Now that the president has been reelected, Obamacare will not be repealed. So let's take another look.
It does good things for Kentuckians. Children, regardless of where they live, may now stay on their parents' health insurance policies up to age 26. Insurance companies will no longer deny health insurance coverage due to a person's pre-existing medical problem.
People with incomes between 138 percent and 400 percent of the federal poverty level will be able to purchase affordable, high-quality health insurance through exchanges — private health insurance that can be purchased over the Internet.
A family of four with an annual income of $38,820, (138 percent of the federal poverty level), will pay $77 per month for a $1,000 per month policy.
With income of $92,200 (400 percent of the federal poverty level), the family will pay $730 per month. The difference between the $1,000 monthly premium and what the family pays will be rebated to the family through a federal income tax credit.
People likely to purchase insurance through the exchanges are working families who have income above 138 percent of the poverty level but do not have employer provided health insurance or self employed people who cannot afford an individual health insurance policy.
There are some 260,000 uninsured Kentuckians who may elect to get their health insurance through the exchanges.
People whose annual income is below 138 percent of poverty ($15,425 for a single individual) will be eligible for Medicaid. This will insure some 400,000 uninsured Kentuckians who are not eligible for existing Medicaid.
Under the Supreme Court decision which upheld the constitutionality of Obamacare, states have the option of not participating in this Medicaid expansion.
A state would be foolish to exercise this option, because the federal government will pay the entire cost of Medicaid for new enrollees through 2017. Furthermore, the state's share of the cost never exceeds 10 percent. If someone offers to give you $9 if you spend $1, take the deal.
If Kentucky rejects Medicaid expansion, federal income taxes paid by Kentuckians will still help pay for Medicaid expansion in other states. Health-care providers in Kentucky who do treat the uninsured will frequently not receive compensation for their services, and some of the cost of indigent heath care will continue to be passed on to the rest of us.
Even worse, people at the poverty level in Kentucky who would have been covered by Medicaid expansion will not be able to purchase health insurance through the exchanges. They will continue to be uninsured.
Obamacare fills the much reviled "doughnut hole" in the Medicare Part D prescription drug program where there is a gap in coverage between the initial drug benefit limit and when catastrophic coverage kicks in.
Filling the "doughnut hole" will save many elderly and disabled people some $2,000 per year. Medicare will now pay for more preventative services. These are the only changes for people on Medicare.
So, how will we pay for this? The nonpartisan Congressional Budget Office determined that due to savings in health care costs inherent in this comprehensive health care reform, Obamacare will not increase the federal deficit. If we do nothing, the inefficiencies in our current system will increase it.
People without medical insurance face horrible risks. For many, it leads to bankruptcy, failure to get treatment for chronic illness, and an early death. The United States is the only Western democracy that struggles to provide health care for all of its citizens. Let's give Obamacare a chance. It will make our country fairer, healthier and more prosperous.
Richard A. Cullison is executive director of Legal Aid of the Bluegrass.