Washington — The Supreme Court’s decision last week to uphold most of the Affordable Care Act has renewed political debate over the health care overhaul. But its full impact may not be felt for years.

While some reforms have already been enacted, the very heart of the Affordable Care Act won’t be implemented until 2014, with the debut of state insurance exchanges that aim to give individuals and companies more — and better — coverage choices.

The expansion of Medicaid, the government-run health program for the poor, will make health care accessible to millions across the country who are now uninsured, including about 130,000 in Connecticut.

Subsidies, tax breaks and penalties will also be implemented in 2014 to prod people to buy insurance, for themselves and their employees.

But hundreds of federal regulations must still be written to implement the Obama administration’s boldest initiative, and although politicians are vigorously attacking or defending the ACA, no one can know for sure at this point how it will work.

What is known is that the health care law will touch the lives of most Americans.

Here is how it is already affecting — or likely to affect — some Connecticut residents:

Matthew Hoffman, 23, video editor

Matthew Hoffman benefited from a Connecticut law that allowed him to remain on his mother’s insurance, even after graduating from college. But Hoffman moved to New York to find work. In one of the first provisions implemented after the Affordable Care Act became law in 2010, Hoffman can stay on his mother’s insurance, no matter where he lives, until he turns 26.


Matthew Hoffman stands between his parents, Hank Hoffman and Jane McNichol.

Jane McNichol of Wallingford, Hoffman’s mother, says this provision of the ACA “is seriously good for my peace of mind and my son’s.”

It’s also popular with other Americans.

But if Hoffman doesn’t have a job that offers him insurance when he turns 26, he will be subject to one of the ACA’s most unpopular provisions, the requirement to buy insurance on the open market or pay a penalty.

In 2014, those without health insurance will be penalized $95 or 1 percent of their income, whichever is greater. In 2016, the penalty increases to $695 for an uninsured adult, and up to $2,085 per household, or 2.5 percent of income, whichever is greater.

But the sting of that mandate may be softened for many Americans by subsidies the federal government will offer to lower the cost of health insurance.

Francis Delaney, 59, small-business owner

Francis Delaney owns West State Mechanical in Torrington, a company that helps businesses comply with environmental standards. He employs 15 people and says it’s been a struggle to provide them with health insurance.

“I’m constantly looking for another plan,” Delaney said. “Premiums keep rising every year.”

Small group plans can be very costly, which is why many small businesses don’t cover their employees.

Delaney said he wants to offer his workers health insurance benefits because he wants to attract “quality employees.”

The Affordable Care Act won’t require Delaney to purchase insurance for his workers. But, beginning in 2014, companies that employ 50 or more people will face penalties if they don’t pick up at least 60 percent of the cost of covering their workforce.

Although Delaney won’t be penalized if he drops coverage for his employees — and he may even qualify for some new tax breaks if he continues to provide insurance for his workers — he’s unhappy about the ACA.

“It’s not apparent it does anything to lower the cost of insurance,” he said.

State insurance exchanges required by the ACA to be up and running in 2014 are expected to foster competition among insurers, resulting in better coverage and lower premiums. But these exchanges are untested.

Brittany Allen, 27, health care advocate with a ‘pre-existing condition’

Brittany Allen of Bristol works at a nonprofit agency that helps people with chronic health conditions and


Brittany Allen of Bristol has those dreaded words, ‘a pre-existing condition.’

suffers from one herself.

She’s had rheumatoid arthritis since she was 11 years old. It’s a debilitating disease that’s expensive to treat.

Ironically, she can’t afford the cost of the health insurance offered by her employer.

So she is paying less money, about $650 a month, to continue the coverage she received from her former employer, which federal law allows her to do for 18 months.

By then, she hopes she’ll be able to afford a health insurance plan on the open market, perhaps through Connecticut’s insurance exchange.

It’s almost impossible right now for Allen to purchase an individual health care policy because she has a “pre-existing condition” that results in insurance companies denying her coverage.

But in 2014, insurers will no longer be able to reject people with pre-existing conditions.

The ACA has given me a new life as the legal stigma of a ‘pre-existing condition’ no longer exists,” Allen said.

Even Republicans who oppose the ACA say they want to prohibit insurers from rejecting people like Allen.

The ACA has already helped those with expensive chronic illnesses by forbidding insurers to place annual or lifetime limits on the payout of claims.

Joseph Mingo, 69, retired insurance salesman who hit ‘the doughnut hole’

Joseph Mingo of East Lyme suffers from diabetes, heart problems and other health conditions that cost him hundreds of dollars in medicines each month.

As a Medicare patient, he had insurance coverage for his prescriptions, until he hit the infamous “doughnut hole” — or gap — in coverage in Medicare’s drug program. This year Mingo hit the doughnut hole in May, and he won’t be eligible for Medicare’s drug coverage until he spends $4,700 on medicine.

But the ACA closes that doughnut hole slowly, until it disappears in 2020.

Medicare patients have also received a $250 rebate to help cover the cost of their prescription drugs. And the ACA does something else for Medicare patients who’ve hit the hole: It has cut the price of name- brand drugs in half.

That should help Mingo, whose name-brand diabetes medicine costs about $500 a month.

But Mingo said drug companies have raised their prices so he’s not saving much.

“I was paying about the same years ago without the discount,” he said.

Analysts say the pharmaceutical industry has raised drug prices an average of 9 percent a year since 2009, when Congress began its debate on the ACA.

There is no mechanism in the health care reform law to prevent drug companies from raising prices.

Ana has written about politics and policy in Washington, D.C.. for Gannett, Thompson Reuters and UPI. She was a special correspondent for the Miami Herald, and a regular contributor to The New York TImes, Advertising Age and several other publications. She has also worked in broadcast journalism, for CNN and several local NPR stations. She is a graduate of the University of Maryland School of Journalism.

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