A Brief Overview of the Affordable Care Act

Jesse Bouchard

12 Important Benefits of the Health Care Act (provided by Families USA)

1. Make sure all Americans have access to affordable health care

2. Regulate the marketplace

3. Assist small businesses

4. Improve Medicare5. Prohibit pre-existing

condition denials6. Limit out-of-pocket

costs7. Extend coverage for

young adults until the age of 26

8. Expand Medicaid to low-income Americans

9. Help make premiums affordable

10.Help ensure our health care dollars are spent wisely.

11.Help prevent insurance company abuse

12.Invest in preventive care

Ensure All Americans Have Access to Affordable Health Care

Those individuals who have been laid off or who work for small businesses will have access to affordable healthcare.

Before this act these individuals had to either go uninsured or pay for extremely expensive private insurance.

There is no one state or federal entity that regulates all markets or controls the information the insurance companies must provide.

With the Health Care Act new marketplaces (state-based exchanges) are being put in place that will provide individuals with information to help them choose the best insurance coverage they need at an affordable price.

In these state-based exchanges insurers are required to make their plans easy to understand. In doing this the idea is to make these plans easy to compare therefore creating a competitive market.

Each state is required to have these markets up and running by 2014.

Regulate the Marketplace

Small businesses are constantly struggling to provide affordable health insurance to their employees, but often it is such an expense they do not offer it at all; especially in our current economic dilemma.

In 2010 approximately 4 million small businesses qualified for a tax credit to help with insurance costs.

Assist Small Businesses

In 2010 most people on Medicare received a $250 rebate check to help offset the costs of prescription drugs.

Starting in 2011 Medicare recipients began receiving 50% off the cost of brand name prescriptions and further discounts on generics.

The goal is to eliminate the “Doughnut hole effect” by 2020. The “Doughnut hole effect” is when those on Medicare reach their cap on prescriptions and they must pay full price for their drugs until they pay $3,610 out of pocket which is when Medicare will kick back in.

Improve Medicare

According to a report by the U.S. Department of Health and Human Services: "12.6 million non-elderly adults - 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market - were in fact discriminated against because of a pre-existing condition in the previous three years."

Due to the new Care Act by 2014 Insurance companies will no longer be able to discriminate against individuals based on pre-existing conditions, age, gender, or health status.

Prohibit Pre-existing Condition Denials

A myth regarding health insurance is that if you are covered you do not need to worry about huge increases in health care costs. Unfortunately this is not always the case. According to a report by Families USA approximately 1 in 4 Americans spent more than 10% of their pre-tax income on health care expenses.

Due to the new Health Care Act there will be a cap on out of pocket health expenses and lower income families will also receive assistance with health care costs

Limit Out-of-Pocket Costs

Under Health Care Reform individuals under 26 will not need to worry about the cost of insurance because they are able to stay on their parents insurance plan while they are pursuing their career goals.

Video of President Obama speaking with a student, Erick, who is in school to be a Physician. Click Play

Extend coverage for young adults until the age of 26

Currently Medicaid is not available to all low-income individuals. You are also required to meet other requirements such as being pregnant or being a child.

With the Health Care Act in 2014 Medicaid will expand to everyone, under the age of 65, with an income of up to 133% of poverty ($24,352 for a family of three in 2010). Most individuals 65 and up will qualify for Medicare.

Expand Medicaid to Low-Income Americans

A study by Families USA showed that health insurance premiums have risen tremendously while incomes have remained at a constant. This has led to many families going without coverage or seeking private health insurance.

Under the new Health Care Act those who have an income too high to qualify for Medicaid, but cannot afford individual health insurance, will be able to qualify for financial assistance.

Help Make Premiums Affordable

The current system does not offer many protections against insurance companies that raise premiums to spend money on marketing or to increase profits.

With the new Health Reform insurance companies will have to change the way they do business. There will be new regulations on how insurance companies spend money. Companies in the large group market will have to spend 85% of premium dollars on medical care and quality improvements while companies in small and individual markets will have to spend 80% (Families USA).

The new Act also helps states to review rate increases to ensure that increases are to serve customers

Help Ensure Our Health Care Dollars Are Spent Wisely

The process called rescission has been a critical part of the debate on health insurance. In this process Insurances companies would drop individuals from coverage when they get sick or retroactively revoke coverage due to alleged fraud or misrepresentation.

As reported by the LA Times an investigation by the House Subcommittee on Oversight and Investigations, three health companies "cancelled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period."

The new Health Reform law puts a stop to companies rescinding policies unless the policy holder actually committed fraud or intentionally misrepresented themselves.

Help Prevent Insurance Company Abuse

With Health Care Reform companies will be rewarded on the quality of care rather than the quantity promoting preventive care.

This new law begins with Medicare and Medicaid by rewarding doctors for working together in providing high quality care.

This also encourages hospitals, doctors and other providers to coordinate patients’ care to help prevent patients paying for the same tests or procedures twice.

Invest in Preventive Care

Instituted March 23, 2010 Better health security by holding insurance

companies more accountable Aims to provide health care for millions more and

improve the quality of care received Decrease in health care costs Guarantees more choices that meet individual health

care needs Enhances the quality of care for all Americans. Up to 20,400 individuals who typically hit their

lifetime limits will benefit from the act (www.whitehouse.gov)

Almost 102 million consumers will no longer have a lifetime limit on their policy. (www.whitehouse.gov)

Facts

Click links below:Health Care Reform Law Made Simple

Overview of Lesson

Click Here: The Affordable Care Act – Implementation Timeline

For Further Information Concerning Affordable Health Care Timeline