Obamacare, The Patient Protection and Affordable Care Act (PPACA) or the Affordable Care Act (ACA), has been in effect since 2010, but private citizens have likely not felt or understood the consequences. However, by January of 2014, more than 45 million Americans will be required to get health insurance under the most disputed part of the law, the individual mandate. Here are the top 10 things you should know about the health care law or Obamacare.
1.Mandatory coverage provision – Under the PPACA, Americans will be required to have health insurance coverage by January 1, 2014. Those who do not obtain it will be fined a premium each year.
$95 or up to 1% over the filing minimum whichever is greater, rising to a minimum of $695 for individuals and $2,085 for families, or 2.5% of income over the filing
By 2015, the fine increases to $325 or 2% of your annual income
In 2016 it will be 2.5% of income or $695
Religious reasons and members of health care sharing ministries, an organization that assists the sharing of health care costs between individual members who have common religious or ethical beliefs
Those who cannot afford it because the lease expensive policy would exceed 8% of their income
The theory behind the mandatory coverage provision is to discourage people from attaining insurance as soon as they find out they are ill. Because of the new pre-existing condition provision in the law, it would be possible to go without insurance until an illness struck, the mandatory coverage provision would prevent that from happening.
2.Health insurance exchanges areestablished – For those who do not have insurance available to them through an employer or spouse, insurance will be available through a public exchange. Internet websites will become accessible in October so participants can compare pricing.
For those who earn between 133% – 400% of the poverty level, a governmental subsidy is available
3.Medicaid eligibility expanding in some states – For those states that opt to participate, Medicaid will be increasing their eligibility to include those who earn up to 133% of the poverty limit.
*June 14, 2013
As of June 14, 26 states are participating, 1 is leaning towards participating, 6 are leaning towards not participating, 13 will not participate, and 4 are pursuing an alternative model – according to American Health Line
4.Pre-existing conditions are a thing of the past – Insurers can no longer deny coverage based on previous illnesses, or gender. Additionally, they cannot charge a higher rate regardless of prior medical claims for any reason.
5.No annual caps on care – No longer will insurers be allowed to place a cap on the amount of coverage you are allotted per year. While most never hit their annual cap, one accident or significant illness can cripple a family or individual financially. Under the PPACA, there will be no limits.
6.Flexible Spending Accounts (FSA) are limited to $2,500 – There is a limit to the tax break for FSA’s at $2,500 across the nation regardless of the cap maintained by an employer.
7.Businesses with over 50 employees must offer health insurance – All businesses who employ over 50 people must offer health insurance or they will be fined.
$2,000 per employee
8.Congress to receive the same level of care as their constituents – Members of Congress will no longer have a premium level of insurance; they will be offered a plan equitable to that of the American public. The plan they and their staff have, the Federal Employees Health Benefits Program, will no longer be available.
9.It will take 10 years for all of the changes to take effect – While some of the biggest changes will occur January 2014, the law was not meant to happen overnight. Some other upsets are still coming:
Doctor’s pay to be determined by their quality of care, using the Medicare fee schedule
Existing health insurance plans must cover preventative care and checkups without a co-payment
Medicaid will be extended to cover former foster care children who are under the age of 25, for at least six months
10.Premiums must be consistent – Premiums can only vary based on region, age, family size, and tobacco use. They cannot be based on gender, race, or any other factor.
Obamacare, aka PPACA or ACA, is confusing, convoluted, and feels like we are being governed with an iron fist. Being penalized with a fine for something some cannot afford or others will not use does not give the impression of the land of the free or the home of the brave anymore.
While President Obama may have embraced the term Obamacare even though others meant it as a derogatory remark, consider what Donald Trump had to say about it, “Let me get this straight … we’re going to be ‘gifted’ with a health care plan we are forced to purchase and fined if we don’t?” (cumberlink.com)
By Dawn Cranfield
Senior Correspondent / Product Specialist