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June 28, 2012: With the unlikely support of conservative Chief Justice John Roberts, the high court upholds the law’s core requirement that most Americans carry health insurance, ruling that the penalties to enforce it are a tax Congress is authorized to levy. But it allows states to opt out of the Medicaid expansion.
Oct. 1: Online insurance markets to open. Consumers must sign up by Dec. 15 for Jan. 1 coverage.
LOCATION MAY MATTER
Having health insurance used to hinge on where you worked and what your medical history said. Soon that won’t matter, with open-access markets for subsidized coverage coming Oct. 1 under President Obama’s overhaul. But there’s a new wild card, something that didn’t seem so critical when Congress passed the law in 2010: where you live.
Entrenched political divisions over “Obamacare” have driven most Republican-led states to turn their backs on the biggest expansion of the social safety net in a half-century. If you’re uninsured in a state that’s opposed, you may not get much help picking the right private health plan for your budget and your family’s needs.
The differences will be more glaring if you’re poor and your state rejected the law’s Medicaid expansion. Unless leaders reverse course, odds are you’ll remain uninsured. That’s because people below the poverty line do not qualify for subsidies to buy coverage in the markets. “We are going to have a new environment where consumers may be victims of geography,” said Sam Karp of the California HealthCare Foundation, a nonprofit. “If I’m a low-wage earner in California, I may qualify for Medicaid. With the exact same income in Texas, I may not qualify.”
The health care law is finally leaving the drawing boards to become a real program. In many parts of the country, the decisions of Republicans opposed to the law will trump the plans of Democrats who wrote it. Still, there is a new bottom line. Health insurance marketplaces in every state will provide options for millions who don’t have job-based coverage, who can’t afford their own plan or have a health problem that would get them turned down. The feds will run the markets in states that refused to do so. The coverage won’t be free, even after sliding-scale subsidies keyed to your income.