It’s a big deal Scott Decker, JD, MPH

What the White House Says:  Improved affordability  Helps 32 million uninsured obtain health insurance  Reduces premiums for middle class  Gets coverage level to 95%  New competitive health insurance market  Greater accountability  Keep premiums down, end insurer abuses and denials of coverage  No discrimination due to pre-existing conditions  Budget deficit reductions  Donut hole prescription drug benefit gap closed

What Critics Say:  Unconstitutional for Congress to require Americans to purchase health insurance  Commerce Clause, 10 th Amendment  PA Attorney General Tom Corbett and 12 other state AG’s  Federalism principles and 10 th Amendment violated by mandatory Medicaid changes and cost impositions  Doesn’t address Medicare’s 2017 bankruptcy  Will lead to increased costs, rationing, higher taxes and increased deficits  Budget gimmicks: Doctor Fix is separate, 10 years of taxes to fund six years of programs

Health Insurance Mandate  Individuals must have qualifying health insurance starting in 2014  Tax penalty imposed for failure to comply  Exemptions for hardship and certain other circumstances

Employers of >50 Employees  If employer does not offer health insurance and…  At least one full-time employee receives a premium tax credit  Then a fee of $2000 per employee is assessed, excluding the first 30  Starts in 2014

Employers of >50 Employees  If the employer DOES offer coverage, but…  At least one full-time employee receives a premium credit  Then the employer is assessed the LESSER of  $3000 per employee receiving the premium credit, or  $2000 per full-time employee  Starts in 2014

Employers Offering Coverage to Employees Earning <400% of FPL  If the employee’s share of the premium is between 8% and 9.8% of their income and…  The employee chooses to enroll in a plan in the Exchange, then the employer must issue a free choice voucher in the amount of the employer’s plan’s coverage costs  Voucher offsets costs of Exchange plan chosen  Starts in 2014

Employers of >200 Employees  Must offer health insurance to employees  Must automatically enroll employees  Employees may opt out of coverage  No effective date in the legislation

Premium Credits  Tied to the cost of a specified plan from the Exchange in the area  Provided to individuals and families with incomes % of Federal Poverty Level (FPL)  Recipients will be required to pay amounts ranging from 2-9.5% of income as their premium contribution  Starts in 2014  Cost-sharing subsidies are also provided for those earning % FPL

Premium Credit Eligibility  If covered by an employer, employees are ineligible unless the plan has an actuarial value of less than 60% or requires the employee to pay in excess of 9.5% of income toward the premium

Employers of <25 Employees  Not subject to any tax penalties for not providing coverage  If average annual wages are less than $50,000 and the business provides health insurance and pays at least half the costs  For eligible for tax credit of up to 35% of employer contribution  For , if coverage is purchased through the Exchange, tax credit of up to 50% of contribution  Maximum credit to employers of 10 or fewer with average incomes <$25,000; phased out as firm or wage sizes increase

Expansion of Medicaid  Covers everyone with an income of up to 133% of FPL who is not eligible for Medicare  Coverage to meet standards set for essential health benefits offered in Exchange coverage  Takes effect in 2014 and 100% funding for the increased coverage is provided to states until Funding tapers to 90% by 2020 and continues at that level into the future.

Exchanges  Must be state-based and administered by a government or non-profit entity  Enable individuals and small businesses (up to 100 employees) to purchase insurance  May permit employers of more than 100 employees to buy from the Exchange beginning in 2017

Insurance  For individuals, small groups and Exchange markets  Guaranteed issue and renewability  Allowable rating variations  Age (maximum 3:1 ratio)  Premium rating area  Family composition  Tobacco use (maximum 1.5:1 ratio)

Insurance  Companies must report premium amounts spent on clinical services, quality and other costs  Consumers receive rebate if amount spent on clinical services and quality is less than  85% in large group market  80% in small group market  Must provide dependent coverage up to age 26  Limit small group deductibles to $2000 for individuals and $4000 for families  Waiting periods limited to 90 days  No annual or lifetime dollar limits on coverage

Prevention  Eliminate cost-sharing for recommended Medicare preventive services  Funding incentives for states to eliminate Medicaid cost-sharing for recommended preventive services  Qualified plans required to offer coverage without cost-sharing for recommended preventive programs

Wellness  Grants for small employers that establish wellness programs  Funding provided from  Rewards to employees permitted for 30% of the cost of coverage  May be increased to 50%  Premium discounts, cost-sharing waivers  Nutritional content of each food item  Vending machines, chain restaurants

References  “Putting Americans In Control of Their Health Care,” retrieved April 21, 2010 from meeting/proposal/whatsnew/overviewhttp:// meeting/proposal/whatsnew/overview  Corbett, Tom (2010) “Health Care Reform Law is unconstitutional,” retrieved April 21, 2010 from  “What You Need to Know about ObamaCare,” retrieved April 21, 2010 from  Pear, Robert. (May 13, 2009) “Recession Drains Social Security and Medicare,” retrieved April 21, 2010 from  Kaiser Family Foundation, “Summary of New Health Reform Law,” retrieved April 21, 2010 from