Thanks to the ACA, the law known as Obamacare, a provision allows young adults to remain on their parents’ health insurance policies until age 26. Dinh, of South Windsor, is covered on her mother’s policy.

“If I lost coverage under my parents, I would not know what to do,” Dinh said. “Chances are I would have to handle medical expenses out of pocket, which would definitely cause a financial strain and make me hesitant to go to the doctor’s unless it is a dire emergency.”

“I am also worried about COVID because the risks are too high under current circumstances to be uninsured,” said Dinh. She’s one of  2.3 million young adults who gained coverage through their parents’ plans under the ACA, according to a Kaiser Family Foundation analysis.

Vyanne Dinh, 21, is a senior at New York University, has health insurance through her mother’s plan.

Striking down Obamacare would have a large-scale impact on the country’s health care system and the lives of millions of people who have gained health insurance coverage through the exchanges and the expansion of Medicaid.  One of the most-popular provisions – protecting people with pre-existing medical conditions – would be eliminated along with coverage for many essential benefits.

The stakes for keeping Obamacare in place are even higher now with the addition of Justice Amy Coney Barrett to the high court, a conservative who could provide the vote needed to overturn it.

“The effects of the Affordable Care Act impacted many parts of the health care system,” said Tiffany Donelson, president and CEO of the Connecticut Health Foundation. “It’s going to be extremely difficult to just patch up a new law if this were overturned. It took years for the Obama administration to work on this. This is one of the things that [people] need to realize. We all gained from the Affordable Care Act.”

Roughly 300,000 people in Connecticut have insurance, in one way or another, thanks to the ACA, Donelson said.

“Our uninsured rates are going to skyrocket, undoubtedly, in our state, if we overturn the ACA at the federal level.” 

— Tiffany Donelson

Everyone benefits when all people can access insurance, said Angela Mattie, professor of management and medical sciences at Quinnipiac University’s Frank H. Netter M.D. School of Medicine.

What’s at stake at the Nov. 10 hearing before the Supreme Court “is extremely significant to our entire population. It’s even more tragic that it’s all under the umbrella of a pandemic,” Mattie said.

Medicaid Expansion

“[Many] people don’t realize that the Affordable Care Act also provided for the expansion of Medicaid,” said Mattie.

In 2010, Connecticut became the first state to expand Medicaid, and Mattie said providing coverage to the most vulnerable populations is more cost-effective than letting them go uninsured in the long run.

“We know that when people don’t have medical coverage, they delay care and end up sicker. And they end up eventually seeking care, because it’s life-threatening, and they end up in a health care facility without any form of payment and we, as a society, end up paying for that,” Mattie said.

As of June 2019, there were 276,885 people in Connecticut who enrolled in Medicaid since 2010, according to the Kaiser Family Foundation. Of those, 243,618 were newly eligible specifically due to the expansion, according to state-level data. Nationwide, about 12 million people in 33 states and in Washington, D.C. became eligible for Medicaid under the expansion, through June 2019.

“Community-based organizations, the ones working with people day in and day out, are extremely concerned,” said Donelson, including federally qualified health centers that serve many on Medicaid. “This is really coming to a head, that there is a good chance the ACA could be overturned, and there is no confidence that there’s a replacement.”

Health Insurance Exchange

Connecticut is one of 15 states that has its own fully run health insurance exchange, Access Health Connecticut (AHCT), which is preparing to launch its eighth open enrollment on Nov. 1.

There are 103,955 Connecticut residents enrolled in plans through AHCT, according to the Kaiser Family Foundation. Of those, 72,767 (70%) receive the Advance Premium Tax Credit, which lets individuals lower their monthly insurance premiums; and 35,304 (34%) receive a cost-sharing reduction that lowers deductibles, copayments and coinsurance.

Enrollment in qualified health plans through Access Health CT is up about 5% from a year ago; enrollment in Medicaid through the exchange is up about 10%, according to Marketing Director Andrea Ravitz.

“This is where we work harder to raise awareness,” she said. “Our mission continues to be to reduce the number of uninsured in Connecticut.”

Nationwide, 10.7 million people were enrolled in insurance through an ACA-created marketplace as of February 2020, according to Kaiser Family Foundation.

Medicare Part D

The ACA closed the coverage gap, known as the donut hole, in Medicare Part D. Prior to the legislation, seniors’ prescription drug coverage dropped off once they hit a certain yearly dollar amount, then kicked back in later.

Without the protection offered by the ACA, seniors could see prescription costs skyrocket, Mattie said.

“When you have to start paying out of pocket and you’re on a fixed income – and these drugs are expensive – you have to start making decisions.”

— Angela Mattie

Some seniors may forego prescriptions, in order to afford rent or food, which can lead to health issues, she added.

Preventive Care

Nationwide, about 150 million people are enrolled in employer insurance plans or individual market insurance plans that must provide free preventive care services, such as annual wellness exams, cancer screenings, and vaccinations under the ACA, according to Kaiser Family Foundation.

“Payment for these types of services will go away” if it’s overturned, said Mattie. “If you decrease the amount of screening, you increase the amount of morbidity and mortality.”

“When people are connected to primary care, overall, they are healthier, because they are getting the consistent care that they need,” said Donelson.

Legislators also passed a law that seeks to reduce the times police officers arrest both the victim and the aggressor on domestic violence calls, or so-called “dual arrests.” And they, in an attempt to close the gender wage gap, passed a bill that prevents potential employers from asking job applicants about salary history.

About that last one, Gov. Dannel P. Malloy said, “This inequity is perpetuated by the practice of asking for salary history during the hiring process, which can disproportionately ensure that women who were underpaid at their first job continue to be underpaid throughout their careers, creating a cycle of poverty and causing real harm to families.”

But let’s give an honest grade for what happened—and what didn’t happen—in the session that ended at midnight May 9.

Connecticut legislators’ effort was a solid C for what they could do for families—or, if we’re feeling generous, maybe a C+. Too many pieces of legislations that could have made a big difference in a small state were left on the table, died in committee, or never got traction.

Perhaps the biggest disappointment was legislators’ failure to pass a paid family leave bill. They also couldn’t raise the state’s minimum wage, which stands at $10.10.

“There was no increase to minimum wage, but we raised the amount before taxes on inheritances take effect,” said Lori J. Pelletier, president of the Connecticut AFL-CIO. “So people making $10,000 a year got left behind, and people who inherit millions of dollars got a break.”

The U.S. is the only industrialized nation that doesn’t offer paid family leave, though employers can offer it at their discretion. Some states, such as New York, New Jersey, and Rhode Island, have gone ahead with the initiative, but not Connecticut. In those states, leaves are administered through disability insurance programs, and funded by employee payroll deductions. While Connecticut is losing its millennials, paid family leave would have been a nice incentive to stay and work in the state. But no.

Khadija Gurnah

“Connecticut MomsRising members were disappointed that our legislature failed to pass a critical paid family and medical leave bill,” said Khadija Gurnah, MomsRising campaign director.

“While we’re disappointed, we won’t give up,” Gurnah said. “We’ll keep working to ensure that all Connecticut families have access to paid family and medical leave.”

Paid family leave would ease a big burden on strapped families trying to live in expensive Connecticut, said Kate Farrar, executive director of the Connecticut Women’s Education and Legal Fund (CWEALF), which pushed hard for the bill.

“Every day women are forced to choose between their paycheck and caring for a sick child or relative or battling their own illness,” Farrar said. “Every day women face harassment in their workplaces. Economic security for women in our state is critical to the well-being of our workforce and prosperity of our state’s economy.”

“I think that this is not a stellar grade this session,” said Karen Jarmoc, president and CEO of the Connecticut Coalition Against Domestic Violence. “I think that there is absolutely more work to do.”

Jarmoc’s organization celebrated the passage of a law that eliminates the state’s 30-year-old “dual arrest” policy, where police can arrest both the victim and the perpetrator in domestic violence incidences. According to a 2017 ProPublica report, since the passage of the law, Connecticut’s rate of dual arrests had risen to about 18 percent, compared to a national average of 7.3 percent. (The rate was even higher, ProPublica said, in towns such as Windsor, where “dual arrests accounted for 35 percent of intimate partner arrests in 2015.” Ansonia’s rate was even higher at 37 percent.)

Jarmoc’s organization also was able to push through an increase in the marriage surcharge. People who apply for marriage licenses will pay $35 as opposed to $20, said Liza Andrews, the coalition’s director of public policy and communications. The extra money will generate roughly $646,000 for 27 domestic violence agencies around the state, Andrews said.

Lori J. Pelletier

And those Affordable Care Act benefits the legislators codified are vital and include emergency services, maternity and newborn health care, mental health and substance use services, prescription drugs, preventive and wellness services, chronic disease management, contraceptives, and pediatric services, including oral and vision care.

“I don’t think they failed,” Pelletier said. “But I don’t think they achieved what they could have. They could have tried harder.”

Susan Campbell is a distinguished lecturer at the University of New Haven. She can be reached at slcampbell417@gmail.com.

“I don’t have a generator—another one of my nightmares,” she said. Downstairs is a full waiting room. A loss of power would be disastrous.

But that is not the only nightmare that haunts the sick and those who provide for them these days. Without enough support, the American Health Care Act—the benighted Republican attempt to replace the Affordable Care Act—was eventually pulled by House Speaker Paul Ryan. Earlier, the Congressional Budget Office said the bill would result in the loss of insurance for 24 million people over the next 10 years. Ryan says his party will continue to push for reform, and prior to this week’s break for Congress, he and other GOP leaders announced that some tweaking had strengthened the failed bill.

But tweaking won’t be enough.

Lagarde said roughly a quarter of her center’s clients are uninsured. The AHCA would have pushed that figure to closer to 40 percent, she said.

But the battle isn’t over. And defending Obamacare is not the country’s only option.

Trump says he will move on to tax reform, but look at his proposed budget, which the press is calling a “skinny budget” for its lack of specifics. A better characterization would be “inhumane” for its potential effect on people such as the ones being treated at Fair Haven, a mid-sized community health care provider that serves a large immigrant population. The battle is not over.

If a budget is a moral document, then President Trump has some explaining to do.

To provide a $54 billion boost to military spending, Trump’s budget cuts funding for services that provide food and health care for the most vulnerable, including children, women, and the elderly. Many of the programs provide preventive care, which is known to provide better (and less expensive) health outcomes.

This all feels like we are arguing about something that was already settled—health care is a human right—so maybe it’s time to settle this once and for all.

With the Republicans’ defeat still stinging, now is the time for Democrats and Republicans to vote for a single-payer health care system. Medicare and Medicaid are basically universal health care lite for particular populations, but it’s time to think about some serious expansion. Organizations such as the Physicians for a National Health Program have long been pushing for a program reflected in a bill proposed every year since 2003, and dubbed “Medicare for All.” As a recent article from The Nation said, Americans have a choice between Obamacare, where “insurance companies made out like bandits,” or Trumpcare, where they could have expected the same.

Many developed countries, including Canada and the U.K., and some of the United States’ historic allies, have a single-payer health care system. In March, America’s Health Insurance Plans, the trade group for health insurance companies, published a chart that showed where money spent on premiums go. Nearly 18 percent of every dollar spent on premiums goes to operating costs. In 2015, administrative costs for traditional Medicare insurance plans for seniors and people with severe disabilities was closer to 1.5 percent.

The bill, which is sponsored by Rep. John Conyers (D-Mich.), is a step in the right direction. Even some of Trump’s trusted advisors agree. Some states have taken it upon themselves to move toward single-payer, including Connecticut in 2007. Two years ago, New York’s state assembly, in a largely symbolic vote, approved a single-payer health care bill. California voters, too, have been discussing something similar.

But the time for symbolism is over. The time for hanging someone’s health on the whims of the marketplace—or the largesse of whatever party is in power—is over. Single payer, and single payer now.

Susan Campbell is a distinguished lecturer at the University of New Haven. She can be reached at slcampbell417@gmail.com.

“My wife gets sick and I don’t have a clue how to navigate,” Greg Butler said. “This stuff is enormously complicated. What does your insurance cover? Or not? How do you appeal this stuff? How do you find the right specialist?”

In July 2015, the Connecticut Health Foundation, where Butler serves as board chair, funded a study that showed that community health workers, or CHWs, could help simplify certain parts of the health care system, and they serve a much-needed role that highly trained medical professionals, such as doctors, can find challenging.

“They know that Mrs. McGillicuddy is on insulin, and they can make sure she’s taken her insulin today,” said Greg Butler. “They know that Mrs. Hernandez’s kids have asthma, and they can make sure she’s vacuuming under the couch.”

Community health workers connect patients with proper medical care.

A doctor can talk to a patient about the importance of proper diet, but a CHW is in the community already, and knows the patients, the culture, and the language. CHWs are health care workers who deliver more than basic medical care. They can connect patients with the proper medical care as needed, and they can influence a patient’s behavior for long-term benefits.

“They must have training but we cannot over-professionalize the CHW,” said Patricia Baker, Connecticut Health Foundation president and CEO. “They are the bridge between community and clinical care. They should be used in a targeted manner such as supporting complex patients.”

CHWs already have had some credible effects on underserved communities throughout the country.

Connecticut has had CHWs for a while, Baker said. They’ve been called navigators, patient advocates, and outreach workers. One Massachusetts study said CHWs go by as many as 50 different titles. The foundation has long supported CHW programs, but Baker said they’ve shifted their attention to more systemic investments. Otherwise, programs end when grant money runs out, Baker said.

The non-profit Project Access in New Haven uses CHWs to great success. Founded in 2009 by local physicians to overcome inequality of health care, 73 percent of Project Access patients are Hispanic or Latino; 63 percent are female; and 78 percent have a high school education or less. All the agency’s patients are poor, and all are uninsured. Community health workers are critical to the success of the program, Baker says.

Baker says the recent election of Donald J. Trump, who has promised to dismantle some or all of Obamacare, shouldn’t affect CHW programs.

“Even states that are considered red,” such as Texas, “are utilizing CHWs in their Medicaid Managed Care plans so this work is happening,” Baker said. Research shows that the workers curb health care costs, and deliver better health outcomes.

A 2012 American Cancer Society study found that community health workers generate lifetime benefits of $12,348 per person served, or $851,410 for every CHW who serves at least 69 individuals a year. The benefits come in the form of more taxes paid by people who live longer, as well as savings from a reduction in the use of emergency or urgent care facilities. Every $1 invested in a CHW yields $2.33 in return, according to the study. A similar study in Denver yielded the same results.

In Baltimore, a CHW intervention program saved an average of $2,245 per patient, for a total savings of $262,080 for 117 patients. The study said the intervention program also gave the patients a better quality of life.

The program works, and members of a state community health worker advisory committee within the Office of the Healthcare Advocate are studying what should be their training, promotion, and certification process. As of a year ago, 15 states had established or were moving toward establishing their own certification process. In neighboring Massachusetts, training includes 80 hours in the class, though for now, credit is given for work already completed. That pathway will be eliminated within the next few years.

In short, this is an approach the works. It saves money. It gives patients a shot at better outcomes. As we feel our way through the next few uncertain years, we could use a community-based program like this.

Susan Campbell is a distinguished lecturer at the University of New Haven. She can be reached at slcampbell417@gmail.com.

Some of this is pure conjecture, since Trump’s policy talks have been notably short on details. Trump has, however, repeatedly said he intends to repeal most of the Affordable Care Act, or Obamacare, which would have grave effect on hundreds of thousands of families, if not more.

Since 2010, the ACA has cut in half the number of uninsured citizens to a historic low of 8.6 percent of citizens, or 27.3 million people . A 2015 Congressional Budget Office study said that repealing the program would eliminate insurance coverage for about 22 million in 2017, and coverage of birth control and critical prenatal care might no longer be offered.

The study also said that the repeal of Obamacare could increase the federal budget deficit by some $137 billion by 2025, a conjecture that has been lost in the discussion.

Obamacare is not without its challenges. Recently, some insurance companies announced they were backing out because they weren’t making enough money. Simply, old and sick people in need of insurance coverage are signing on faster than are young, healthy people. Insurers that have stepped back include Hartford’s Aetna —and here is more on that company’s healthy quarterly earnings. Industry watchers predict rate hikes for roughly 10 million people who are insured through health exchanges in their states, such as Connecticut’s Access Health CT.

That’s a fixable speed bump, but one that Trump seized upon in his campaign. He called Obamacare a “horror,” and promised to repeal and replace it with a program that will push the vulnerable to suckle at the dry tit of the marketplace.

iStock Photo.

Coverage of birth control could be eliminated if the ACA is repealed or amended.

And how will the marketplace treat women? If history is a teacher, prior to Obamacare, women were subject to something called gender rating, where companies on the individual insurance market considered gender when setting premium rates. Women could pay more—sometimes one and a half times more—than men for the exact same coverage. Obamacare eliminated that. Without laws in place—and Trump has shown a disdain for government regulation—the insurance industry could revert to the bad old days, where being a woman costs more—medical care-wise—than being a man.

And what of features such as domestic violence screenings, now included in the ACA? That’s any one’s guess. Again, we’d look to the marketplace for succor.

Even without repealing Obamacare, Trump could eliminate coverage of birth control—one of the ACA’s most popular features—without the input of Congress. All that requires is a request to the Department of Health and Human Services for what means preventive health benefits for women, which by the current administration’s definition includes contraceptives.

As for reproductive rights, Trump says he’s anti-abortion and late in the campaign moved even further into the anti-abortion camp by affirming his support of the Hyde Amendment. Last March, he told MSNBC he believed that women who get abortions should be punished. Trump soon amended that statement to say that he meant the doctors who perform abortions should be punished.

Trump said he intends to appoint Supreme Court justices who will overturn Roe v. Wade—unless, of course, the Democratic Senate serves up the same kind of obstructionism their Republican colleagues have since the March nomination of Merrick Garland, the District of Columbia federal judge who’s been in limbo as Republican after Republican has blocked his appointment.

But if you are not a Trump supporter—or if you simply favor a progressive future—take heart. A 2014 study said that the more heated a campaign, the more effusive politicians become with their promises. The study also said that promises aren’t just talk. On average, politicians fulfill roughly 60 percent of their promises, but that’s contingent on constituents pushing them to live up to their word. In the end, it just may come down to who pushes harder.

Susan Campbell is a distinguished lecturer at the University of New Haven. She can be reached at slcampbell417@gmail.com.

Now in its fourth year, the state’s health insurance marketplace looks different than it has in the past. Most notably, it has only two insurance carriers, ConnectiCare and Anthem, instead of four.

State insurance regulators approved a 17.4 percent increase in ConnectiCare’s rates for exchange plans and approved a 22.4 percent rate hike for Anthem’s plans.

With the high-profile departure of UnitedHealthcare from the exchange and health insurance co-op HealthyCT going out of business, consumers will no longer be able to enroll in those plans.

Open enrollment begins Nov. 1.

That means consumers currently enrolled in UnitedHealthcare and HealthyCT plans must find alternative options by Dec. 31. The exchange currently has about 9,500 people enrolled in HealthyCT and 1,800 in UnitedHealthcare plans, according to AHCT officials.

AHCT officials expect the exchange to enroll 125,000 consumers in plans during the upcoming open enrollment period that runs Nov. 1 to Jan. 31, up from 116,000 last year, said Andrea Ravitz, marketing director.

Of those currently in plans bought on the exchange, 60 percent are enrolled in either ConnectiCare or Anthem, which should soften the blow of other carriers leaving, she said.

Still, she said, “We want to make sure that people understand that if they chose [UnitedHealthcare or HealthyCT] in the past, those companies are no longer a choice.”

The Marketplace

AHCT is the online marketplace created by the Affordable Care Act (ACA), sweeping health care reform legislation that requires most Americans to have health insurance or pay a penalty.

During open enrollment people without coverage can shop for insurance plans and those with coverage can renew or change their plans.

For 2017, consumers can shop on the marketplace for plans offered by ConnectiCare and Anthem. Open enrollment runs Nov. 1 through Jan. 31, but individuals must enroll in plans by Dec. 15 if they want coverage to begin Jan. 1.

After open enrollment ends Jan. 31, consumers can sign up for 2017 coverage only if they have a qualifying life event, such as loss of insurance, marriage or the birth of a child.

Consumers can apply online, call AHCT at 855-805-4325, get in-person help, or use AHCT’s free mobile app for smartphones or tablets.

AHCT call centers are being operated by a new vendor, Faneuil Inc., which Ravitz said should result in better customer service. The vendor was chosen following an open-bid process that included prior client recommendations, among other things. AHCT hired Faneuil in September.

Also new this year, Faneuil is hiring about 20 insurance brokers to help consumers by phone and in person at enrollment centers. In previous years, insurance carriers had incentivized brokers to enroll consumers in exchange plans by paying them a commission—about $16 per member per month—but the carriers are no longer paying those commissions, Ravitz said, so AHCT has devised a short-term plan to give consumers access to brokers.

Photo Provided By ConnectiCare.

ConnectiCare opened a health insurance store in Manchester.

As in the past, plans are organized into bronze, silver, gold and platinum categories, and consumers should compare plans to see what works best for them. Platinum plans, for instance, typically have higher premiums but lower out-of-pocket costs whereas bronze plans have the lowest premiums but highest out-of-pocket costs.

While most people have to wait until Nov.1 to enroll in plans, enrollment in Medicaid (HUSKY) and the Children’s Health Insurance Plan (CHIP) is open year-round to eligible people and families.

Paying The Price For No Insurance

As in previous years, people who don’t have health insurance will face fines in 2017 but they are not increasing over 2016. Most people without coverage in 2017 will pay either 2.5 percent of their yearly household income or $695 per person ($347.50 per child under age 18), whichever is higher.

Consumers will pay the fine on the federal income tax return they file for the year in which they lack coverage. Most people will file 2017 returns in early 2018, and will be asked on their returns whether they had insurance coverage in 2017.

There are some exemptions but the vast majority of consumers need insurance to avoid a fine.

Consumers faced the same fines for lacking coverage in 2016, but those fines were higher than the previous year. In 2015, consumers with no coverage paid 2 percent of yearly household income or $325 per person ($162.50 per child), whichever is higher.

While there are no liens, levies or criminal penalties for failing to pay the fine, those who don’t pay will see it deducted from future tax refunds.

For more information on the Affordable Care Act click here.

Access Health CT (AHCT), now in its third year, enrolled close to 100,000 individuals in private insurance plans in its first two years, according to Andrea Ravitz, director of marketing. About 500,000 enrolled in Medicaid through AHCT, during the first two years.

The marketplace aims to enroll between 105,000 and 115,000 in private plans by the end of open enrollment, Ravitz said. AHCT concentrated on attracting new enrollees its first two years but this year it has been focusing on retaining enrollees, she added.

Consumers, particularly those who are uninsured, may have noticed AHCT’s increased marketing efforts.

AHCT has increased its public awareness campaign, she said, including identifying 640 “community influencers” at more than 330 locations across the state to help spread the word. Those people include politicians, teachers, nurses, faith-based leaders and others within various communities that have a large uninsured population, she said.

The organization also reached about 270,000 people during the summer, when representatives attended dozens of community events statewide as part of a campaign to boost awareness, Ravitz said.

The Marketplace

AHCT is the online marketplace created by the Affordable Care Act (ACA), sweeping health care reform legislation that requires most Americans to have health insurance or pay a penalty.

During open enrollment, which runs from Sunday through Jan. 31, people without coverage can shop for insurance plans and those with coverage can renew or change their plans.

For 2016, consumers can shop on the marketplace for plans offered by Anthem, ConnectiCare, HealthyCT and United Healthcare. Coverage begins as early as Jan. 1, but those who want coverage to start on that date must enroll by Dec. 15.

Consumers can apply online, call AHCT at 855-805-4325, get in-person help, or use AHCT’s free mobile app for smartphones or tablets.

As in the past, plans are organized into bronze, silver, gold and platinum categories, and consumers should compare plans to see what works best for them. Platinum plans, for instance, typically have higher premiums but lower out-of-pocket costs, whereas bronze plans have the lowest premiums but highest out-of-pocket costs.

While most people have to wait until Sunday to enroll in plans, enrollment is open year-round to people who have experienced a qualifying life event, such as the birth of a child, a death in the household, a marriage, or a loss of coverage.

Also, enrollment in Medicaid (HUSKY) and the Children’s Health Insurance Plan (CHIP) is open year-round to eligible people and families.

The number of insured Connecticut residents is on the rise, according to U.S. Census Bureau figures and AHCT.

AHCT officials said earlier this month that an analysis by the marketplace found 3.8 percent of Connecticut residents are uninsured this year, down from 4 percent last year.

Census figures paint a slightly different picture, but still show steady improvement in the state. The Census estimates 7 percent of Connecticut residents lacked health insurance in 2014, down from nearly 10 percent in 2013, according to data released in September.

Paying The Price For No Insurance

Those who don’t have health insurance will face heftier fines in 2016. Most people without coverage in 2016 will pay either 2.5 percent of their yearly household income or $695 per person ($347.50 per child under age 18), whichever is higher.

Consumers will pay the fine on the federal income tax return they file for the year in which they lack coverage. Most people will file 2016 returns in early 2017, and will be asked on their returns whether they had insurance coverage in 2016.

There are some exemptions but the vast majority of consumers need insurance to avoid a fine.

In 2015, consumers with no coverage will pay 2 percent of yearly household income or $325 per person ($162.50 per child), whichever is higher.

While there are no liens, levies or criminal penalties for failing to pay the fine, those who don’t pay the fine will see it deducted from future tax refunds.

Update And Compare Plans for 2016

People enrolled in the health insurance marketplace can re-enroll or choose a new plan for 2016.

Consumers should update their income and household information for 2016 and review all new insurances plans and pricing.

Even those who plan to keep their current plans should update their household information; it’s the only way to ensure any tax credits they may be eligible for in 2016 are accurate. Consumers can update household information as soon as Sunday.

Plans and prices change each year and those who don’t research 2016 options may spend more than they need, get an outdated premium tax credit or be enrolled in a plan for which they are no longer eligible. Some may mistakenly get a higher tax credit than they qualify for, meaning they will have to pay back some or all of it when they file federal taxes.

“Go check your options,” Ravitz said. “There could be some extra savings.”

Rules Changing For Businesses

Under the federal law, employers with 50 or more full-time-equivalent employees must offer their full-time, eligible workers “minimal essential coverage” that is affordable, or face penalties.

Starting in 2016, however, “how you count those employees is different,” said Ken Comeau, senior vice president of the Connecticut Business & Industry Association. The change could result in businesses having to offer coverage to more workers.

Currently, businesses must provide insurance coverage to full-time workers if they have 50 full-time-equivalent employees, which historically has referred to those who work full time. But beginning Jan. 1, businesses must calculate their full-time-equivalents by taking into account all full-time workers and prorating hours worked by part-time employees, Comeau said.

The change will impact businesses that have few full-time employees but many part-timers, such as restaurants, he said. Full-timers work 30 hours a week or more; part-timers work fewer than 30 hours.

Additionally, through this year, businesses with 50 to 100 full-time-equivalent employees that haven’t offered the required coverage haven’t been penalized. But as of Jan. 1, that “transitional relief” disappears and businesses not complying with the law may face penalties, Comeau said.

Sources: Healthcare.gov, Access Health CT, Connecticut Business & Industry Association

The doctor was better known as an apothecary, as a nod to his main function of dispensing medicine, but for the most part in those days health care was delivered by the women of the family. Only when herbs and home remedies didn’t work were “bone-setters,” or surgeons and physicians such as Jepson, summoned. Treatment might involve bloodletting, which is exactly as it sounds.

Preventive care—the standard for today’s medicine—has a spotty history in this country. Even after medical care began more institutionalized in the 1800s, curing disease took precedent over avoiding it. Other than an occasional nod to the importance of sanitation, scant little attention was paid to preventive care, at great emotional and financial cost to the culture.

For a stark example, see the R.J. Reynolds advertisements from the ’40s that included white-coated men and the legend “More doctors smoke Camels than any other cigarette.” The ad seems tragically ironic today. In fact, the makers of Camel cigarettes, in a nod to their product’s lethality, recently banned smoking in their offices.

Until the fairly recent past—say, the 1950s—good health was considered the result of good genes and good luck.

Today, Jepson’s home is gone, and he would not recognize medical care in his state with well-woman visits, clinical screenings, and checkups performed to prevent disease.

For the most recent leap forward in preventive care, thank Obamacare. For all the arguments about its implementation—arguments that continue—President Obama’s signature health care law has reinforced the importance of good preventive medical care.

The numbers have said that for a while. The Centers for Disease Control and Prevention says that with the proper clinical preventive care, more than 100,000 lives could be saved every year. Last year the CDC released a report that said as many as 40 percent of the nearly 900,000 Americans who died from the five leading causes of death suffered from deaths that were preventable. Those five causes are heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries. Together they accounted for 63 percent of all U.S. deaths.

The takeaway? With a change in behavior, a significant number of people can live longer. Add to that regular visits for checkups and screenings, and you can add years to your life.

Since the implementation of Obamacare—known officially as the Affordable Care Act—and its mandates of certain free preventive services, young women have sought more dental care and routine checkups. Since the law’s implementation, women have saved an average of roughly $250 a year on birth control. And women continue to push for annual mammograms, despite a recent recommendation from the U.S. Preventive Services Task Force that suggested, instead, that women can get fewer mammograms.

Women’s embrace of the Affordable Care Act’s deep preventive push is stunning, in part because the idea of preventive care for women is relatively new, according to a 2011 study published in Harefuah, the Israeli equivalent of our JAMA: The Journal of the American Medical Association. In fact, including women in clinical trials is relatively new as well. For generations, studies focused on the male model.

Obamacare covers a host of preventive services when in-network providers provide them. Those services range from anemia screenings for pregnant women, mammograms, certain contraceptives, and well-woman visits for women under age 65. (For more on that, the Henry J. Kaiser Family Foundation has a nifty website that outlines all the preventive services covered by private health plans under the law.)

If bloodletting and discussion of the body’s humors are a thing of the past, perhaps preventive care—as old as medicine, as new as Obamacare—is here to stay.

On Oct. 7, the Conn. Health I-Team, in collaboration with ConnectiCare, is hosting a forum, “Get Health Wise: The Benefits of Preventive Care,” from 5:30 to 7:30 p.m. at the Artists Collective, 1200 Albany Ave., Hartford. The keynote speaker is Dr. Jewel Mullen, commissioner of the state Department of Public Health. Admission is free. You can register here.

Susan Campbell is a distinguished lecturer at the University of New Haven and the Robert C. Vance Chair for Journalism and Mass Communication at Central Connecticut State University. She can be reached at slcampbell417@gmail.com.

But then, Connecticut residents had a relatively easy time the first go-round, even while the federal exchange’s website crashed beneath the weight of would-be applicants.

If enrollment is easier all around this time, the law itself faces some of its toughest challenges. The Supreme Court will hear a case that will examine the legality of important federal subsides that help low- and middle-income Americans pay for policies in states that haven’t set up their own exchanges. At issue is the law’s language that refers to subsidies being paid in exchanges “established by the state.” Roughly 4 million people receive those subsidies.

This is serious business for states without exchanges, but not so for Connecticut, where we have the much-lauded Access Health CT. The state’s official insurance marketplace was the subject of a Harvard Business School case study, and the left-leaning Center for American Progress produced a video titled “Affordable Care Act Enrollment: Lessons From Connecticut.” The process has been simple, and the exchange is doing what it’s supposed to do. According to Access Health CT, a little more than half – 54 percent – of new exchange customers did not have insurance beforehand.

All this is going on in an economic environment where incomes have remained stagnant or worse, while health care costs have been going up. Caught in the middle are some of the most financially vulnerable state residents. A new report from The Commonwealth Fund says that people who earn low incomes actually pay the most, percentage-wise, out-of-pocket expenses for health care. In fact, in the last decade, all of us have been paying more for health care. From the report:

• More than 20 percent of adults aged 19 to 64 paid 5 percent or more of their incomes on out-of-pocket health care costs. That figure does not include paying for premiums.

• Of that same age group, 13 percent paid more than 10 percent in out-of-pocket costs. That figure doesn’t include premiums, either.

• Three of five adults with low incomes and half of those with moderate incomes say their high deductibles present a hardship.

During a year when hourly wages for workers across the economic spectrum have dropped, insurers have continued their decade-long trend of requiring more cost-sharing by consumers – in part to discourage customers from seeking unneeded health care. But high deductibles and co-payments have actually had a far more damaging effect. The report said that adults who are struggling financially – despite the gains made with Obamacare, or the Affordable Care Act – end up delaying medical procedures because they simply can’t afford them.

Can Obamacare change that equation? Opponents of the law like to worry over its complexity, but much of that comes from, as Mother Jones’ Kevin Drum says, the “sausage-making process” of getting the law passed in the first place.

The Affordable Care Act was supposed to make insurance coverage accessible and affordable for everyone, but nothing happens in a vacuum. Unless something is done about wages and health care costs, the already troubled landmark law could have scant impact on the health of the nation.

As the Commonwealth report said, nearly 400 pages of the Affordable Care Act are devoted to improving the quality of health care, and bringing down costs to consumers. Those pages are directed at improving Medicare, and we can only hope that some of that innovation and cost-savings will affect the rest of the system, too.

That’s if you’re white.

If you’re African American, your healthy life expectancy drops to 12 years, or age 77. And from other studies, Hispanics and Latinos don’t fare much better.

Connecticut faces what people are calling a silver tsunami – a state with a rapidly aging population which presents a potential drastic drain on public resources. Sadly, the tsunami will crash onshore with the same racial disparity in health as exists in housing, in wages, in nearly all measurable marks of well-being in one of the country’s wealthiest states. In 2010, the Connecticut Health Foundation published a study that looked at a decade of efforts to achieve health equity in the state, and said Connecticut “still has a long way to go” – so long, in fact, that the foundation recently announced it would shift its focus strictly to health equity.

A 2009 report by the state Department of Public Health said that even while Connecticut is becoming more racially diverse, there remains “striking” inequalities that result in a mortality rate among African American residents that was 1.2 times higher than that of Caucasian residents. African American residents of Connecticut don’t live as long as their white neighbors, and they’re not as healthy.

According to the study, for the time period studied (2000-2004), the leading cause of death among all Connecticut residents was heart disease, followed by cancer and stroke –illnesses that can be heavily influenced by social factors such as access to healthy food. Diabetes was the seventh leading cause of death, but compared to Caucasians, diabetes was the cause of death 2.5 times more often among African Americans, and 1.5 times more often in Hispanics. African Americans were nearly four times more likely to face amputation as an effect of diabetes; Hispanics were 3.1 times more likely.

The list goes on, from an unequal amount of screenings, tests, and well-patient doctor visits – all of which factor into mortality rates. Add to that subsequent research on the effect of housing, neighborhood safety, fair wages and jobs, and transportation, and you have a recipe for gross inequality that cuts lives short – or hampers the later years with health maladies that are utterly preventable.

The immorality of that imbalance is staggering, but let’s look at some numbers.

Nationally, health care inequity among races will cost $300 billion by 2018, according to the Urban Institute. The Connecticut Commission on Health Equity, created by legislative mandate in 2008, is particularly attuned to the disparity between races and ethnicities among people living with HIV/AIDS, diabetes, cancer, cardiovascular disease, and asthma, as well as the consequences of low-birth weight. By not paying attention, a recent report from the commission says the disparity creates a “significant” financial burden to the state, as well as to the patients and their families.

The same inequality exists throughout the country, according to a healthy life expectancy study published recently in the Centers for Disease Control and Prevention’s journal, the deliciously-named Morbidity and Mortality Weekly Report.

In every state except New Mexico and Nevada, Caucasians could expect a longer healthy life than African Americans. (No other races were included in the study.)

Healthy life expectancies after age 65 were lower in the south; Mississippi had the shortest, at 10.8 years. The average healthy life expectancy was 14, said the study’s lead correspondent Man-Huei Chang.

Obamacare is supposed to level the playing field for health care access, but officials in other states have approached the landmark legislation with varying levels of enthusiasm. Connecticut was among the first states to opt in to Medicaid expansion.

For all the questions surrounding the historic Affordable Care Act, if it’s going to work anywhere, let’s hope it works here.