ACA Help Desk

with Sheldon Weisgrau

Welcome to the ACA Help Desk. We hope you will use this page as a resource to answer some of your questions about the Affordable Care Act. Answers are provided by resident ACA expert, Sheldon Weisgrau. If you have a question not on this page, please submit it using the form in the right column. If it is suitable for a wider audience, we will publish it, along with Sheldon's response.

The best website for information about the ACA is This is also the website where residents of Kansas and Missouri will access the health insurance marketplace.

In addition, you can get information about the law and have your questions answered by calling 1-800-318-2596. Starting on October 1, you can also enroll in insurance coverage by calling this toll-free number.

Information for Kansas residents can also be found at and for Missouri residents at

The health care system in the U.S. does many things well. We have widespread medical technology, plentiful specialty care and state-of-the-art facilities. Despite all this, however, we trail other developed countries in measures of access, quality, and cost.

The U.S. spends at least twice as much on health care as any other nation on earth, yet nearly 50 million people are uninsured and outcomes for many treatable conditions are poor. Our system has much to commend it, but still much room for improvement.

Health care is expensive, so health insurance can be costly, as well. The ACA includes tax credits and other subsidies to help people pay for insurance and health care services. Eligibility for these credits and subsidies depends on income, family size, and other factors. It is expected that most people who purchase insurance in the new marketplaces established under the ACA will qualify for some level of assistance.

One of the ways insurance companies manage their risk and cost is by denying coverage to people with “pre-existing conditions.” If the insurer determines that you’re likely to need a lot of health care services, they may decide that you’re too risky to insure. Alternatively, they may offer a policy to those with pre-existing conditions, but charge a higher premium for it or sell a policy that doesn’t cover certain diseases or body systems. The list of conditions that will get someone closed out of the insurance market is extensive, ranging from high blood pressure to cancer and heart disease.

Under the ACA, insurance companies will be required to sell policies to anybody who wants to buy one, regardless of health status or pre-existing conditions. In addition, they may not charge more to those with pre-existing conditions or exclude diseases or body systems.

Requiring insurers to cover everyone regardless of health status may make the pool of insured people relatively sicker and increase insurers’ risk. As a result, the ACA requires nearly everyone to get health insurance. Including young, healthy people in the insurance pool should mitigate the increased risk of covering those with pre-existing conditions by spreading the cost of care over a larger population.

When the navigator program is fully operational, navigators and other consumer assisters will be available in place such as hospitals, clinics, local health departments, area agencies on aging, and community mental health centers. Other community organizations, such as libraries, senior centers, and social services agencies, may also make space available for navigators to meet with consumers. When the program is operational, navigator locations will be available at and by calling 1-800-318-2596.

In addition, many Federally Qualified Health Centers (FQHCs) have hired staff specifically to help their patients and other consumers understand their options and enroll in insurance in the new marketplace. You can find an FQHC in your area at this website.

Dental coverage for children is considered an “essential health benefit” and will be included in all plans offered in the marketplace. Dental coverage for adults will be available in stand-alone plans and may be offered as a benefit in comprehensive health plans sold in the marketplace.

Your eligibility for plans in the new marketplace is based on place of residence, so you should shop on the exchange of the state in which you live. If you use health care providers located near your workplace, you should make sure they’re part of the network of the plans you consider.

In Kansas, the marketplace will include health plans from Blue Cross Blue Shield of Kansas, Blue Cross Blue Shield of Kansas City, and Coventry. All of these insurers will offer multiple plan choices.

We don’t yet know what companies will offer plans in Missouri.

Medicaid is a shared federal-state program that provides health coverage to some low-income people. The income eligibility requirements are different in each state.

The ACA standardized Medicaid so all people with annual income below 138 percent of the Federal Poverty Level ($15,856 for a single person, $26,951 for a family of 3) would have been eligible for coverage in 2014. In Kansas and Missouri, several hundred thousand currently uninsured residents would have gained insurance coverage under this provision of the law.

The Supreme Court, however, ruled that expansion of Medicaid is optional for states. To date, both Kansas and Missouri have decided not to expand their programs. As a result of these state decisions, many people who would have been covered by insurance under the ACA will remain uninsured.

There is no deadline on state decisions to expand Medicaid and states may revisit this question in the future. If you’re interested in this issue, you may choose to contact your governor and state legislators to weigh in.

A gap between the Medicaid program and the ACA is created when an individual's income is too high to qualify for the current Medicaid program, but too low to qualify for tax credits to help purchase private insurance in the new marketplace (tax credits are available to people with income between 100 percent and 400 percent of the federal poverty level, or $11,490-$45,960 for a single person and $19,530-$78,120 for a family of three). If you fall into this coverage gap, you will still be eligible to buy insurance in the marketplace, but may find it to be unaffordable. In this case, you will be exempt from the mandate to purchase insurance and will not have to pay a tax penalty.

There are no requirements for employers to provide insurance coverage to employees. Some large employers that don't offer coverage that meets certain minimum standards, however, may be required to pay a fine (called a "shared responsibility payment") starting in 2015. This has sometimes been called the "play or pay" requirement.

Businesses with less than 50 employees are not subject to the "play or pay" requirement and are under no legal obligation to offer insurance to employees. If they do, however, they may be eligible for federal tax
credits to help cover the cost.

Starting in 2015, businesses that have 50 or more employees and don't offer insurance coverage to full-time employees will be subject to fines if any of their employees purchase insurance in the new marketplace and receive federal tax credits to help cover the cost.

Extensive information about the ACA and how it affects businesses can be found at this website:

Under the ACA, businesses with 50 or more employees must offer insurance coverage to full-time employees or pay a fine, a so-called "shared responsibility payment." Full-time employees are defined as those who work 30 hours per week or more. There have been reports in the media of some businesses reducing staff hours to less than 30 hours per week to get around this requirement.

Whether these reductions are a direct result of the ACA is difficult to determine. Businesses increase or reduce employment because of many factors, including insurance costs and other costs of doing business. Most
employers do not make these decisions lightly; in addition to the effect on employees, there may also be increases in training and other costs associated with moving workers from full-time to part-time positions.

There may well be some employers who have cut staff hours in response to the ACA. There is little evidence, however, that this is happening on a broad level. State and national labor and economic data do not show any recent increase in part-time versus full-time work. The federal government estimates that less than 1 percent of employees have weekly hours slightly above the 30-hour cutoff, are employed by businesses affected by the employer mandate, and do not already have health insurance.

About Sheldon

Sheldon Weisgrau

Sheldon Weisgrau
Health Reform Resource Project Director

Sheldon Weisgrau is the Director of the Health Reform Resource Project, a foundation-supported initiative to provide education and technical assistance to consumers and other stakeholders in the implementation of health reform and the Affordable Care Act in Kansas. Sheldon has 30 years of experience in health policy and has worked effectively in the public, private, and non-profit sectors to ensure the delivery of health care services in rural and underserved communities and to enhance the knowledge and engagement of health care consumers, providers, and policymakers. Sheldon earned his undergraduate degree from Cornell University and a master’s degree in health policy and management from the Johns Hopkins University School of Public Health.

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