Perhaps the following summary and website, including the nifty side‐by‐side comparison of the health reform proposals at the link below, will be of benefit:
Patient Protection and Affordable Care Act:
Summary of Coverage Provisions
The Patient Protection and Affordable Care Act was released on November 18, 2009 and was passed by the Senate on December 24, 2009. The following summary explains key health coverage provisions in the legislation.
Individual Mandate
All individuals will be required to have health insurance, with some exceptions, beginning in 2014. Those who do not have coverage will be required to pay a yearly financial penalty of the greater of $750 per person (up to a maximum of $2,250 per family), or 2% of household income, which will be phased‐in from 2014‐2016. Exceptions will be given for financial hardship and religious objections; and to American Indians; people who have been uninsured for less than three months; if the lowest cost health plan exceeds 8% of income; and if the individual has income below the poverty level ($10,830 for an individual and $22,050 for a family of four in 2009).
Expansion of Public Programs
Medicaid will be expanded to all individuals under age 65 with incomes up to 133% of the federal poverty level ($14,404 for an individual and $29,327 for a family of four in 2009). This expansion will create a uniform minimum Medicaid eligibility threshold across states and will eliminate a current limitation of the program that prohibits most adults without dependent children from enrolling in the program today. Eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) for children will continue at their current eligibility levels until 2019. People with incomes above 133% of the poverty level will obtain coverage through the newly created state health insurance Exchanges.
�� The federal government will provide 100% federal funding for the costs of those who become newly eligible for Medicaid for three years (2014‐2016). In 2017 and 2018, states will receive an increase in the federal medical assistance percentage (FMAP) based on current state eligibility levels for adults, and then beginning in 2019, all states will receive the same FMAP increase. Different funding rules apply for Nebraska and certain states that are not eligible for the increased FMAP because they have already expanded Medicaid eligibility.
American Health Benefit Exchanges
States will create the American Health Benefits Exchanges where individuals can purchase insurance and separate exchanges for small employers to purchase insurance. These new marketplaces will provide consumers with information to enable them to choose among plans. Premium and cost‐sharing subsidies will be available to make coverage more affordable.
�� Access to Exchanges will be limited to U.S. citizens and legal immigrants and subsidies will only be available to those without other coverage or whose share of the premium for coverage offered by an employer exceeds 9.8% of their income. Small businesses with up to 100 employees can purchase coverage through the Exchange.
�� Although there will not be a public plan option in the Exchanges, the Office of Personnel Management,which administers the Federal Employees Health Benefit Program, will contract with private insurers to offer at least two multi‐state plans in each Exchange, including at least one offered by a non‐profit entity. In addition, funds will be made available to establish non‐profit, member‐run health insurance CO‐OPs in each state.
�� Plans in the Exchanges will be required to offer benefits that meet a minimum set of standards. Insurers will offer four levels of coverage that vary based on premiums, out‐of‐pocket costs, and benefits beyond the minimum required plus a catastrophic coverage plan.
�� Premium subsidies will be provided to families with incomes between 100‐400% of the poverty level (or $22,050 to $88,200 for a family of four in 2009) to help them purchase insurance through the Exchanges. These subsidies will be offered on a sliding scale basis and will limit the cost of the premium between 2% of income for those between 100‐133% of the poverty level to 9.8% of income for those between 300‐ 400% of the poverty level.
�� Cost‐sharing subsidies will also be available to people with incomes between 100‐200% of the poverty level to limit out‐of‐pocket spending.
Changes to Private Insurance
New insurance market regulations will prevent health insurers from denying coverage to people for any reason, including their health status, and from charging people more based on their health status and gender. These new rules will also require that all new health plans provide comprehensive coverage that includes at least a
minimum set of services, caps annual out‐of‐pocket spending, does not impose cost‐sharing for preventive services, and does not impose annual or lifetime limits on coverage (existing individual and employer‐sponsored plans do not have to meet the new benefit standards).
�� Health plan premiums will be allowed to vary based on age (by a 3 to 1 ratio), geographic area, tobacco use (by a 1.5 to 1 ratio), and the number of family members.
�� Health insurers will be prohibited from imposing lifetime limits on coverage and will be prohibited from rescinding coverage, except in cases of fraud.
�� Increases in health plan premiums will be subject to review before they can be implemented.
�� Young adults will be allowed to remain on their parent’s health insurance up to age 26.
�� States will be allowed to form health care choice compacts that enable insurers to sell policies in any state that participates in the compact under a single set of rules.
�� Employers that impose a waiting period for health coverage of more than 60 days will be required to pay a penalty of $600 per full‐time employee who is subject to the waiting period.
Employer Requirements
There is no employer mandate but employers with more than 50 employees will be assessed a fee of $750 per full‐time employee if they do not offer coverage and if they have at least one employee who receives a premium credit through an Exchange. Employers that do offer coverage but have at least one employee who receives a premium credit through an Exchange are required to pay the lesser of $3,000 for each employee who receives a premium credit or $750 for each full‐time employee.
�� Employers that offer coverage will be required to provide a free choice voucher to employees with incomes below 400% of the poverty level if their share of the premium cost is between 8‐9.8% of income and who choose to enroll in a plan in an Exchange. Employers that offer a free choice voucher will not be subject to the above penalty.
�� Large employers that offer coverage will be required to automatically enroll employees into the employer’s lowest cost premium plan if the employee does not sign up for employer coverage or does not opt out of coverage.
Coverage and Cost Estimates
The Congressional Budget Office (CBO) estimates that the bill will reduce the number of uninsured by 31 million in 2019 at a net cost of $871 billion over ten years. According to the CBO, by 2019, the bill will result in 26 million people obtaining coverage in the newly created state health insurance Exchanges, including some who previously purchased insurance on their own in the individual market. In addition, 15 million more people will enroll in Medicaid and the Children’s Health Insurance Program. The cost of the bill is financed through a combination of savings from Medicare and Medicaid and new taxes and fees. The Congressional Budget Office estimates the proposal will reduce the deficit by $132 billion over ten years.
For more information about the Patient Protection and Affordable Care Act, see the side‐by‐side comparison of the health reform proposals at
http://www.kff.org/healthreform/sidebyside.cfm.In addition, here is the 2009 POVERTY LEVEL GUIDELINES for ALL STATES (EXCEPT ALASKA AND HAWAII) AND DC, Income Guidelines as Published in the Federal Register on January 23, 2009 Annual and Monthly:
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