Obamacare

1. Obamacare is officially known as the Patient Protection and Affordable Care Act (PPACAP). It also known as Obama care, Affordable Care Act (ACA), and health care reform.
2. President Barack Obama signed the Affordable Care Act into law on March 23, 2010, and after several court challenges, it was upheld by the Supreme Court on June 28, 2012 (due to the federal government’s sovereign right to tax).
3. Obamacare, together with the Health Care and Education Reconciliation Act, is the most significant regulatory revision of the U.S. health care system since Medicare and Medicaid were passed in 1965.
4. Obamacare doesn’t create insurance; it expands and improves insurance options.
5. Obamacare requires insurers to spend between 80–85% of every premium dollar on medical care (as opposed to administration, advertising, and so on). If insurances do not meet this, they have to rebate the excess to their customers. The law is already in effect and, consequently, insurers are expected to rebate $1.1 billion in 2013.
6. All the provisions of Obamacare aren’t implemented right way, but take effect incrementally between 2010 and 2020.
7. During the last election, both Hilary Clinton and Obama proposed a health care plan to cover the approximately 45 million Americans who don’t have insurance at some point during the year. The main difference between Obama’s and Clinton’s proposals was that Clinton’s plan would have required all Americans to get coverage (an individual mandate), while Obama’s plan provided a subsidy while rejecting the use of an individual mandate. However, Obama now seems to strongly favor a mandate.
8. The purpose of Obamacare is to reform the health care industry by 1) giving Americans access to quality, affordable health insurance and 2) reduce the growth in health care spending.
9. Obamacare has two main ways for increasing insurance coverage: 1) expand Medicaid eligibility to include individuals within 138% of the federal poverty level and 2) create state-based insurance exchanges where small business and individuals can buy private health insurance plans.
10. Several states filed and lost a suit against the federal government. The states argued that it is unconstitutional for the federal government to make individual citizens buy health insurance (those with incomes between 100%–400% of the poverty level will be eligible for subsidies to buy health insurance).
11. Among the people who will remain uninsured under Obamacare will be 1) illegal immigrants (around 8 million), 2) those who are eligible for Medicaid but not enrolled, 3) those who wish to pay the penalty rather than purchasing insurance, 4) citizens whose insurance coverage would cost more than 8% of household income and are exempt from paying the annual penalty, and 5) citizens who live in states that opt out of the Medicaid expansion and who don’t qualify for existing Medicaid coverage or subsidized coverage through the state’s new insurance exchanges.
12. The drafters of Obamacare believe that increasing insurance coverage will increase quality of life, reduce job lock (the inability of an employee to leave a job due to loss of health coverage), and help decrease medical bankruptcies, which are the leading cause of bankruptcies in America.
13. Obamacare does not replace private insurance, Medicaid, or Medicare. It expands the affordability, quality, and availability of private and public health insurances. It does this through insurance exchanges, taxes, subsidies, regulations, consumer protection, and other reforms.
14. One of the most controversial changes that will take place under the Affordable Care Act is the requirement that contraceptives be covered without a co-pay.
15. The Congressional Budget Office estimates that by 2022, the Affordable Care Act will cover 33 million Americans who would otherwise not have insurance.
16. Politicians and journalists—such as Jonathan Alter from the Washington Post, Chris Matthews from MSNBC, and Former House Speaker Nancy Pelosi—note that Obamacare, specifically the individual mandate, actually has conservative origins in the Heritage Foundation think tank.
17. NPR notes that while patients, taxpayers, and lawmakers debated the impact of Obamacare, Washington lobbyists (several sponsored by pharmaceutical companies) benefited. Specifically, about 1,750 business and organizations spent at least $1.2 billion in 2009 on lobbying teams to work on the health care overhaul.
18. Anger over health care reform has lead to a nearly three-fold increase in serious threats against Congress members.
19. According to the New York Times, Obamacare would leave 2–4 million Americans unable to afford family coverage under their employers’ plans yet ineligible for subsidies to buy coverage elsewhere.
20. Obamacare eliminates gender discrimination and pre-existing conditions.
21. Under Obamacare, insurance companies are not allowed to discriminate on pre-existing conditions.
22. Obamacare is expected to spend a bit over $1 trillion in the next 10 years, but its spending cuts (many which fall on Medicare) and tax increases are expected to raise a little more than that, which the Congressional Budget Office estimates will slightly reduce the deficit.
23. Obamacare’s success at controlling costs will depend on the way health care is delivered, which previously has had little regulation. Types of regulation include penalizing hospitals with higher rates of preventable infections to creating an independent board able to quickly implement new reforms through the Medicare system.
24. The House of Representatives tried to repeal or defund Obamacare over 40 times.
25. Under Affordable Care Act, health insurance premiums will be based on three or four factors, depending on the state. All states will use 1) age rating (older people will not pay more than 3 times the amount young people pay), 2) premium rating area (high-cost health areas will charge more than low-cost health areas), and 3) number of family members (the more people covered, the higher the premium). The only lifestyle factor allowed by the ACA is tobacco use. In states that allow it, tobacco users will pay up to 1.5 times the premium of non-tobacco users.
26. In 2014, employees will have to self-report their employer’s coverage ability. If the coverage is deemed affordable, the employee can still purchase insurance on the exchange, but they will not be eligible for a premium tax credit. In 2015, large employers will be required to offer affordable insurance.
27. If an individual is on COBRA, they will be eligible for a policy on the exchange. They do not have to wait until his or her COBRA expires.

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