Obamacare Basics

Patient Protection and Affordable Care Act of 2010 (ACA) or “Obamacare” was designed to create more affordable access to health care and initiate health care reform. While there are plenty of opinions and diverging views on this very controversial health reform act, it is not the intent of Camelback Health Care to engage in discussions of its impact on the economy or social issues. Instead, the intent is to breakdown the law into understandable bullet points that will enable our patients to make informed decisions.

Here are the facts in a nutshell:

1. It is law that all individuals are mandated to have health insurance as of October 1, 2013. The sign-up period lasts through March 31, 2014.
2. Individuals who elect not to carry insurance and do not sign up by March 31, 2014 will be forced to pay a penalty tax up to 1% of their gross annual income. This is managed by the Internal Revenue Service (IRS). This tax will increase in 2015 and 2016 if an individual does not have insurance by that time.
3. All insurances must provide coverage in the following 11 categories and insurances companies cannot deny coverage for any individuals due to any pre-existing health conditions.
   1. Provide coverage for outpatient care.
   2. Emergency Department services must be provided as part of coverage.
   3. Hospitalization coverage must be provided.
   4. Preventive and wellness visits must be provided.
   5. Contraceptions must be provided.
   6. Maternity and Newborn care must be provided.
   7. Mental and Behavioral treatment must be provided.
   8. Broad coverage of all categories of prescription drugs.
   9. Durable medical goods coverage.
   10. 100% coverage for preventive lab and imaging tests but excludes chronic disease management.
   11. Pediatric care must include vision and dental care.
   12. If an individual has insurance coverage by the same insurance provider and it existed before March 23, 2010, they can keep their insurance plan regardless of whether or not it meets the provisions outlined in ACA.
   13. If the current insurance plan meets the criteria mentioned here, the insurance cannot be cancelled.
   14. Each state has set up Health Care Exchanges either funded through the State or by the Federal government to facilitate sign up.
   15. If individual or family cannot afford to pay for health care, and they meet the 133% of Federal poverty level or $15,281 for an individual or $31,321.50 for a family, State Medicaid will be available to help offset the cost.
   16. Business owners with more than 50 employees are mandated to provide health care coverage for its employees. However, this mandate has now been postponed until year 2015.
   17. Individuals making more than $200,000 per year will see increased income tax in year 2013.

This is not the exhaustive list but rather a bullet point information for our patients at Camelback Health Care to understand and obtain basic information about the ACA or Obamacare.

For more information please also see:

1. What is Obamacare? about.com
2. healthcare.gov