A lot has been written about ObamaCare but you probably still don't know anything about it. So before you decide to embrace it or hate it, take the time to learn what it is, what it does, and what it does not do. In this post and the next two, I'm going to lift the hood on the Affordable Care Act and show you the truth... then, you can decide. I've broken this down into five categories: how the law affects Insurance Companies, Consumers, Rural Citizens, Medicare & Medicaid, and Taxpayers.
Here's what the Affordable Care Act does:
- holds insurance companies accountable for unreasonable rate hikes.
- gives you a way to appeal insurers' coverage determinations or claims and establishes an external review process.
- bans insurers from discriminating based on your pre-existing conditions or gender.
- bans insurance companies from denying coverage to children under age 19 due to a pre-existing condition.
- bans insurance companies from rescinding coverage; previously, insurers could search for an error or technical mistake on your application and use it to deny payment.
- bans insurers from imposing lifetime dollar limits on essential benefits, like hospital stays.
- requires new plans cover certain preventive services, like mammograms and colonoscopies, without charging a deductible, co-pay, or coinsurance.
- bans insurers from dropping or limiting coverage because you choose to participate in a clinical trial.
- provides free preventive care for seniors.
- brings down health care premiums by requiring insurers give customers rebates if their "administrative costs" are too high.
- reduces paperwork and administrative costs by requiring electronic health records.
- permits young adults to stay on their parents’ plan until they turn 26.
- provides new coverage options to anyone uninsured for at least six months because of a pre-existing condition.
- sets up an easy-to-use website where you can compare health insurance coverage options and pick the coverage that works for you.
- creates a program to give financial help to employment-based plans to continue coverage to those who retire between ages 55 and 65, as well as their spouses and dependents.
- starting in 2014 if your employer doesn’t offer insurance, you'll be able to buy it directly in an Affordable Insurance Exchange.
- requires most individuals who can afford it to get basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans. This is the "individual mandate".
- funds scholarships and loan repayments to attract primary care doctors and nurses to under-served areas.
- increases payment to rural health care providers to help them continue to serve their communities.
Medicare, Medicaid, and CHIP
- closes the gap in Medicare prescription drug coverage (the “donut hole”) in 2020, and grants a 50% discount on drugs until then.
- creates new tools to combat fraud in Medicare and Medicaid programs.
- increases Medicaid payments for primary care doctors.
- allows those earning less than $14,000 to enroll in Medicaid
- allows states to cover more people on Medicaid, if they choose to do so.
- provides more funding for the Children’s Health Insurance Program (CHIP)
- gives Small Business Health Insurance Tax Credits to 4 million eligible small businesses to help them provide insurance benefits to their workers.
- gives tax credits to make insurance affordable for the middle class - people with income between 100% to 400% of the poverty line not eligible for other coverage. (In 2010, 400% of the poverty line equaled $43,000 for an individual or $88,000 for a family of four.)
In my next post, I'll tell you what I like about the Affordable Care Act and what I don't like about it. I'll also clear away the confusion on whether the Individual Mandate is a tax, what the "Public Option" is, and what "Single Payer" means.