Straight Talk on Obamacare (The Affordable Care Act)

Straight Talkon

Obamacare(The Affordable Care Act)

The Affordable Care Act

Signed March 2010, it affects:

States – Employers

Insurance Providers – Individuals Implemented in stages:

2010: coverage for children with preexisting conditions & appeals of coverage denials

2011: spending caps, preventative care & prescription coverage

2012: doctors can join Accountable Care Organizations, report racial disparities, electronic records

2013: Medicaid can cover preventative care, increasing Medicaid payments, Bundled payments between practitioners

2014: Individual mandates & exchanges, Medicaid expansions

State Medicaid Expansion

ACA: States getting federal Medicaid funding must expand coverage:

Includes for the first time non-disabled, non-pregnant adults up to 133% of the poverty line

Approximately 17 million new people 100% federally funded through 2016, then states must pay up

to 10% of additional costs in 2020

Supreme Court: Tying old money to new mandates is coercive to the states

Federal government can refuse to give new money, but not take away current funding

States may opt in to Medicaid Expansion Michigan is on the fence

Private Insurance Providers

Glenn Smith

Cannot deny coverage for pre-existing conditions

Must allow children to stay on their parents plan until age 26

Cannot place lifetime limits on coverage

Must include preventative care in plans

Must spend 80% of premiums on actual care

20% for overhead, salaries, advertising, etc.

Employer Obligations Large Employer Obligations (> 50 Full Time Employees)

Must automatically enroll new full-time employees in health insurance

Full Time > 30 hours per week

Must offer “affordable” health insurance to employees (< 9.5% of income)

Based on lowest cost self-only coverage

Must offer coverage for children up to age 26 (but not spouses)

May charge higher premiums for spouses, dependents

If employees instead apply for Tax Credits or to Exchanges, employers must pay a fine

= Cost of Employee's Tax Credit x Number of employees

Employers can avoid penalty based on the employee's W-2 earnings

Small Businesses (<25 Employees)

If they offer health insurance are entitled to tax credits up to 35% now, increases to 50% in 2014

Starting 2014, can participate in Co-op Insurance Plans and Exchanges

Individual Mandate Requires most people to maintain minimum health insurance coverage for

themselves & their dependents.

Exemptions:

Undocumented immigrants Religious objectors Incarcerated people

Can be satisfied through

Employer-provided insurance

Individual Insurance Plans

Health Insurance Exchanges

Government Sponsored Coverage (Medicaid/Medicare)

9 out of 10 non-elderly people would see no change because they are already covered or exempt

Failure to be covered causes a tax liability that grows over the years

But not criminal prosecution for tax evasion

But not if employer self-only coverage is > 8% of household income

Health Insurance Exchanges

Almost anyone can apply to participate in exchanges

U.S. citizen or national (or lawfully present) Living in the U.S. Not incarcerated

Low-income individuals may be eligible for tax credits and/or price caps on their premiums

Must not be entitled to “affordable” insurance from any other source (employer, Medicaid)

Income is based on adjusted household income (even if only 1 member of the household is applying)

Health Insurance Premiums

Income for Individual

Income for Family of 2

Household Income (% of Poverty Line)

Premium Cap (% of Household Income)

Max Annual Payment for Individual

Max Annual Payment for Family of 2

$15,282 $20,628 133% 3% $458 $619

$22,980 $31,020 200% 6.3% $1,448 $1,954

$28,725 $38,775 250% 8.05% $2,312 $3,121

$34,470 $46,530 300% 9.5% $3,275 $4,420

Civil Rights ● Family ● Criminal

248-764-8584 www.schmidtlawservices.com

Questions?

Special Thanks to: Glenn Smith, InSphere Insurance Solutions

Amber Colegrove, UAW