The Affordable Care Act was passed by Congress and then signed into law by the President on March 23, 2010.
On June 28, 2012 the Supreme Court rendered a final decision to uphold the health care law.
In 2013
IMPROVING QUALITY AND LOWERING COSTS
- Improving Preventive Health Coverage. To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost. Effective January 1, 2013. Learn more about the law and preventive care.
- Expanding Authority to Bundle Payments. The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care. Under payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare. For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care. It aligns the incentives of those delivering care, and savings are shared between providers and the Medicare program. Effective no later than January 1, 2013.
INCREASING ACCESS TO AFFORDABLE CARE
- Increasing Medicaid Payments for Primary Care Doctors. As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government. Effective January 1, 2013. Learn how the law supports and strengthens primary care providers.
- Providing Additional Funding for the Children’s Health Insurance Program. Under the law, states will receive two more years of funding to continue coverage for children not eligible for Medicaid. Effective October 1, 2013. Learn more about CHIP.
In 2014
NEW CONSUMER PROTECTIONS
- Prohibiting Discrimination Due to Pre-Existing Conditions or Gender. The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, the law eliminates the ability of insurance companies to charge higher rates due to gender or health status. Effective January 1, 2014. Learn more about protecting Americans with pre-existing conditions.
- Eliminating Annual Limits on Insurance Coverage. The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive. Effective January 1, 2014. Learn how the law will phase out annual limits by 2014.
- Ensuring Coverage for Individuals Participating in Clinical Trials. Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial. Applies to all clinical trials that treat cancer or other life-threatening diseases. Effective January 1, 2014.
IMPROVING QUALITY AND LOWERING COSTS
- Making Care More Affordable. Tax credits to make it easier for the middle class to afford insurance will become available for people with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. (In 2010, 400% of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four.) The tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time. It’s also refundable, so even moderate-income families can receive the full benefit of the credit. These individuals may also qualify for reduced cost-sharing (copayments, co-insurance, and deductibles). Effective January 1, 2014. Learn how the law will make care more affordable in 2014.
- Establishing Affordable Insurance Exchanges. Starting in 2014 if your employer doesn’t offer insurance, you will be able to buy it directly in an Affordable Insurance Exchange. An Exchange is a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance through Exchanges, and you will be able buy your insurance through Exchanges too. Effective January 1, 2014. Learn more about Exchanges.
- Increasing the Small Business Tax Credit. The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations. In this phase, the credit is up to 50% of the employer’s contribution to provide health insurance for employees. There is also up to a 35% credit for small non-profit organizations. Effective January 1, 2014. Learn more about the small business tax credit.
INCREASING ACCESS TO AFFORDABLE CARE
- Increasing Access to Medicaid. Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years. Effective January 1, 2014. Learn more about Medicaid.
- Promoting Individual Responsibility. Under the law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans. If affordable coverage is not available to an individual, he or she will be eligible for an exemption. Effective January 1, 2014. Learn more about individual responsibility and the law.
In 2015
IMPROVING QUALITY AND LOWERING COSTS
- Paying Physicians Based on Value Not Volume. A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care. Effective January 1, 2015.
If that doesn't give you pause, maybe this will..........
Study: Romney health care plan to leave 72M uninsured
The percentage of uninsured people without either act by 2022. / THE COMMONWEALTH FUND
A new study released by the private foundation, The Commonwealth Fund, has revealed that 72 million Americans would be uninsured by 2022 if Republican presidential nominee Mitt Romney wins the election and has his health care plan enacted. That compares to 27 million uninsured by the same time if President Barack Obama's Affordable Health Care Act (ACA) was kept in place with his reelection.
"There are stark differences between what each candidate has proposed for our health care system, and this report shines a light on how Americans might be affected, based on their age, their income, and where they live," the report's lead author Sara Collins, vice president for affordable health insurance at the Commonwealth Fund said to CNN. "The report finds that repealing the ACA would significantly increase the number of Americans without health insurance, limiting their ability to get the health care they need and exposing them to burdensome medical bills and debt."
The analysis was conducted by economist Jonathan Gruber, who advised the policymakers who wrote the ACA.
Currently, the government says there are more than 48 million Americans -- about 16 percent of the population -- without health insurance.
The percentage of uninsured people with President Barack Obama's Affordable Health Care Act by 2022.
/THE COMMONWEALTH FUND
While some of President Barack Obama's ACA has already been implemented -- such as free preventive women's health care, allowing children 26 and younger to be covered by their parent's plans and not allowing insurance companies to deny people with pre-existing conditions -- many of the proposed changes will not be enforced until 2014. These include implementing near-universal health care coverage, with steps like expanding Medicaid health insurance plans to cover more low income people and organizing state-regulated plans that people can choose from.
State plans would all have to fit regulations set by the federal government, which has also set goals of including free annual wellness exams and getting rid of the prescription drug benefit's "donut hole" -- or gap between the initial coverage limit and the upper limit set by the federal government. In general, they are high-deductible insurance plans, which means low premiums but higher deductibles in case of an accident.
The Commonwealth Fund, which has supported the ACA, said that if all the intended changes were made, 23 million more Americans would get insurance.
However, in comparison, The Commonwealth Fund's analysis showed that 12 million fewer Americans would receive health insurance under Romney's plan compared with current rates. Romney has pledged to repeal the ACA and implement his own changes, which he believes will encourage more private insurance incentives (instead of state-decided plans) and give the individual more say in choosing a plan that is right for them. For example, those who wouldn't seek preventive women's health care wouldn't pay for those services under his plan.
The study also found that Romney's plan would cost Americans more money. People who choose to buy health insurance on their own would pay 14 percent of their income, compared to only 9 percent under the ACA, The Commonwealth Fund stated. The Congressional Budget Office and the Joint Committee on Taxation added that repealing the ACA would cost a federal budget deficit of $109 billion between 2013 and 2022.
The Romney campaign argued the fund's study results were false.
"The Commonwealth study sadly contributes little to the health reform conversation that this country deserves," Romney spokeswoman Andrea Saul toldTPM. "It badly mistakes Governor Romney's proposals. Worse, it assumes a fantasy world where Obamacare has been a success. Instead, Americans have seen their insurance premiums increase, small businesses are facing massive tax increases, and seniors will have reduced access to Medicare services. The simple truth is this: The American people do not want this law, we cannot afford this law, and when Mitt Romney is President he will repeal it and replace it with common-sense, patient-centered reforms that strengthen our health care system."
The percentage of uninsured people with Republican presidential candidate Mitt Romney's health care plan by 2022.
/ THE COMMONWEALTH FUND
Though Romney hasn't provided exact details, he has laid out a broad framework for his health care proposal. Instead of opting for state-selected plans, the consumer would choose which private company they wanted to be insured by based on their needs. He or she would pay for that plan from funds from a personal health savings account (HSA) and be aided by tax breaks. Employers would deposit money into the HSAs, and the employee would choose the health care company.
Proponents of the HSA plan argue it will give Americans more choice.
"Health savings accounts empower the consumer in all aspects of health care decision making," Alabama Governor Robert Bentley said in a statement to the Associated Press explaining why he rejected the "essential health benefits" plan under the ACA on Oct. 1.
Bentley, a physician, added that having the federal government mandate what states should provide restricts people to picking plans that may not fit their needs.
"The Affordable Care Act includes many provisions, all supposedly geared toward making health insurance affordable, yet it does not include any significant mention of health savings accounts. I contend that the law does not make health insurance affordable and negatively affects consumer choice," he added.
Romney's plans would still allow for ACA provisions such free annual wellness exams and getting rid of the prescription drug benefit's donut hole and, theoretically, would push people towards high-deductible insurance plans. However, instead of being mandated by the federal government to include these benefits, consumers can choose to go with a company that includes these provisions. That way people will only pay for what they want coverage for.
"Healthcare is the only service in the United States that you buy and use without knowing what the price is," Dr. Scott Atlas, a Romney adviser with Stanford University's Hoover Institution, told Reuters. "If you're paying out of a health savings account, you actually see the bill. It really does reduce prices."
Critics, however, argue that those plans would not help people who have prolonged illnesses because they would spend their allotted health care funds faster and be forced to pay for care out of pocket.
Medicaid block grants would allow states to dole out the funds to the groups who they think need it the most, rather than try to add coverage for a federally-set amount of people.
Romney has argued that the ACA will increase costs for consumers, who already pay an average of $15,734 per hospital stay and spend 17.4 percent of the GDP on health care costs, NBCNews.com pointed out. For comparison, Romney's old health care plan he enacted in Massachusetts, the basis for the ACA, did increase costs while making sure that 98 percent of the population was insured. But, Romney has since claimed that while the plan worked for Massachusetts, it shouldn't become a federal mandate, and states and individuals should have more choice in choosing their health care.
The Commonwealth Fund isn't the first group to criticize Romney's plan. Families USA released a report stating that Romney's plan would cost families 92 percent more than the ACA by 2016.
• ObamaCare's goal is to provide