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Health Care: What Now? 

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First, the Affordable Care Act was at the mercy of the U.S. Supreme Court. Then it was left up to a drawn-out presidential race, as Mitt Romney promised he’d repeal it. Now, it’s clear that reform will go forward, and states are expected to make that happen — whether they’re ready or not.

The good news: Washington looks poised to meet federal requirements by 2014. The state Legislature passed laws to start creating an insurance exchange (an online marketplace where people will shop for plans), and it could be available by next October. State exchanges are meant to give residents an easy system for buying insurance and states authority over the providers.

The bad news: Things have been rockier in Idaho, where even Republican attempts to build a state-run exchange didn’t survive the Obamacare-loathing state Legislature. The Idaho Department of Insurance recommended almost a year ago that the state get started on an exchange, but lawmakers didn’t act. Last month, a working group summoned by Gov. C.L. “Butch” Otter came to the same conclusion. With no action by Dec. 14, a federal exchange will take hold. The insurance department warns that could make plans more expensive because the federal government will require more benefits than the state would. If Otter finally decides on a state exchange, Idaho is behind on planning and implementation, and it’s unclear whether they can get it done by 2014.

The cost: Between grants to local governments, employers and community organizations, the feds have spent about $415 million on Washington and $91.5 million on Idaho to help them prepare for reform, according to nonprofit health research group the Kaiser Family Foundation.

What it means for you: Starting in 2014, you’ll be required to have insurance privately or through your employer, according to the law. If you’re uninsured and making $44,600 a year or less, you’ll be eligible for tax credits to help pay for coverage. Make $15,000 or less, and you’ll qualify for Medicaid (expansion is optional for states, but Washington says it will comply and Idaho’s working group recommended the same.) Not into it? The penalty for not having insurance starts in 2014 at $95 per adult or 1 percent of family income (whichever is greater). By 2016, it’ll be $695 or 2.5 percent.

— HEIDI GROOVER

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