We present the facts on Obama Care (ObamaCare), the health care plan for America. Our goal is to help you understand the Affordable Care Act. Decide for yourself what you think about the new health care law, based on the facts and not the talking points.
(ObamaCare Facts Image Public Domain, Photo by Chuck Kennedy; U.S. Government Work)
• The official name for “ObamaCare” is the Patient Protection and Affordable Care Act (PPACA). It is also commonly referred to as Obama care, health care reform, or the Affordable Care Act (ACA).
• The Affordable Care Act was signed into law toreform the health care industry by President Barack Obama on March 23, 2010 and upheld by the supreme court on On June 28, 2012.
• ObamaCare’s goal is to give more Americans access to affordable, quality health insurance, and to reduce the growth in health care spending in the U.S. What is ObamaCare?
• The Affordable Care Act expands the affordability, quality, and availability of private and publichealth insurance through consumer protections, regulations, subsidies, taxes, insurance exchanges, and other reforms.
• The fact is ObamaCare does not replace private insurance, Medicare, or Medicaid.
• ObamaCare doesn’t regulate your health care, it regulates health insurance and some of the worst practices of the for-profit health care industry.
• ObamaCare offers a number of new benefits, rights and protections including provisions that let young adults stay on their plan until 26, stop insurance companies from dropping you when you are sick or if you make an honest mistake on your application, prevent against gender discrimination, stop insurance companies from making unjustified rate hikes, do away with life-time and annual limits, give you the right to a rapid appeal of insurance company decisions, expand coverage to tens of millions, subsidize health insurance costs, and require all insurers to cover people with pre-existing conditions.
• ObamaCare’s new benefits, rights and protections also include the requirement that all non-grandfatheredhealth insurance plans cover preventive services and provide new Essential Health Benefits. Learn more aboutGrandfathered health plans.
• Ten Essential Health Benefits including emergency care, hospitalization, prescription drugs, maternity, and newborn care must be included on all non-grandfathered plans with no annual or lifetime dollar limits.
• Free Preventive services including yearly check-ups, immunizations, counseling, and screenings must be included on all non-grandfathered plans at no out-of-pocket costs.
• Many of Obamacare’s numerous provisions have already been enacted. The rest of the program starts in 2013-2014 and continues to roll out until 2022.
• The Affordable Care Act contains ten titles that span over 1000 pages, but most of it’s key provisions are in the first Title. The first title is about 140 pages long (these pages are mostly white space with about 450 characters per page). If you would like to read the whole title, would like a summary of the title, and/or a summary of the provisions within check out our Summary of the Patient Protection and Affordable Care Act.
• Over 100 million Americans have already benefited from the new health care law. This includes more than 105 million people who accessed critical preventive services for free that had previously been subject to out-of-pocket costs, billions of dollars saved for seniors from the gradual closing of the Medicare Part D “Donut Hole”, billions saved from new accountability measures for insurance companies, and much more.
• The Affordable Care Act also includes new taxes. Most new taxes are on high-earners, large businesses, and the healthcare industry. However, there are some tax related provisions every American should be aware of: Tax Credits to subsidize costs for low-to-middle income Americans and small businesses starting 2014, an Employer Mandate for large employers to provide health insurance to full-time employees by 2015, an Individual Mandate for individuals and families obtain health insurance by 2014, and lastly new limits to medical deductions.
• In exchange for the new rights and protections most Americans must obtain health coverage by 2014, get an exemption, or pay a per-month fee. Learn more about the ObamaCare Individual Mandate.
• A “short coverage gap” exemption means that you can go up to three months in a row in 2014 without insurance and still avoid the per-month fee on your 2014 federal income taxes for not having insurance . ObamaCare’s Health Insurance Marketplace is open until March 31st, 2014. Get covered by mid-March and you are technically safe from the fee.
• The CBO estimates that in 2016, after the major provisions of health care reform are implemented, 24 million people will be exempted from the Individual Mandate. In many cases if you don’t think you can afford health insurance, you may be exempt and eligible for cost assistance.
• Hardship Exemption Update December 20th, 2013: If you had your plan canceled in 2014 due to the Affordable Care Act you now qualify for a hardship exemption in 2014. That means you won’t have to pay the fee if you decide to go without insurance and will qualify for a low premium, high out-of-pocket catastrophic plan on your State’s health insurance marketplace. This change does not affect your ability to get subsidies or purchase other marketplace plans.
• ObamaCare helps to cover working families who don’t have access to health insurance. Come 2015 large employers will have to insurance full-time workers, while small businesses will get tax breaks for offering coverage. ObamaCare and Small Business.
• If you like your plan, you can keep it. Americans who like their health insurance can keep it until 2015 at which point all non-grandfathered health plans must meet the requirements of the ACA or be switched to a new plan. On November 14th, 2013 the President announced a “fix” that lets insurance companies renew plans and extend coverage of existing plans, that don’t comply with the ACA, until the start of 2015. Some States have rejected the fix due to it creating two risk pools which could potentially drive up the cost of new plans. Learn more about keeping your insurance under ObamaCare.
• ObamaCare creates State specific health insurance marketplaces (also known as exchanges) where individuals, families and small businesses can shop for subsidized health insurance and find out if they qualify for Medicaid, CHIP or Medicare. NOTE: If you have coverage through work, you can’t get subsidies on the marketplace.What is the Health Insurance Marketplace?
• Health and Human Services (HHS), the department in charge of implementing and overseeing the Affordable Care Act, reported that in the first two months of open enrollment nearly 1.2 million Americans of the 1.9 million who enrolled in the marketplace have selected a plan or had a Medicaid or CHIP eligibility determination.
• Americans making less than $45,960 as individual or $94,200 as a family of 4 may be eligible for free or low-cost health insurance due to cost assistance subsidies like Tax Credits that reduce premium costs and cost sharing subsidies that lower cost sharing on copays, coinsurance and deductibles.
• The CBO estimates the average marketplace subsidy per subsidized enrollee will be $5,290 in 2014.
• There are three ways to save money on your health insurance through ObamaCare’s marketplaces: Advanced premium tax credits which lower your monthly premium costs, cost sharing subsidies which lower your out-of-pocket costs for copays, coinsurance and deductibles, and Medicaid which does both. Learn more about ObamaCare Cost Assistance.
• Over 15 million men, women and children will be eligible for Medicaid in State’s that participate in Medicaid Expansion.
• The 2013 Federal Poverty Guidelines are used to determine cost assistance on the marketplace for 2014.
• Cost assistance is only offered through your State’s Health Insurance Marketplace, although some health insurance brokers and providers may be able to assist you in getting subsidies.
• There are 4 types of Qualified Health Plans (sometimes called metal plans) available on the marketplace. Each one has the same benefits, rights and protections, but different networks and cost-sharing. As a rule of thumb the more “valuable” the metal the higher the premium and lower the out-of-pocket costs. Don’t buy health insurance without understanding actuarial value and deductibles, the cheapest option won’t always be the best one for you and your family. Learn about the Types of Health Plans sold on the Marketplace.
• Aside from the 4 basic “metal” health plan types, a “catastrophic” health plan is available through the health insurance marketplace for people under 30 and people with hardship exemptions. Catastrophic health plans have a low premium but very high out-of-pocket costs.
• Wondering how health insurance works? You pay a premium for every month you have coverage. The higher the premium the less out-of-pocket expenses you are responsible for and the larger network of doctors and providers you can utilize. All plans starting after 2014 are required to offer the same benefits, rights and protections but difference out-of-pocket costs. Learn more about how health insurance works and how to buy health insurance for 2014.
• To get coverage that started by January 1st, 2014 you had to sign up for the marketplace by the December 23rd, 2013 deadline. If you signed up before the deadline remember to follow up with your insurance company if you don’t receive your welcome packet and make sure your first premium is paid on time. (The first payment date has been extended to the 10th of January 2014 in many States).
• Moving forward if you sign up for coverage in the first half of the month your insurance will start on the 1st of the next month after you pay your premium. If you sign up during the second half of the month your coverage won’t start until the second month.
• You can enroll in a marketplace plan at anytime after filling out an application (assuming you enroll before open enrollment ends March 31st, 2014). Even if you plan to buy insurance off-marketplace, it is still smart to know your options.
• Get coverage that starts by April 1st, 2014 to avoid a per month fee in 2014 due to a “short coverage gap” exemption.
•The opening of the SHOP “Small Business Health Options Program” (the part of the marketplace small businesses use to buy employee health plans) has been pushed back to November 1st, 2014. Small businesses can still buy a SHOP plan through an agent now and claim tax breaks up to 50% of their share of employee premiums starting January 1st, 2014. small business health care tax credit may be carried back and applied retroactively to previous tax years, or carried forward to future tax years. Learn more about the ObamaCare SHOP Small Business Health Options Program.
• Aside from the “key provisions” of the Affordable Care Act (ObamaCare) there are hundreds of little talked about provisions that are very effective, but rarely talked about. For example, Section 3022 of the PPACA includes guidelines for the establishment of accountable care organizations (ACOs) under the Medicare Shared Savings Program. ACOs are doctors who band together and get paid based on their patients’ medical outcomes rather than on how many tests and procedures they perform. Learn more about ObamaCare and Medicare Reform.