Straight Talk on Obamacare (The Affordable Care Act)

The Affordable Care Act Signed March 2010, it affects:  States– Employers  Insurance Providers– Individuals Implemented in stages:  2010: coverage for children with preexisting conditions & appeals of coverage denials  2011: spending caps, preventative care & prescription coverage  2012: doctors can join Accountable Care Organizations, report racial disparities, electronic records  2013: Medicaid can cover preventative care, increasing Medicaid payments, Bundled payments between practitioners  2014: Individual mandates & exchanges, Medicaid expansions

State Medicaid Expansion ACA: States getting federal Medicaid funding must expand coverage:  Includes for the first time non-disabled, non-pregnant adults up to 133% of the poverty line Approximately 17 million new people 100% federally funded through 2016, then states must pay up to 10% of additional costs in 2020 Supreme Court: Tying old money to new mandates is coercive to the states  Federal government can refuse to give new money, but not take away current funding  States may opt in to Medicaid Expansion Michigan is on the fence

Private Insurance Providers Glenn Smith Cannot deny coverage for pre-existing conditions Must allow children to stay on their parents plan until age 26 Cannot place lifetime limits on coverage Must include preventative care in plans Must spend 80% of premiums on actual care  20% for overhead, salaries, advertising, etc.

Employer Obligations Large Employer Obligations (> 50 Full Time Employees)  Must automatically enroll new full-time employees in health insurance Full Time > 30 hours per week  Must offer “affordable” health insurance to employees (< 9.5% of income) Based on lowest cost self-only coverage Must offer coverage for children up to age 26 (but not spouses) May charge higher premiums for spouses, dependents  If employees instead apply for Tax Credits or to Exchanges, employers must pay a fine = Cost of Employee's Tax Credit x Number of employees Employers can avoid penalty based on the employee's W-2 earnings Small Businesses (<25 Employees)  If they offer health insurance are entitled to tax credits up to 35% now, increases to 50% in 2014  Starting 2014, can participate in Co-op Insurance Plans and Exchanges

Individual Mandate Requires most people to maintain minimum health insurance coverage for themselves & their dependents.  Exemptions: Undocumented immigrants Religious objectors Incarcerated people Can be satisfied through  Employer-provided insurance  Individual Insurance Plans  Health Insurance Exchanges  Government Sponsored Coverage (Medicaid/Medicare) 9 out of 10 non-elderly people would see no change because they are already covered or exempt Failure to be covered causes a tax liability that grows over the years  But not criminal prosecution for tax evasion  But not if employer self-only coverage is > 8% of household income

Health Insurance Exchanges Almost anyone can apply to participate in exchanges  U.S. citizen or national (or lawfully present)  Living in the U.S.  Not incarcerated Low-income individuals may be eligible for tax credits and/or price caps on their premiums  Must not be entitled to “affordable” insurance from any other source (employer, Medicaid)  Income is based on adjusted household income (even if only 1 member of the household is applying)

Health Insurance Premiums Income for Individual Income for Family of 2 Household Income (% of Poverty Line) Premium Cap (% of Household Income) Max Annual Payment for Individual Max Annual Payment for Family of 2 $15,282$20,628133%3%$458$619 $22,980$31,020200%6.3%$1,448$1,954 $28,725$38,775250%8.05%$2,312$3,121 $34,470$46,530300%9.5%$3,275$4,420

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