No, Obamacare Doesn’t ‘Start’ Oct. 1, But Here’s What Changes

In this March 23, 2010, file photo, President Obama signs the Affordable Care Act. (J. Scott Applewhite/AP)

In this March 23, 2010, file photo, President Obama signs the Affordable Care Act. (J. Scott Applewhite/AP)

By Georgia Feuer
Guest contributor

“I heard the ACA is starting October 1st,” an acquaintance mentioned the other day.

I was confused. The Affordable Care Act — better known as Obamacare — is a massive law with wide-ranging effects all throughout the health-care system and many, many start dates; in fact, 65 start dates have already passed. They include the start date for letting young adults up to age 26 stay on their parents’ insurance; for progress towards closing the Medicare drug coverage gap; and for money to explore health care delivery reform through creation of the Center for Medicare and Medicaid Innovation.

So what was she referring to when she said “the ACA is starting Oct. 1st”?

When I google “Obamacare”, it becomes clear that right now, the word is synonymous with just one aspect of the health care act, the section that calls for the creation of health insurance exchanges. Oct. 1, 2013, marks the opening of these health insurance exchanges; marketplaces where John Q. Public can shop for and enroll in a health insurance plan that will provide coverage as of Jan. 1, 2014. He cannot be denied coverage and the amount that he pays for this coverage cannot be influenced by his current health status (although he can be charged more if he is a smoker).

(You may also want to check out today’s Here and Now which answers many questions about Obamacare.)

Health care consultant Georgia Feuer (Courtesy)

Health care consultant Georgia Feuer (Courtesy)

Every state will have its own exchange, which may be run by a state agency or a federal agency, but in some states, information about the exchange can be hard to come by. The reason: controversy over Obamacare is abundant, and one tactic used to derail Obamacare involves preventing people from hearing about how the law might positively affect them.

A USA Today story about Oklahoma Republicans resisting efforts to help people navigate the new exchanges also helps to explain why ignorance about aspects of the law remains so high. For example, only 49% of people polled in a recent survey knew that federal subsidies will be available to help low-income residents buy health insurance5.

Alongside the opening of the exchanges comes the option for more people to enroll in Medicaid. However, many states have not opted into the Medicaid expansion, despite evidence that the expansion is in a state’s financial best interest. One of the consequences of not expanding Medicaid is a cost gap, depicted below, that I refer to as the “Sorry, you aren’t making enough money to qualify for assistance” conundrum:

(Courtesy of Georgie Feuer)

(Courtesy of Georgia Feuer)

Here in Massachusetts, we’ve already had a health insurance exchange for some time: over six years, in fact. So what does Oct. 1 mean for us?

There are changes coming to our exchange, called the Health Connector, such as…dental plans! Starting Oct. 1st, consumers will be able to select from a variety of dental plans to supplement health insurance. Another new benefit is that people with incomes at 300-400% of the federal poverty level, who previously did not qualify for assistance, will now have access to a health insurance subsidy, which will be seamlessly applied when enrolling through the Health Connector. Four hundred percent of the federal poverty level means a yearly income of about $46,000 for an individual.

Massachusetts is getting more money from the federal government to fund MassHealth and health insurance subsidies. In order to incorporate this money, the Health Connector is going through a reshuffling, changing the names of programs and implementing a new website that will direct visitors to the plans that they are eligible for.

Unfortunately, this means that about 150,000 current enrollees in Health Connector plans will have to visit the Health Connector website and enroll in a new plan by Dec. 23 in order to have coverage in January. This is why organizations like Health Care for All are working on outreach campaigns to boost enrollment.

I can understand why the headlines would say “the ACA starts October 1.” The exchanges are the aspect of the ACA that may have the largest impact on consumers. And it sounds a lot snappier than “Enrollment for a way to buy health insurance and some money to pay for it starts Oct. 1.”

You can visit the Massachusetts Health Connector at and find links to exchanges in other states at NPR answers some Obamacare questions here, and Kaiser Health News has a guide to health insurance exchanges here.

Readers, if you have lingering questions or concerns about Obamacare, please post them in the comments section below and we’ll consider them for future posts. And if you’re feeling confused, you’re in a lot of good company. For some comic relief, you might want to check out CommonHealth’s over-the-top radio soap opera on how federal health reform affects Massachusetts, Married to Obamacare.

Georgia Feuer is a health care consultant in the Boston area. Her website is and you can follow her on Twitter at @GeorgiaFeuer.

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  • Michal U

    Greetings from Germany , guys did you ever read the Book of revelation ? Read the chapter 13, just type in Google : revelation 13-16-18
    i just want to warn you not to take this obamacare ,


  • Martin Thompson

    I’ve checked on these affordable coverage plans and who decides that 350. dollars is affordable for the majority. That is with a 3000. dollar deductible, no prescription coverage “liability” type coverage. To me its not worth it, but I will be forced to have it, pay for it. Just another way to put the middle class in jeopardy.

  • Banannamom

    B/C I am disabled, I qualify for MA Health. But over the last five years, they have eliminated virtually all Dental benefits. What will the Dental Ins. coverage for MA Health be under the ACA?

  • Georgia Feuer

    Response to Charlie Crowder: You are correct. There is no gap in financial assistance for low income Massachusetts residents. The diagram refers to states that opt out of the Medicaid expansion. In these states, people with incomes below the eligibility for federal subsidies and above the eligibility for the state’s existing Medicaid program will have no financial assistance for purchasing health insurance. You can read more about the coverage gap here:, all states were required to expand Medicaid. The Supreme Court changed participation in the Medicaid expansion to voluntary.

  • queenofzeegeeks

    Great job, Georgia :)

  • Charlie Crowder

    Ms. Feuer chart is very misleading. Unless Mass has something odd going on subsidies apply to everyone from 100% of the poverty level to 400%. There is no gap.

  • road.rep

    That article puts about the best face possible on this very complicated legislation. But near the bottom it finally states that about 150,000 current Massachusetts enrollees in Health Connector plans will have to visit the Health Connector website and enroll in a new plan by Dec. 23 in order to have coverage in January. Do you think that is going to happen? Neither do I. Is this what we had in mind when our legislators voted for this abomination. NOBODY seems to fully understand it, and it has very limited support among voters. Most of the government is exempt, and even the unions are protesting many of the provisions. Some of the unintended consequences seem to be a reduction in hiring, and reducing many jobs to less than 29 hours per week. If this is the best my legislators can do, then I need new legislators!

    • Danieemac

      I agree with the consequence of this legislation being retaliation in reducing jobs. I also agree that no much how much literature anyone reads who is actually interested in understanding this law its so overwhelming to understand. Another question I have is what about middle class America? The government for the past few decades have been over and over again promising middle class is going to be saved. Unfortunately. from what I have read there seems to be only subsidies for low in come families (which consequently this act will benefit most and this population may even need it the most) however, what about incentives for the rest? I also believe the retaliation in reducing jobs is a direct result of small business employers not able to make the demands that this act implies. I would like to know if anyone has any information regarding this questions. I am also wondering how this is going to affect how American medicine with regards to and not limited to research, practice, and advancement. Obviously this is an ambiguous question with a more rhetoric sense and most likely will not be answered for many years to come. I just don’t think people realize that the government health care system does influence those very important parts of medicine.

    • Michael Allen

      Nobody understands it because people like you have been telling lies ,starting with Palins “death panels” and now going on about how as of today,the 1st were all being “forced into Obamacare” (along with the bs statement that “congress and the preseident are exempted from being “forced” into Obamacare” which is true enough,because NO ONE is being forced to change their insurance plan). Republican politicians are actively spreading disinformation,actively discouraging people from getting access to government benefits they are entitled to,and trying to do everything they can to make it not work. If they are SO certain that its going to be a disaster,why all the effort to help it fail,shouldn’t it be able to do that on its own.

      • road.rep

        Calm yourself Michael. I can feel your lather from here. I told no lies. I am not a republican. I never mentioned Palin’s death panels (whatever they are), or anyone being forced into Obamacare. Obamacare is the law. But it is a very bad law that was enacted by very bad politicians who neither read nor understood the legislation when they voted for it. The President and congress are exempted. That is a fact. The legislation is not well supported by the voters. That is a fact. The unions (one of Obama’s biggest supporters) are trying to change many provisions of the law. That is another fact. You sound crazy. That is a fact too. Have a nice day, and I hope you never get sick under Obamacare.

      • kem63

        It will fail only because people can’t afford it. you think every one against it has not checked to find out if they can get cheaper premiums, how stupid is that. I thought ACA was a great Idea until I checked and I read the bill and I found out it would cost me $300mo I only net 1,200mo I don’t qualify for the reduced or free ACA or Medicaid. I can’t afford to pay and wait for subsidies to kick in I would be dead from starvation before that happened. and I know for FACT I’m not the only one. people that is against ACA is not against it because what others say, They against it because of their own experience, because what they have seen it do to their loved ones. try waiting 4 months for very needed surgery like my daughter in-law has too. or finding out your son was starving himself because of employee doubled premiums. oh and BTW if you don’t have qualifying insurance to the standards of the secretary, You are penalized. sorry but ACA is forced.. It’s not giving people a choice.

        • Elizabeth Palmer McDaniel

          If your daughter-in-law had to wait four months for surgery it wasn’t due to ACA. That part hasn’t begun yet.

      • notgettinganyyounger

        It is true that there are already “healthcare decision makers” contacting seniors. I know several. According to the new law, they are required to meet with said decision makers every five years, to “make decisions”. You can take that any way you want it. The thing that irks me about ACA is certainly NOT that more people will get healthcare. It’s not even the MOST important thing that we were lied to about savings, and will in fact, pay more. The thing that irks me most is the fact that privacy, and patient/doctor confidentiality are out the window, along with personal decision making, based upon ability to pay. Now, someone else decides what we can, and cannot have, for care. You can call that whatever you want. It’s not death panels, but it could easily limit treatment to folks who would have otherwise had access to it.


        How’s that working for you – lost your insurance, yet? Obamacare requires a totally new set of benefit requirements. Government Staffers and Unions have received “Taxpayer funded prremium subsidies”; unless the Government has created a New Profit generating business they haven’t shared with the public.
        Read the Law- you probably voted for the people who said they has to pass it to read it??. 100′s of thousands of polices are being cancelled
        in all states every week.