Obamacare overview

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The Patient Protection and Affordable Care Act, commonly known as Obamacare, was passed in its finality on March 21, 2010, and signed into law by President Barack Obama on March 23, 2010.[1]

Law overview

The aim of the law was to provide an expansion of health insurance coverage to more Americans through both individual health insurance marketplaces as well as through employer-provided plans. Minimum requirements of coverage were established and both individual and employer mandates were established over a period of years in order to achieve the goal of expanded coverage. Subsidies and tax credits are provided to individual consumers based on income level and dependents, and existing programs such as medicaid and CHIP were expanded to increase reach. Small businesses receive tax credits based on the level of insurance offered to employees, as well.[2]

Ten essential benefits for coverage

The law included ten essential benefits that plans created after the law's passage needed to include. Existing plans were grandfathered in, but few of the grandfathered plans remain due to frequent changes to health insurance policies.[3] The ten essential benefits outlined by the ACA are:[4]

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

Congressional passage


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The Patient Protection and Affordable Care Act (H.R. 3590) was sponsored by Rep. Charlie Rangel (D-NY) and co-sponsored by 37 House Democrats and 3 House Republicans.[5] On October 10, 2009, the bill passed through the House to the Senate. After amendments were added in the Senate, the bill was passed by Democrats in the Senate with voting strictly along party lines, 60-39.[6] The bill returned to the House for a vote on its final passage. All 178 House Republicans opposed the bill's passage along with 34 Democrats, while 219 Democrats voted in favor, leaving the final vote in favor of passage at 219-212.[7]

Democrats in opposition

Following is a list of U.S. House Democrats who voted against Obamacare's passage during the March 21, 2010 vote:[7]

Implementation timeline

The following is a timeline of the implementation dates of key aspects of Obamacare:[8]

2010

  • January 1: Small business tax credits provided for small businesses offering health insurance to employees
  • July 1: Pre-existing Condition Insurance Plans offered by either the federal government or individual state governments
  • July 1: Healthcare.gov minimal functioning website established to educate consumers on coverage options
  • July 1: Tax of 10% on indoor tanning services implemented
  • September 23: Adult children are permitted to remain on a parent's healthcare plan until age 26
  • September 23: Insurance plans prohibited from setting lifetime coverage limitations
  • September 23: Insurance plans required to allow appeals with an external review process
  • September 23: New plans required to cover the established minimum coverage

2011

  • January 1: Insurers required to provide rebate the following year if a minimum proportion of premiums were not spent on medical services
  • January 1: Limitations placed on uses for tax-free health accounts such as HSAs, FSA and HRAs
  • March 23: Grants awarded for the establishment of state health insurance exchanges

2012

  • September 23: All insurance providers must provide a uniform summary of care and benefits to consumers

2013

  • January 1: States required to notify the U.S. Department of Health and Human Services whether they would form their own exchanges or join the federal exchange
  • July 1: Consumer Operated and Oriented Plan (CO-OP) put into action to encourage non-profit, member-run health insurance companies

2014

  • January 1: Medicaid coverage expanded to those under 65 with income levels up to 138% of the federal poverty level
  • January 1: Minimum medical coverage required for people with individual insurance plans
  • January 1: Annual coverage limits on insurance plans prohibited

2015

  • January 1: Employers with more than 100 employees assessed fees, per employee, for not providing health insurance options

2016

  • January 1: Employers with 50-99 employees assessed fees, per employee, for not providing health insurance options

Individual mandate

Healthcare exchanges began a six month open enrollment period for individuals on October 1, 2013, during which uninsured individuals could sign up for health insurance plans to avoid fines assessed if not insured by the end of the period, March 31, 2014.

Health insurance exchanges

See also: Healthcare.gov website rollout
Image from the Healthcare.gov sign-up page
Healthcare.gov is the website published by the federal government that is intended to serve as the central online hub for the rollout of Obamacare. The federal website is intended to provide insurance options and administer government subsidies for residents of 36 states.[9] Fourteen states elected to create their own healthcare exchanges, including the District of Columbia.[10]

Rollout issues

The rollout date was met with high demand for the website, both by those seeking insurance and those curious to see how the site worked. Attempts to use the website have resulted in errors, including:

  • Error messages while creating an account and trying to log in[11]
  • Data transfer problems from the exchange to healthcare providers[12]
  • Errors in price quotes when not logged in[13]
  • Lack of ability to sign up directly through individual insurance providers[14]

Post-enrollment period data inconsistencies

The HHS inspector general released a report in June 2014 that from October to December 2013, 2.6 million data inconsistencies were not able to be resolved and pressured the Centers for Medicare and Medicaid to establish a public plan for resolving the inconsistencies. The healthcare exchange's data hub was designed to fact check applications against federal information from the Internal Revenue Service, Social Security Administration and U.S. Department of Homeland Security, but the initial tech issues with the data hub created the inconsistencies that possibly mislead customers about their eligibility to certain plans and tax credits. The inconsistencies that could not be resolved by the federal exchange dealt with citizenship status, income verification, and employee-sponsored minimum essential coverage. Eleven state marketplaces also reported inconsistencies during the rollout, but only four states have reported having unresolved problems. If the customer received a premium tax credit due to an inconsistency, the IRS would likely either seek benefits that were not supposed to be given or award tax credits to those who should have been eligible. The report stated, "If the applicant chooses the advance premium tax credit, the Internal Revenue Service (IRS) will reconcile the actual credit amount made on behalf of the individual when an individual files a tax return at the close of the year."[15]

Eligibility-verification sting operation

The Government Accountability Office (GAO) conducted a sting operation on the verification system of the federal healthcare exchange in which they submitted fake account information while signing up. The verification system allowed 11 of the 18 fake accounts to sign up for subsidized health insurance. The GAO tried telephone and online signups, while failing in their attempts at using in-person navigators. Several Republican members of Congress requested the operation prior to the Healtcare.gov website rollout.[16]

Health insurance policy cancellations

See also: Health insurance policy cancellations since Obamacare

Leading up to the passage of Obamacare into law, one statement made repeatedly by the President, administration and Congressional supporters, was some form of the line Obama gave in an August 22, 2009, internet address, claiming, "If you like your private health insurance plan, you can keep your plan. Period."[17]

However, when the law was enacted on October 1, 2013, many individually insured people began receiving letters from their insurance carriers notifying them that their current plans would be canceled at the end of the policy term. The plans were canceled because they did not meet new minimum coverage requirements set by the law.[18]

On November 14, 2013, under pressure from Democratic members of Congress, President Obama announced the administration's intention to allow people whose insurance plans had been canceled to re-enroll in their plans.[19] On December 19, 2013, the administration announced that those whose plans were canceled under the law met the Health and Human Services Department's "hardship exemption." The stated exemption covers those who "experienced financial or domestic circumstances, including an unexpected natural or human-caused event, such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan."[20]

On March 5, 2014, the administration announced that the delayed mandate could extend to two years, one more than was offered in the original delay due to canceled plans. Sen. Mitch McConnell stated his opposition to the new delay, stating, "By announcing a new delay in requiring that policies meet minimum coverage standards, the administration avoids a new round of health policy cancellations set to hit shortly before the November elections."[21]

Enrollment numbers by deadline

March/April enrollment official report

The official report for the closing of the open enrollment period was released May 1, 2014. Below are some notes from the report:

  • At the conclusion of the open enrollment period, 8,019,763 users had selected a plan. Of those signups, 5,446,178 signed up through the federal exchange.[22]
  • Of the signups, 34% were age 34 and under, while 48% were between the ages of 45 and 64.[22]

Enrollment goals

  • The federal government expected that seven million Americans who were previously uninsured would buy a health insurance plan by March 31, 2014. The White House hoped to have about 2.7 million of the enrollees be young adults in order to offset the costs of insuring those with pre-existing conditions.[23]
  • Ezra Klein of the Washington Post, wrote on November 26, 2013, that when asked what the measurement of success would be for enrollment on Healthcare.gov, the administration claimed the ratio for success would be having 39% of the signups be young, healthy people. If the number of young and healthy people did not reach that number, Klein suggested the premium costs for next year could be disastrous.[24]

Initial enrollment period results

In a report released June 18, 2014, the Health and Human Services Department announced that due to federal subsidies, 3.2 million Americans were paying less than $100 per month for their health insurance coverage. A senior HHS official claimed the average premium went from $346 to $82 because of the tax credits through the federal marketplace. Opponents of the credits claim the federal budget would suffer from the increased burden. President of the American Action Forum Douglas Holtz-Eakin noted, "The report does not demonstrate that families had more choices or that premiums are lower in the past. It does demonstrate that consumers avoid 76 percent of premiums because federal spending subsidizes the cost."[25]

Polling released by Gallup, the Commonwealth Fund and the Urban Institute on July 10, 2014, found that the number of uninsured people in the United States dropped by anywhere from 8-9.5 million Americans. Experts agreed there was no definitive number on the amount of people with health insurance that weren't previously insured, but the number of uninsured was lower than it was prior to Obamacare taking effect.[26]

Sebelius resignation

Sebelius resigned on April 10, 2014.
On April 10, 2014, Secretary of Health and Human Services Kathleen Sebelius resigned from her position following the troubled rollout of Obamacare. She and President Obama determined that the end of the open enrollment period provided a chance for change. Sebelius saw her public appearances dwindle as the problems with the Healthcare.gov rollout persisted. President Obama named Director of the Office of Management and Budget Sylvia Mathews Burwell as the nominee to succeed Sebelius.[27] Mathews Burwell was confirmed on June 5, 2014.[28]

Penalties

The penalty for not being enrolled in a health insurance plan by March 31, 2014, was a charge of either $95 per person or 1% of household income, whichever is greater.[29] White House Press Secretary Jay Carney would not say on October 21, 2013, whether the struggles of the website could delay the individual mandate.[30] The administration announced in March 2014, that uninsured users could still enroll April, paying their first premium, to avoid the penalty as long as a plan was selected by March 31, 2014.[31]

Employer mandate

For businesses with more than 100 employees, employers must extend health insurance options to 70% of full-time employees by 2015, and that number must rise to 95% by 2016 in order to avoid paying fines. For businesses with 50-99 employees, employers must extend health insurance to all employees by 2016.[8]

Boehner lawsuit

See also: Boehner's lawsuit against the Obama administration
John Boehner
Claiming President Obama "changed the healthcare law without a vote of Congress, effectively creating his own law by literally waiving the employer mandate and the penalties for failing to comply with it," Speaker of the House John Boehner (R-OH) announced a lawsuit focusing on the president's failure to enforce the employer mandate as written in the ACA.[32] A draft resolution to for a Bipartisan Legal Advisory Group (BLAG) was introduced on July 10, 2014, by House Rules Committee Chairman Pete Sessions (R-TX).[33][34]

Penalties

Fines consist of paying $2,000 per employee, after 30 employees, who are not extended health insurance, if there is at least one employee who receives a premium tax credit. Employers offering health insurance, but have at least one full-time employee receiving premium tax credit will be fined to less amount between $3,000 for each employee receiving a premium tax credit or $2,000 for each employee after the first 30 employees.[8]

Attempts to change or repeal

Congress

As of March 13, 2014, Congress made 51 attempts to change, defund or repeal the law since Obamacare's passage.[35] Bills have been introduced to defund the entire law and portions of the law, repeal Obamacare and various key parts of it and delay mandates. While some of the measures passed into law, none of the bills that passed altered the fundamentals of Obamacare.[36]

United States Supreme Court

See also: Obamacare lawsuits

Commerce clause

The United States Supreme Court ruled to uphold Obamacare in a court case decided June 28, 2012. The 5-4 decision to uphold the law hinged on the Commerce Clause of the United States Constitution. According to the Court, the Commerce Clause did not permit the federal penalties of remaining uninsured after the law went into effect. However, the penalties can be collected as a tax. Explaining the ruling, Justice John Roberts wrote, "The court today holds that our Constitution protects us from federal regulation under the Commerce Clause so long as we abstain from the regulated activity. But from its creation, the Constitution has made no such promise with respect to taxes."[37]

Contraception mandate

On March 25, 2014, the Supreme Court heard the case put forward by Hobby Lobby and Conestoga Wood Specialties. The case argued that mandated coverage of birth control violated religious freedoms. Both companies' appeals were heard together during a one-hour public session.[38]

The Supreme Court ruled in favor of Hobby Lobby in Burwell v. Hobby Lobby on June 30, 2014. The 5-4 decision allowed companies to opt out of offering contraceptives on the basis of religious beliefs. Justice Samuel Alito wrote the court's opinion, stating, "We doubt that the Congress that enacted RFRA — or, for that matter, ACA–would have believed it a tolerable result to put family-run businesses to the choice of violating their sincerely held religious beliefs or making all of their employees lose their existing healthcare plans."[39]

The dissenting justices claimed the ruling would allow companies to "opt out of any law (saving only tax laws) they judge incompatible with their sincerely held religious beliefs." Likewise, the Obama administration argued that companies that did not wish to provide the contraceptive coverage or other areas of coverage due to religious beliefs could decide not to provide any company-wide options.[39]

Although the decision expanded the notion of corporate personhood to include religious rights "to provide protection for human beings," members of the public found it highly divisive in nature as it reaffirmed the Court's "pro-business" stance.[40] Senate Majority Leader Harry Reid (D-NV) pledged to restore the Affordable Care Act's contraception coverage, stating, "If the Supreme Court will not protect women’s access to health care, then Democrats will. We will continue to fight to preserve women’s access to contraceptive coverage and keep bosses out of the examination room."[41]

Recent news

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See also

External links

References

  1. New York Times, "Obama Signs Health Care Overhaul Bill, With a Flourish," March 23, 2010
  2. Kaiser Family Foundation, "Summary of the Affordable Care Act," March 12, 2014
  3. Washington Post, "This is why Obamacare is canceling some people's insurance plans," October 29, 2013
  4. National Association of Insurance Commissioners, "Patient Protection and Affordable Care Act of 2009: Health Insurance Exchanges," April 20, 2010
  5. Congress.gov, "H.R.3590 - Patient Protection and Affordable Care Act," accessed March 12, 2014
  6. GovTrack, H.R. 3590 (111th): Patient Protection and Affordable Care Act," December 24, 2009
  7. 7.0 7.1 GovTrack, "H.R. 3590 (111th): Patient Protection and Affordable Care Act," March 21, 2010
  8. 8.0 8.1 8.2 Kaiser Family Foundation, "Health Reform Implementation Timeline," accessed March 12, 2014
  9. NBC News, "Better use the phone: Why Obamacare website is such a fail," October 21, 2013
  10. Reuters, "State Obamacare exchanges enroll 3 pct of target so far -report," November 11, 2013
  11. USA Today, "Obama adviser: Demand overwhelmed Healthcare.gov," October 6, 2013
  12. Bloomberg, "Insurers Getting Faulty Data From U.S. Health Exchanges," October 8, 2013
  13. CBS News, "HealthCare.gov pricing feature can be off the mark," October 23, 2013
  14. Politico, "Another obstacle to signing up for ACA crops up," October 21, 2013
  15. Department of Health and Human Services, "Marketplaces Faced Early Challenges Resolving Inconsistencies With Applicant Data," June 2014
  16. National Journal, "GAO Launched an Obamacare Sting Operation—and Almost All Fake Insurance Applications Were Approved," July 23, 2014
  17. Boston Globe, "Obama slams 'outrageous myths' on health care; Republicans say president 'plays fast and loose' with facts," August 22, 2009
  18. New York Times, "Cancellation of Health Care Plans Replaces Website Problems as Prime Target," October 29, 2013
  19. Cite error: Invalid <ref> tag; no text was provided for refs named NYTfix
  20. Washington Post, "The individual mandate no longer applies to people whose plans were canceled," December 19, 2013
  21. Fox News, "Administration offers 2-year ObamaCare extension for canceled health plans," March 5, 2014
  22. Cite error: Invalid <ref> tag; no text was provided for refs named Marchofficialreport
  23. The Hill, "White House stands by Sebelius amid ouster calls over ObamaCare rollout," October 15, 2013
  24. Washington Post, "Obamacare won’t get 7 million enrollees in 2014 — and that’s okay," November 26, 2013
  25. The Hill, "HHS touts O-Care subsidies as reducing average premium to $82," June 18, 2014
  26. Politico, "The verdict is in: Obamacare lowers uninsured," July 10, 2014
  27. New York Times, "Health Secretary Resigns After Woes of HealthCare.gov," April 10, 2014
  28. The Washington Post, "Senate confirms Burwell as new secretary of HHS," June 5, 2014
  29. Bloomberg, "Four things we think we know about Obamacare," October 18, 2013
  30. The Hill, "Carney hedges on whether ObamaCare mandate could be delayed," October 21, 2013
  31. Cite error: Invalid <ref> tag; no text was provided for refs named foxdelay
  32. L.A. Times, "House lawsuit over Obamacare to focus on employer mandate delay," July 10, 2014
  33. CNN.com, "Boehner plans lawsuit against Obama over executive orders," accessed July 8, 2014
  34. Politico, "GOP’s Obama lawsuit to focus on employer mandate," July 10, 2014
  35. Fox Business, "Attempt No. 51: Tying 'Doc Fix' to Obamacare Repeal," March 12, 2014
  36. Politico, "If at first you don't succeed," January 30, 2014
  37. Christian-Science Monitor, "How John Roberts upheld health-care law while limiting congressional power," June 28, 2012
  38. CNN, "Justices to hear 'Hobby Lobby' case on Obamacare birth control rule," March 23, 2014
  39. 39.0 39.1 Politico, "Supreme Court sides with Hobby Lobby on contraception mandate," June 30, 2014
  40. Reuters, "U.S. birth control ruling fuels battle over corporate rights," July 1, 2014
  41. Politico, "SCOTUS sides with Hobby Lobby on birth control," June 30, 2014