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Patient Protection and the Affordable Care Act: Features (Health Care Reform, Obama Care)

Mike has a keen interest in the effects of politics in our culture. He has a unique way of simplifying complex concepts.

Since the Individual Mandate and the Affordable Care Act (Obama Care/health care reform) were upheld by the Supreme Court (6/28/2012), I thought it would be a good idea to sell the features of the law. President Obama did a great job of crafting the law and navigating through all the opposition, but he didn't do a very good job of selling it to the people.

Do You Like the Features of the Law?

I find it interesting that, when presented with the individual aspects of the law, a majority of the people like it. But when it is presented as "Obama Care," they don't like it. As you will see, it has already done many good things, and there are many benefits that the law brings into effect in the very near future. At the end of this article is a link to the site where you can get more detailed information on each aspect of the law.

Click on chart to view full size.

Click on chart to view full size.

Premium Costs for a Family of Four

This chart shows what the premium costs are for a family of four without health care reform and with health care reform. Without health care reform at any income level, the average cost is greater than $11,000.

With health care reform, a family of four with an income of $33,075 would pay $1,500 in premiums. As you can see as you progress up the income scale, the yearly premium would increase as well—but nowhere as high as it does without health care reform. At almost a $100K of income, the premium would be about $9,000 per year.

Today, a family of four pays over $1,000 per year to cover those without health care insurance. This is just in emergency room costs. Because health care reform brings more people into the system, the health care costs are lower.

Explaining the Features

For purpose of explanation, the law can be divided into four main parts:

  1. Consumer Protection
  2. Wellness Care
  3. Individual Mandate
  4. Job Creation

1. Consumer Protection

No Pre-Existing Conditions

In 2014, the days of insurers discriminating based on pre-existing conditions will be gone for good. Americans with cancer and diabetes will get the care they need. Parents of sick children can no longer be refused coverage because of pre-existing conditions.

Patient’s Bill of Rights

There is legislation that prevents Insurers from cancelling your coverage without cause when you get sick. They may no longer put lifetime dollar limits on your benefits. By 2014 most annual dollar limits on benefits will be a thing of the past.

Better Value for Your Health Care Dollar

A Medical Loss Ratio Rule law states that 80% of your premium dollars must go to your own health care. It must not go to your insurance company for administrative cost, advertising, or CEO salaries and bonuses.

Premium Review Laws

Your insurance company can’t raise rates by 10% or more without first explaining its reasons to your state or a federal Rate Review program. Your Rate Review program will determine if the rate increase is unreasonable. A rate hike is unreasonable if, for example:

It is based on faulty assumptions or unsubstantiated trends. It charges different prices to people who pose similar risks to the insurer.

Your state regulator can approve or reject an unreasonable or excessive rate increase, if your state laws give the regulator this authority

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2. Wellness Care

Preventive Care for Seniors

Seniors will not have to pay for cancer screening and other recommended preventative care. It will be offered at no additional costs. Screening includes the following:

  • Mammograms every 12 months for eligible beneficiaries age 40 and older.
  • Colorectal cancer screening, including flexible sigmoidoscopy or colonoscopy.
  • Cervical cancer screening, including a Pap smear test and pelvic exam.
  • Cholesterol and other cardiovascular screenings.
  • Diabetes screening.
  • Medical nutrition therapy to help people manage diabetes or kidney disease.
  • Prostate cancer screening.

Doughnut Hole

The doughnut hole is the coverage gap in Medicare coverage for prescription drugs. The new law begins to eliminate the gap with a 50% discount on brand-name drugs in 2011. The hole will be fully phased out over the next few years.

3. Individual Mandate (Individual Responsibility Law)

This law is better known as the individual mandate. This is the law that was under Supreme Court deliberation. Since it was up held by the Supreme Court, the law will be effective 1/1/2014. Under this law, most individuals who can afford it, will be required to obtain basic health insurance coverage or pay a tax 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. This law will affect 1% of the population.

Please understand: If you already have insurance, this law will not affect you.

Click on chart to view full size.

Click on chart to view full size.

4. Job Creation

Job Losses From Health Care Repeal

This chart shows that if health care reform were repealed that premiums would increase at such a rate that employers would not be able to keep employees on the job. It would cause the following:

  • Increase medical spending by $125 billion by the end of this decade and add nearly $2,000 annually to family insurance premiums
  • Destroy 350,000 to 400,000 jobs annually over the next decade
  • Reduce the share of workers who start new businesses, move to new jobs, or otherwise invest in themselves and the economy

Tax Credits for Small Businesses

In 2019 when health care reform will be fully implemented, there will be tax credits for small businesses. Health Care will save employers an estimated $3,000 per employee per year. This will help companies be more competitive, create jobs, and help strengthen our economy

More Information: The Health Care Law and You

Below is the link to the website Health Care Law and You. Here you will be able to read the entire law, if you so desire, read key features of the law, and work with an interactive time line that shows what has already been implemented and what will be implemented. Also included, you will be able to compare service providers, and get information on preventive care.

http://www.healthcare.gov/law/index.html

Updates

5/8/2012: Fighting Medicare fraud has long been a top priority for President Obama. Today, we are releasing a new infographic that describes how the Affordable Care Act—the new health care law—is helping the Obama Administration crack down on Medicare fraud and make Medicare stronger.

7/19/2012: As of July 11. 2012, the Republican house has voted 33 times to repeal Obama Care, in spite of the Supreme Court ruling on The Individual Mandate.. They say the definition of insanity is doing the same thing over and over again and expecting a different result. But is it really insanity? I think they are using repetition to brainwash the people into thinking it is bad. They also say if you tell a lie over and over again, it becomes believable. I think that is what they are doing.

Advocate and Share

If you like what you read here and you think the law is good, then advocate for it and pass this information on to others to help eliminate the confusion.

If you don't like it, then you may want to advocate against it, but be careful what you wish for—you might get what used to be.

This content reflects the personal opinions of the author. It is accurate and true to the best of the author’s knowledge and should not be substituted for impartial fact or advice in legal, political, or personal matters.

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