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46 Important Facts About . . .

Obamacare

  1. Obamacare is officially known as the Patient Protection and Affordable Care Act (PPACAP). It also known as Obama care, Affordable Care Act (ACA), and health care reform.l
  2. President Barack Obama signed the Affordable Care Act into law on March 23, 2010, and after several court challenges, it was upheld by the Supreme Court on June 28, 2012 (due to the federal government’s sovereign right to tax).l
  3. Obamacare, together with the Health Care and Education Reconciliation Act, is the most significant regulatory revision of the U.S. health care system since Medicare and Medicaid were passed in 1965.r
  4. Obamacare Facts Obamacare doesn't create insurance; it expands and improves insurance options
  5. Obamacare requires insurers to spend between 80–85% of every premium dollar on medical care (as opposed to administration, advertising, and so on). If insurances do not meet this, they have to rebate the excess to their customers. The law is already in effect and, consequently, insurers are expected to rebate $1.1 billion in 2013.h
  6. All the provisions of Obamacare aren’t implemented right way, but take effect incrementally between 2010 and 2020.b
  7. During the last election, both Hilary Clinton and Obama proposed a health care plan to cover the approximately 45 million Americans who don’t have insurance at some point during the year. The main difference between Obama’s and Clinton’s proposals was that Clinton’s plan would have required all Americans to get coverage (an individual mandate), while Obama’s plan provided a subsidy while rejecting the use of an individual mandate. However, Obama now seems to strongly favor a mandate.c,n
  8. The purpose of Obamacare is to reform the health care industry by 1) giving Americans access to quality, affordable health insurance and 2) reduce the growth in health care spending.q
  9. Obamacare has two main ways for increasing insurance coverage: 1) expand Medicaid eligibility to include individuals within 138% of the federal poverty level and 2) create state-based insurance exchanges where small business and individuals can buy private health insurance plans.m
  10. Several states filed and lost a suit against the federal government. The states argued that it is unconstitutional for the federal government to make individual citizens buy health insurance (those with incomes between 100%–400% of the poverty level will be eligible for subsidies to buy health insurance).m
  11. Among the people who will remain uninsured under Obamacare will be 1) illegal immigrants (around 8 million), 2) those who are eligible for Medicaid but not enrolled, 3) those who wish to pay the penalty rather than purchasing insurance, 4) citizens whose insurance coverage would cost more than 8% of household income and are exempt from paying the annual penalty, and 5) citizens who live in states that opt out of the Medicaid expansion and who don’t qualify for existing Medicaid coverage or subsidized coverage through the state’s new insurance exchanges.q
  12. The drafters of Obamacare believe that increasing insurance coverage will increase quality of life, reduce job lock (the inability of an employee to leave a job due to loss of health coverage), and help decrease medical bankruptcies, which are the leading cause of bankruptcies in America.r
  13. Obamacare does not replace private insurance, Medicaid, or Medicare. It expands the affordability, quality, and availability of private and public health insurances. It does this through insurance exchanges, taxes, subsidies, regulations, consumer protection, and other reforms.l
  14. One of the most controversial changes that will take place under the Affordable Care Act is the requirement that contraceptives be covered without a co-pay.i
  15. The Congressional Budget Office estimates that by 2022, the Affordable Care Act will cover 33 million Americans who would otherwise not have insurance.h
  16. Politicians and journalists—such as Jonathan Alter from the Washington Post, Chris Matthews from MSNBC, and Former House Speaker Nancy Pelosi—note that Obamacare, specifically the individual mandate, actually has conservative origins in the Heritage Foundation think tank.p
  17. NPR notes that while patients, taxpayers, and lawmakers debated the impact of Obamacare, Washington lobbyists (several sponsored by pharmaceutical companies) benefited. Specifically, about 1,750 business and organizations spent at least $1.2 billion in 2009 on lobbying teams to work on the health care overhaul.e
  18. Anger over health care reform has lead to a nearly three-fold increase in serious threats against Congress members.f
  19. According to the New York Times, Obamacare would leave 2–4 million Americans unable to afford family coverage under their employers’ plans yet ineligible for subsidies to buy coverage elsewhere.a
  20. Obamacare Obamacare eliminates gender discrimination and pre-existing conditions
  21. Under Obamacare, insurance companies are not allowed to discriminate on pre-existing conditions.l
  22. Obamacare is expected to spend a bit over $1 trillion in the next 10 years, but its spending cuts (many which fall on Medicare) and tax increases are expected to raise a little more than that, which the Congressional Budget Office estimates will slightly reduce the deficit.h
  23. Obamacare’s success at controlling costs will depend on the way health care is delivered, which previously has had little regulation. Types of regulation include penalizing hospitals with higher rates of preventable infections to creating an independent board able to quickly implement new reforms through the Medicare system.h
  24. The House of Representatives tried to repeal or defund Obamacare over 40 times.m
  25. Under Affordable Care Act, health insurance premiums will be based on three or four factors, depending on the state. All states will use 1) age rating (older people will not pay more than 3 times the amount young people pay), 2) premium rating area (high-cost health areas will charge more than low-cost health areas), and 3) number of family members (the more people covered, the higher the premium). The only lifestyle factor allowed by the ACA is tobacco use. In states that allow it, tobacco users will pay up to 1.5 times the premium of non-tobacco users.j
  26. In 2014, employees will have to self-report their employer’s coverage ability. If the coverage is deemed affordable, the employee can still purchase insurance on the exchange, but they will not be eligible for a premium tax credit. In 2015, large employers will be required to offer affordable insurance.j
  27. If an individual is on COBRA, they will be eligible for a policy on the exchange. They do not have to wait until his or her COBRA expires.j
  28. All policies on the exchange will be required to provide maternity coverage. However, the coverage cannot be turned down, even if a person has no chance of getting pregnant.j
  29. An individual cannot simply wait to buy insurance if they suddenly get sick. A person is allowed to buy insurance during the open enrollment periods—which began on October 1, 2013, and goes through March 31, 2014. In following years, open enrollment will be from October 1 through December 7 of each year.j
  30. If an individual already has insurance, they can keep it if the following apply: 1) a person’s insurance was in existence before March 23, 2010 (it’s been grandfathered in), 2) a person’s employer keeps its plan (although many companies are dumping or changing their plans, and 3) a person’s insurance keeps the plan (although many have canceled plans that don’t meet the minimum requirements).l
  31. Under Obamacare, all insurance plans (except those in place before March 23, 2010) must have coverage in 10 essential health benefit categories: 1) outpatient care; 2) ER services; 3) hospitalization; 4) preventive and wellness visits; 5) maternity and newborn care; 6) mental and behavioral health treatment; 7) prescription drugs; 8) services and devices to help people with injuries, disabilities, or chronic conditions; 9) lab tests; and 10) pediatric are.l
  32. The Obamacare standard of benefits (“Ten Essential Benefits”) prevents insurers from cutting benefits to lower costs. However, insurance companies will not necessarily need to raise premiums to compensate for increased benefits because, according to President Obama, insurance companies’ revenues will actually rise as millions of currently uninsured Americans start paying premiums.l
  33. ER Those without insurance often use the ER as their primary care physician
  34. Over 32 million Americans don’t have insurance and, consequently, they often use the ER as their primary care physician, which raises costs for everyone. President Obama hopes that his health care act will reduce overall health care costs by making more services available and affordable to everyone.m
  35. Obamacare does not apply to business with fewer than 50 employees.n
  36. Many of the 30.1 million people who have bough their own private insurance in the past have had their plans cancelled because their plans don’t meet the “10 essential health benefits” required under Obamacare. Sometimes, their replacement insurance is more expensive because it must include all 10 benefits, including maternity (which they may not have wanted in the first place).m
  37. Many businesses may find it more cost effective to dump their insurance and let their employees purchase their own insurance plans on the exchanges. This means 3–5 million people could lose their company-sponsored health care plans.m
  38. It is estimated that 1.2% of the population, or 4 million people, will ultimately pay the tax rather than buy health insurance. The Congressional Budget Office estimates this will cost $54 billion.
  39. Under Obamacare, pharmaceutical companies will have to pay an extra $84.8 billion in fees over the next 10 years to pay for closing the “donut” hole in Medicare Part D. What this means is that drug costs could increase if they pass this cost onto consumers.m
  40. Even in 2013, three years after its approval, 54% of Americans oppose Obamacare. Approximately 35% oppose it because they think it’s too liberal. Approximately 16% think it doesn’t go far enough. Another 12% are opposed because they think it has been repealed, while 7% think it has been overturned by the Supreme Court.d
  41. Those who think Obamacare is too liberal argue that the act gives the federal government too much power over personal health care decisions and benefits. They oppose the act on grounds that it violates personal liberty and states’ rights. Additionally, they believe it will add to the national debt.o
  42. Obama Care Under Obamacare, preventive services are free
  43. Under Obamacare, preventive services are free, which reduces health care costs by treating diseases before they reach an expensive crisis.m
  44. Under Obamacare, parents can put their children up to age 26 on their plans. This increases profit for insurance companies since they get more premiums without higher costs for younger and often healthier individuals.n
  45.  Some analysts note that many of the newly insured will undergo free preventive care, which will detect diseases that have previously gone untreated. While this is beneficial to them, it would increase costs for everyone.o
  46. During the 2012 presidential campaign, Mitt Romney was accused of being hypocritical because he had implemented a form of Obamacare when he was governor of Massachusetts (some critics called it “Obamneycare”).m
  47. After Obamacare was passed in 2010, 21 states sued to protect their citizens from being forced into purchasing health insurance.m
  48. While the pre-existing clause in Obamacare means children who are diagnosed with autism cannot be denied coverage, there won’t be a national standard for the coverage of autism treatment until 2016 (currently the decision remains with the state).g
  49. Colorado has launched a new ad campaign in an attempt to get young people to sign up for Obamacare. In one ad, a flirty young woman holds a package of birth control pills leaning against a man and says, “OMG, he’s hot. Hopefully he’s as easy to get as this birth control.”k
  50. On October 1, after a relatively small number of insurance seekers attempted to shop for health insurance on HealthCare.gov, the site crashed. Four months later, the site still is scrambling to fix errors and to implement some type of appeals process.m
    Obamacare Timeline q
    March 2010
    Obama signs the Patient Protection and Accordable Care Act into law
    July 2010
    A government high-risk pool provides insurance for adults with pre-existing conditions until all insurance plans provide this coverage in January 2014
    September 2010
    Children under 18 can no longer be rejected by insurers because they have a pre-existing health condition
    Children up to age 26 can be insured as dependents on their parents insurance
    Insurance plans can no longer impose a lifetime limit on a policyholder’s benefits
    Insurance plans can no longer impose an annual limit on a policyholder’s benefits (a phase-in period begins with a total ban effective January 2014)
    Insurance companies can no longer terminate policies they deem too costly due to consumers’ health
    A maximum tax credit of 35% of the cost of insurance premiums is available to small businesses with 25 or fewer employees
    January 2014
    Medicaid expands to cover people with an income level of up to 133% of the federal poverty line (A few states, such as Texas and Florida, refuse this part of Obamacare. Because of a 2012 Supreme Court ruling, the federal government cannot punish them financially for their noncompliance.)
    Health insurance exchanges (HIXs) selling insurance to individuals and small businesses open for businesses nationwide. If a state does not set one up (Florida and Alaska announced they won’t), the federal government will create and run it for them
    An individual mandate tax will be established: Americans who do not obtain health insurance expose themselves to a maximum penalty of $285 per year
    Adults 18 and older cannot be rejected for insurance coverage because of pre-existing conditions
    Young adults under 30 can buy low-priced catastrophic insurance through HIXs
    Insurance plans must cover “essential health benefits”
    A maximum tax credit of 50% of the cost of insurance premiums is available to small businesses with 25 or fewer employees
    January 2015
    The individual mandate tax increases: Americans who do not have insurance are subject to a maximum penalty of $975
    An Independent Payment Advisory Board (IPAB) can begin making recommendations to cut Medicare spending
    January 2016
    The individual mandate tax increases : Americans who do not have health insurance may be subject to a maximum penalty of $2,085
    January 2017
    HIXs can be expanded to include large businesses with more than 100 employees, if a state chooses to let them in
    January 2018
    The Independent Payment Advisory Board’s recommendations about Medicare’s budget can be implemented. A tax on high-end insurance plans begin
    Obamacare Health Benefits l
    Obamacare's 10 Essential Health Benefits
    1. Outpatient Care
    2. ER Services
    3. Hospitalization
    4. Preventive and Wellness Visits
    5. Maternity and Newborn Care
    6. Mental and Behavioral Health Treatments
    7. Prescription Drugs
    8. Services and Devices to Help People with Injuries, Disabilities, & Chronic Conditions
    9. Lab Tests
    10. Pediatric Care

-- Posted February 9, 2014

References

a “A Cruel Blow to American Families.” The New York Times. February 2, 2013. Accessed: December 31, 2013.

b “A Timeline of the Affordable Care Act.” The Washington Post. November 2, 2013. Accessed: December 31, 2013.

c Cline, Andrew. “How Obama Broke His Promise on Individual Mandates.” The Atlantic. June 29, 2012. Accessed: December 26, 2013.

d Delreal, Jose. “Polls Show Most Disapprove of Obamacare.” Politico. Updated December 11, 2013. Accessed: December 31, 2013.

e Eaton, Joe, M.B. Pell, and Aaron Mehta. “Lobbying Giants Cash In on Health Overhaul.” NPR. March 26, 2010. Accessed: December 31, 2013.

f Horwitz, Sari and Ben Pershing. “Anger over Health-Care Reform Spurs Threats against Congress Members.” The Washington Post. April 9, 2010. Accessed: December 31, 2013.

g Joss, Laurel. “How Will Obamacare Affect Autism Coverage?” Autism Daily News. August 13, 2013. Accessed: December 31, 2013.

h Klein, Ezra. “11 Facts about the Affordable Care Act.” The Washington Post. June 24, 2012. Accessed: December 31, 2013.

i Kliff, Sarah. “Here’s Obamacare’s Most Controversial Regulation.” The Washington Post. March 25, 2013. Accessed: December 26, 2013.

j McClanahan, Carolyn. “Reader’s Questions about Obamacare—Misinformation Abounds.” Forbes. August 8, 2013. Accessed: December 31, 2013.

k Miller, S.A. “Easy Sex and Booze Used to Sell ObamaCare.” New York Post. November 13, 2013. Accessed: December 31, 2013.

l “ObamaCare Facts: Facts on the Affordable Care Act.” ObamaCare Facts. 2013. Accessed: December 31, 2013.

m ObamaCare for Beginners. 2013. Kindle Edition. Amazon Digital Services: Garamond Press.

n “Part 2 of CNN Democratic Presidential Debate.” CNN. Updated January 21, 2008. Accessed: December 26, 2013.

o Robillard, Kevin. “Poll: 54 Percent Against Obamacare.” Politico. May 27, 2013. Accessed: February 4, 2014.

p Roy, Avik. “How the Heritage Foundation, a Conservative Think Tank, Promoted the Individual Mandate.” Forbes. October 20, 2011. Accessed: December 26, 2013.

q “Summary of the Affordable Care Act.” The Henry J. Kaiser Family Foundation. April 25, 2013. Accessed: December 31, 2013.

r Tate, Nicholas J. 2012. ObamaCare Survival Guide. Kindle Edition. West Palm Beach, FL: Humanix Books.