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Patient Protection and Affordable Care Act

Bill NumberHR-3590
Public Law Number111-148

Enacted - Signed by the President

Sponsor & Key Contributors
Charles B. Rangel

Related Issues...
ObamaCare: What you should know
Repealing (and Replacing?) Obamacare
Understanding Health Care Policy

Related Court Cases
(2015) King v. Burwell
(2014) Burwell v. Hobby Lobby
(2012) NFIB v. Sebelius

Other names for this bill...

The Patient Protection and Affordable Care Act also is known as...

o "ObamaCare"
o ACA (for Affordable Care Act)
o Health Care Reform

Major provisions of the bill

The Patient Protection and Affordable Health Care Act does several things to make health care more accessible to Americans...

o Makes it easier for many people to obtain insurance

o Protects patients from certain insurance company actions

o Establishes "exchanges" that make it easy for people to compare insurance companies and policies

o Requires most Americans to obtain insurance

We'll expand on these topics below...

More people can be insured

The Patient Protection and Affordable Care Act does the following to make it easier for most Americans to obtain health care coverage...

o Children can be insured on their parents' policy until they're 26 years old.

o Insurance companies must insure everyone, regardless of their health. In other words, the concept of "pre-existing conditions" was eliminated as of 2014.

o Insurance companies cannot charge higher premiums because of a person's health.

Insurance is better and safer

The Patient Protection and Affordable Care Act protects people from previously common insurance industry practices...

o Insurance companies cannot limit the amount they will pay in a year or over the lifetime of an insured person.

o Insurance companies cannot rescind coverage on someone if they get sick.

o Insurance companies must offer a way for a customer to appeal a denied claim.

o Insurance companies must spend at least 80 percent of the premium dollars they receive on health care. If they don't, they must provide rebates. In comparison, government-run Medicare spends more than 95 percent of the money it receives directly on health care services.

Online exchanges make it easy to shop

As of 2014, each state is required to provide an easy way to shop for and compare health insurance policies from various companies. Those "marketplaces" are what the Affordable Care Act refers to as "Exchanges."

It's the same concept as a travel website that lets you compare airline flights or hotels, but with important differences.

For one thing, any policy offered on an exchange will be required to meet certain conditions regarding what they offer. These include requirements on...

o Preventive and wellness services
o Laboratory services
o Prescription drugs
o Emergency services and hospitalization
o Mental health services
o Maternity and pediatric care

For another thing, using the exchange will allow you to receive a discount (the Exchange calls it a subsidy) on your policy based on your income.

Also, you cannot be turned down, regardless of your age or health.

You are not required to buy your health insurance through the exchange. However, that will be the only way you'll be able to receive a subsidy and ensure your policy meets the above standards.

Most people will be required to buy insurance

Starting in 2014, most people are required to pay a penalty tax if they don't have health insurance that meets the law's minimum requirements.

For 2014 the tax will be small - the greater of $95 or 1 percent of your income. By 2016 it will increase to $695 or 2.5 percent of your income. The tax only applies to those with an income high enough to afford insurance. As previously mentioned, those who cannot afford insurance may receive subsidies to help pay for it.

Those living in poverty would receive free health care

The Patient Protection and Affordable Care Act tries to ensure that every American can afford health care. However, it does so in different ways based on your (or your family's) income...

As shown in the above chart, if you make less than the federal poverty level, the law does not require you to purchase insurance. Rather, it simply makes you eligible for Medicaid - virtually free health care.

Medicaid is administered by each state independently, and each state sets its own eligibility rules - with limits typically well below the poverty level. As part of the Patient Protection and Affordable Care Act, anyone earning less than the poverty level would now be eligible for Medicaid. The federal government would pay virtually the entire cost of this Medicaid Expansion.

Physician Payments Sunshine Act

This section of the law (Section 6002) requires that makers of medical products disclose payments or gifts given to health care providers. The information is available to the public.

Supreme Court upholds Obamacare but limits Medicaid Expansion

In June 2012, the Supreme Court ruled on the constitutionality of the Patient Protection and Affordable Care Act (National Federation of Independent Business v. Sebelius, Secretary of Health and Human Services). The decision affected two key components of the law.

It ruled that the mandate - requiring people to maintain a minimum level of insurance - was constitutional.

However, the court struck down the requirement that states expand their Medicaid programs (even though there would be little cost to the states).

As of 2014, approximately half of the 50 states have accepted Medicaid Expansion. Most residents of those states now have health care coverage.

In the states that rejected Medicaid Expansion, most people who earn too little to qualify for subsidies (i.e. less than the federal poverty level) yet too much to qualify for their state's Medicaid program, have remained uninsured.

The ACA allows strict limits on abortion coverage

The Medicaid part of the law contains a provision known as the Hyde Amendment - which prevents federal money from being used for abortions. Because each state administers its own Medicaid program, states still can allow for abortions. They just need to use state money to pay for them.

Those who purchase policies through the exchange also face restrictions. Insurance plans offered through the exchanges are not required to provide coverage for abortions. In fact, the law allows states to states to pass their own laws that prohibit any plans on their exchanges from covering abortions.

For more on the details of abortion and the Affordable Care Act, and to find out the law in your state, see this Kaiser Family Foundation report.

Note: In most cases, there are exceptions for pregnancies that endanger the life of the mother and those that are the result of rape or incest.

Repeal attempts

Since the Patient Protection and Affordable Care Act took effect, there have been more than 50 attempts to repeal it, weaken it, or to restrict funding and make it difficult to administer. None have succeeded. They include...

Date            Bill         Sponsor
Jan 2015 HR-30 Todd Young
Aug 2013 HR-2988 Daniel Lipinski
Jun 2013 HR-2575 Todd Young
Jun 2013 S-1188 Susan Collins
Jan 2013 S-177 Ted Cruz
Jan 2013 HR-132 Steve King
Jan 2013 HR-45 Michele Bachmann
July 2012 HR-6079 Eric Cantor
Mar 2010 HR-4903 Michele Bachmann

More information...

To read a description of every Obamacare provision in plain english, click here.

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