Everyone from the youngest child to the oldest adult could be impacted by the Affordable Care Act.
How much they will be affected, however, will be determined in part by their current state of health and, of course, their age.
One of the largest impacts, however, crosses all demographics: Everyone must invest the effort to make sure they understand the benefits of the different plans and choose the best product for them, said Bryan Bucklew, president and chief executive officer of the Greater Dayton Area Hospital Association.
With the opening of the online marketplaces on Oct. 1 to buy health care plans, the uninsured and self-employed will have more choices and people with insurance from their jobs will have the option to comparison shop if they want.
Start to make an informed decision by understanding the biggest impact the ACA will have on you and your family.
Impact on children and adolescents
One of the biggest changes the youngest will see is an increased focus on wellness and preventive care, Bucklew said.
Under the ACA, most health plans must offer a wide range of preventive care services to children and adolescents at no cost to the patient or their family. That eliminates co-pays or deductibles for these services.
According to the U.S. Department of Health and Human Services, these include immunizations, behavioral assessments, and screenings for autism, blood pressure and vision.
The recent reforms will likely mean that more children will be seen for health services, said Dr. William Cotton, advocacy chairman of the Ohio Chapter of the American Academy of Pediatrics.
Many Ohio children already are eligible for free well-child care, said Cotton, also the medical director of the Primary Care Network at Nationwide Children’s Hospital in Columbus. Well-child care is covered by plans like Medicaid and the Children’s Health Insurance Program.
The health care reforms also might mean healthier babies, said Dr. Robert Lerer. He is the Butler County health commissioner and senior partner at Pediatric Associates of Fairfield, Hamilton, West Chester and Harrison.
If more young women are insured, Lerer said, that could lead to more of them receiving prenatal care when pregnant.
“The only way that I know of that we are going to be able to lower the high infant mortality rate in Ohio … is to improve the health care of women, which includes social, emotional, as well as physical care,” he said.
Impact on adults in their 20s and 30s
A significant change that young adults will see is the ability to remain covered under their parents’ insurance until they are 26, said Dana Engle, chief executive officer of the Rocking Horse Community Health Center in Springfield. Rocking Horse is a federally qualified health center that treats people of all ages.
That eligibility – even if the person is married, doesn’t live at home or is eligible for insurance through their job – might give young adults just starting out after school more options, Engle said.
People in this age group are sometimes referred to as the “invincibles,” said Brent Gambill, an attorney at the law firm Coolidge Wall Co., L.P.A. in Dayton. They can’t imagine getting sick or hurt, and they wonder why they should spend much money on medical premiums.
They are more likely to decline to purchase the coverage that the individual mandate calls for because they look at it from a cost-benefits standpoint, he said.
“Those are the individuals who are young enough, they feel nothing is ever going to happen to them,” said Gambill, who specializes in employee benefits and employment law.
They may compare what they would spend monthly for insurance to the tax penalty for not complying – $95 per year or 1 percent of their income in 2014, with the amounts increasing in the future – and choose the latter.
Some people in this age group who work for a small business with lots of other younger workers could see an initial sticker shock on plan rates, Gambill said, as a result of some underwriting changes made as a part of the ACA.
Although some workers in this age group could see their rates go up initially, he said, they likely will get better coverage. Then hopefully, as competition increases, premiums will be driven lower.
Another element this age group must consider, Bucklew said, is the changes in their living situation. Have they married or had children? These life changes will all factor into which plan will work best for them.
“For them, it’s making sure the health care decision (is) more than just a budget decision,” Bucklew said.
Impact on adults in their 40s and 50s
The Affordable Care Act could change the labor market, said John McAlearney, an assistant professor at Wright State University’s Boonshoft School of Medicine.
Many in their 40s and 50s have significant pre-existing conditions and so they couldn’t easily change insurance plans or purchase benefits on their own. They experienced what is termed job lock, he said, essentially forcing them to keep their current job because if they quit, they would lose benefits.
But there is no reason someone who has well-managed diabetes, for example, shouldn’t be able to start a business, McAlearney said.
They can now find a more affordable individual policy with the reforms that prohibit denying coverage for pre-existing conditions, so he said they can explore other job opportunities, such as starting that business.
While this change will affect all age groups, McAlearney said, it will particularly impact those in their 40s and 50s because they have built up their skills but aren’t locked in to their present job. With the freedom to find a new health plan, this group might just take a chance and go out on their own.
The ACA wouldn’t be the only thing that would cause this change in the labor market. The economy must also be open to small businesses for this to occur, McAlearney said.
Impact on adults 60 and older
The Affordable Care Act will affect those between the ages of 60 and 64 differently than seniors who are 65 and older, said Robert Applebaum, a professor of gerontology at Miami University and director of the Ohio Long-Term Care Research Project.
Those in the younger group who are still in the workforce and have insurance might not see much of an impact. But members of this group who have lost their jobs and have had difficulty finding a new job might be uninsured or under-insured, Applebaum said.
Many of those adults had trouble buying insurance on the open market, particularly if they had any type of health condition, he said. And for adults who retired early and weren’t eligible for Medicare, insurance could be prohibitively expensive. The ability to buy insurance through an exchange will have a significant impact on them, Applebaum said.
In general, most seniors 65 and older will have Medicare and won’t see much change regarding their acute care, he said. However, he noted that the ACA attempts to fix the Medicare prescription drug coverage gap.
On the plus side for all seniors, the Affordable Care Act should give more people access to primary care, Applebaum said. But there could be access difficulties. Most people in medical school now aren’t choosing to be primary care doctors, he said.
“We actually have fewer geriatricians today than we did 10 years ago,” Applebaum said.
Applebaum said it’s also important for this age group to note what isn’t changing: long-term care benefits.
A proposal to provide funding for those services was stripped out, he said, and the Affordable Care Act doesn’t include any major changes to long-term care coverage.
The ACA will require more diligence on the part of consumers because they have more choices to make, Applebaum said.
“Choice is good,” he said, “but it can be overwhelming.”