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Question of insurance coverage remains despite high court's healthcare ruling

While the U.S. Supreme Court has upheld the federal healthcare overhaul law, the fight over it is far from over. Many questions about President Barack Obama’s signature legislation remain—like who will be covered under the Affordable Care Act? Who will have to buy insurance, and, will it bring down costs?  The results may be just as complex as the law itself.

On the day the U.S. Supreme Court announced its ruling upholding the federal healthcare overhaul law, a woman named Patricia is standing outside Florida’s Capitol building. She’s on a tour of the Capitol with a 4-H group.  “I have not investigated it myself, to be honest. My husband is more into that stuff and he gives me an overview," she said.

And while she admits she doesn’t know much about the specifics of the law, she is aware of its main requirement—that people purchase health insurance or pay a fine. “I just know that those that don’t have insurance are probably thinking it’s a really special thing. I mean, I’ve always had insurance. There are lots of benefits for those who need it, but who knows, that may be me tomorrow.”  

There are more than 300 million people living in the United States, and according to the federal government, 16 percent of them are uninsured.  The federal healthcare law attempts to address that by requiring most people carry insurance or pay a fine, or a tax. But there are many questions about WHO will provide that insurance. Will it be the federal government? Private companies? Businesses? The answer is—all of the above.  And that’s where things get tricky.

“The hope was to greatly expand insurance, but it was never realistically suggested that it was going to cover everybody.”  Dr. Marshall Kapp is a professor at the Florida State University College of Medicine. Under the federal healthcare law, programs like Medicaid, which provides support to states to insure low-income people, will expand.  For those who make too much money to qualify for Medicaid, but aren’t covered by their employer, there will be state-run online “marketplaces” called insurance exchanges, where they can buy federally-subsidized plans. Some adults are now allowed to stay on their parents’ insurance plans longer. But even with more people being covered many more will still be without coverage.

“Even with the various subsidies, there are going to be people who make too much money for Medicaid, too young for Medicare, are not employed in jobs where the employer provides insurance, and simply can’t afford to participate," said Kapp.

The federal healthcare law seeks to entice businesses to cover more people. One way it’s doing that is by offering tax credits to those that ensure their employees.

“I was really excited last year when, it turns out, the tax credit I got was on my personal income tax. And I had no idea. So that was really exciting news," said Wendy Halleck owner of Tallahassee’s Quarter Moon Imports store. She has a small staff of employees and insures one of them. While she’s been able to tap into tax credit program, under the law she’s not obligated to provide that health insurance.

That’s because business with fewer than 50 employees are exempt from the law’s penalty tax and are eligible for the credits if they choose to cover their workers. But, the larger the businesses, the less those tax credits will cover. And FSU’s Dr. Kapp says for some employers, it may make financial sense to actually drop employees from their plans.

“Many employers may find it much cheaper economically to pay the penalty  that employers of 50 or more will have to pay if they don’t provide insurance, rather than continue providing insurance. That is supposed to be handled by the exchange system.”  

But if those people turn to the exchanges, they could end up paying more out-of-pocket costs.  Kapp says even when the healthcare law is fully in effect, millions of Americans will still be without insurance, access to services due to a lack of providers will remain a problem, and costs may still rise.But, he also admits, he could be wrong about the whole thing:

“Anybody who predicts what is going to happen is just speculating today. Within a few years, we will have some answers about the accuracy of various speculations, because for better or worse, we’re entering an experiment of which we are all unwilling subjects.” 

The law’s opponents are pushing to get it repealed and the House has scheduled a vote on the matter. Congress could also enact legislation attempting to withhold funding from parts of the law, in effect, starving it. And in November there will be a presidential election, which may determine whether the law stays or goes.