The ACA and Legal Practices (#21) / Representing individuals as health consumers

January 7, 2015

health-care-lawThis is installment #21 in a series of blog postings on the Affordable Care Act (ACA) and legal practices. 

Individuals as health consumers are often confused about the ACA.

This is partly because of the complex nature of the program, partly because of limited educational efforts directed toward the public, and partly because of public resistance.

Attorneys may often need to help individual clients sort out their options.

There is more urgency now, since individual penalties apply for the first time on tax returns to be filed by April 15 of this year, for 2014 income.

Many consumers remain unaware of the individual mandate and penalties, and do not know how to sign up for 2015.

The penalty for 2014 is the larger of $95 per person or one percent of income. The penalty increases for 2015.

This is just part of the larger picture for individuals. Arrangements for health insurance (through an Exchange, or outside of an Exchange) are not easy to set up.

And even for those with insurance through employment, reporting on tax forms may be confusing.

On top of this, there are numerous exemptions in place that allow individuals to sit out the ACA requirements.

Understanding and applying for these exemptions can often be difficult.

And individuals may need to appreciate that health insurance is desirable and they may be best served by signing up.

Anyone who is self-employed in a small company, or who wants to be free to change jobs without worrying about health insurance, or has a pre-existing medical condition may need to see that the ACA has become a “game-changer” that should be assessed (or reassessed).

The drumbeat of criticism about the ACA sometimes produces knee-jerk reactions that prevent personal advantages from being understood.

Individuals often do not realize that subsidies are available, based on income.

Thus, attorneys may find that some individual clients need help in sorting through the entire issue of health insurance and the tradeoffs involved.

Such advice may be similar to recommendations sometimes given to senior clients regarding options to pay for long-term care, and the considerations that need to be weighed.

In order to gain insight into all of these considerations, attorneys may wish to prepare their own explanations of those aspects of the ACA that affect individuals, and list the options that clients may want to discuss.

Advice of this type can help attorneys better meet client needs, and strengthen client relationships.

Recent posts to this blog about representing large employers and small-business employers with respect to ACA issues have appeared in “The ACA and Legal Practices” Reports #19 and #20.

More information about implementation of the Affordable Care Act and associated legal practice issues may be found in recent books on the ACA and on the health care system, other postings to this blog, and on the ACA Blog, also written by the author of this series.