophic illness, and being told your coverage had run out. As of Jan. 1, that is no longer a concern.

Coverage begins

Jan. 1 was also the day that the first health plans purchased under the Affordable Care Act went into effect. By now we know the rollout of the Marketplaces where people buy coverage wasn’t smooth at all, but despite that, more than 1.1 million have signed up for coverage through the federal Marketplace. Even more have signed up through state-based Marketplaces (New Hampshire was one of the states that decided against running its own marketplace). For our part, staff at the SEA have worked to help people around the state sign up for coverage through sign-up fairs and individual consultations.

Those who signed up before Dec. 23 had coverage effective Jan. 1. Open enrollment for plans purchased on the Marketplace, accessible at, continues through the end of March. If you still need more information, you can find it at the newly created

Some left out

One thing that’s not happening in New Hampshire is Medicaid expansion. That’s because Republicans in the state Senate put political ideology ahead of Granite Staters in need. Those Republicans twice blocked expansion in 2013, first during budget debate and again in a special session.

Expansion would have covered all adults aged 19-64 (those younger are covered by CHIP, those older are covered by Medicare) who earn up to 138% of the poverty level ($15,400 for a single person, $32,000 for a family of four). An independent study found that would mean an additional 58,000 Granite Staters would have had coverage. The federal government would have covered the full cost of expansion for the first three years, and the vast majority of the cost in the years thereafter.

Setting aside the massive financial cost of rejecting expansion, there’s a huge human cost. Some of NH’s working poor are falling into a gap because they’re not eligible for Medicaid and don’t make enough to qualify for subsidized Marketplace health plans. The Affordable Care Act originally intended for all states to expand Medicaid, but the Supreme Court instead let states decide whether to expand. So for some low-income people in New Hampshire, it’s as if the Affordable Care Act never existed.

We’ll be writing more about Medicaid as the expansion issue remains very much alive and we expect it to come up in the upcoming legislative session.


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