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Affordable Care Act


Jennifer Rogers

on 29 July 2013

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Transcript of Affordable Care Act

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Individual Mandate

Employer Mandate


Medicare Recipients

Medicaid Expansion

How the Law is Paid For
The Problem
The Affordable Care Act
Insurance companies could take advantage of you and turn away the 129 million Americans with pre-existing conditions.
Premiums had more than doubled over the last decade while insurance company profits were soaring.
Tens of millions were underinsured, and many who had coverage were afraid of losing it.
And 50 million Americans had no insurance at all.
Changes to Health Insurance Companies
Because of the ACA, it is illegal for health insurance companies to:
Deny coverage to children because of a pre-existing condition
Put a lifetime cap on how much care they will pay for if you get sick
Cancel your coverage when you get sick by finding a mistake on your paperwork (recission)
Starting in 2014, they will no longer be able to deny coverage to anyone due to a pre-existing condition
Better Options for Getting Coverage
Young adults under the age of 26 can now stay on their parents' health plans.
Also starting in 2014:
Discriminating against people with pre-existing conditions or gender will be illegal.
Under the Health Insurance "Exchanges" or "Marketplaces" refundable tax credits will make buying insurance more affordable.
More Affordable Coverage
For all non-grandfathered health insurance plans, insurance companies are now required to cover preventive services for free including:
Cancer screenings such as mammograms and colonoscopies
Vaccinations such as flu, mumps & measles
Blood pressure screening
Cholesterol screening
Tobacco cessation counseling and interventions
Birth control
Depression screening
And more...
Health Insurance Marketplace
In March 2010, President Obama signed into law the Affordable Care Act.
What does the Affordable Care Act accomplish?
End insurance company abuses
Makes health insurance more affordable
Provides better options for coverage
Health Care Reform Quiz
Visit www.healthcare.gov/prevention
for a full list
BEFORE, insurance companies spent as much as 40 cents of every premium dollar on overhead, marketing and CEO salaries.

TODAY, the new 80/20 rule says insurance companies must spend at least 80 cents of your premium dollar on your health care or improvements to care. If they don't, they must repay the money.
Independent estimates (KFF) have shown that due to this new rule, insurance premiums in the individual market were $1.9 billion lower in 2012; this is in addition to the rebates consumers received.
Additional benefits under the bill:
An interim high-risk health insurance plan for those unable to obtain or afford coverage, the Pre-Existing Condition Insurance Plan.
The creation of the Health Insurance Marketplace.
A new "marketplace" where small businesses and eligible individuals can select and enroll in a private health insurance plan.
Enrollment starts October 1, 2013
Coverage starts January 1, 2014
Through the Marketplace, individuals will be able to find out if they are eligible for programs to make health insurance more affordable.
Advance payments of the premium tax credit
Cost-sharing reductions, or
Health programs like Medicaid and the Children's Health Insurance Program (CHIP)
Small Business Health Options Program - starting in 2015 - will provide a new way for small employers to offer their employees choices among health plans, giving small businesses the clout that big businesses already enjoy when purchasing insurance.
Eligibility and Enrollment
Rules and requirements for marketplace participants:
Live within its service area
Be a U.S. citizen or national, or
Be a non-citizen who is lawfully present in the U.S. for the entire period for which enrollment is sought
Not be incarcerated
Either individuals or families can purchase coverage.
Enrollment Process
Complete one streamlined application.
Applications may be submitted online, by phone, by mail, or in person.
Catastrophic plans for young adults (under the age of 30) or those who cannot afford coverage and obtain a hardship waiver from the Marketplace:
Plans with high-deductibles and lower premiums
Includes coverage of 3 primary care visits and preventive services with no out-of-pocket expenses
Protects consumers from high out-of-pocket costs.
Assistance will be available:
Toll-free call center
Enrollment counselors
In-person Assistors
Community-based organizations
Agents and brokers (depending upon each state's determination
Tax Credits and Cost Sharing in the Marketplace
Eligibility for the new tax credit is based on:
Household income and family size for the year
Income must fall between 100% - 400% of the Federal Poverty Level (FPL)
Ineligibility for other health benefits coverage, other than the individual insurance market (i.e. employer-sponsored coverage)
Subsidy Calculator: http://healthreform.kff.org/subsidycalculator.aspx?source=QL
Tax credit amount depends upon income as a percentage of the FPL:
Based on a sliding scale
Based on the cost of the second lowest silver Qualified Health Plan, adjusted for the age and rating area of the covered person.
Limits premium payments as a percent of income.
How will they work:
With most tax credits, you have to wait until you file your taxes to get the credit. But the new tax credit available through the Marketplace lets you reduce your costs right away (advance payments).
Once you enroll in a qualified health plan, you can control how much of your tax credit you want to use to help pay your monthly health plan premiums.
The tax credit is sent directly to your insurance company and applied to your premium, so you pay less out of your own pocket.
Essential Benefits:
Ambulatory patient services
Emergency services
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including dental and vision care
Since then...
3.1 million young adults have gained insurance through their parents' plans
6.1 million people with Medicare through 2012 received $5.7 billion in prescription drug discounts
34 million people with Medicare received a free preventive service
71 million privately insured people gained improved coverage for preventive services
105 million Americans have had lifetime limits removed from their insurance
Cost Savings...
Slowest sustained national health sending growth in 50 years
Rate increases fell from 75% in 2010 to 14% so far in 2013
$1 billion in health insurance company rebates were returned to cnsumers last summer
$4.2 billion recovered in 2012 from anti-fraud efforts - a record high - for a total of nearly $15 billion over the last four years, double that of the previous four years
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