The official name of the Obamacare bill is the Patient Protection and Affordable Care Act (Public Law 111–148). It became law on March 23, 2010, when it was signed by President Obama. Many people have a basic idea of what Obamacare does. However, there are many components of the bill itself that aren't well known. Since this Act is as comprehensive as the Social Security Act, it's a good idea to know what's in it.
The Act has ten titles, or sections. Here's a summary of what they are. All Titles are being implemented by the Secretary of Health and Human Services except for Titles VIII and IX, which are being implemented by the Secretary of the Treasury Department.
Title I. Quality, Affordable Health Care for All AmericansThis is the most well known part of Obamacare. In 2014, it requires the 32-50 million uninsured Americans to buy insurance or pay a tax of up to 1% of their income. Those who currently have insurance can keep their plans. Illegal immigrants are not covered by this requirement, or allowed to get Obamacare.
Health insurance exchanges have been set up to allow everyone to compare health plans, and find out if they qualify for Medicaid or tax credits. Congress is mandated to use the exchanges, as well. States received Federal funding to set up the exchanges, or allow the Federal government to run its exchange instead.
Businesses with 50 or more employees are required to provide health insurance, or pay an excise tax of $2,000 per employee except for the first 30 employees. This requirement was delayed to January 1, 2015. Any company with fewer than 100 employees can use the exchanges. Companies with 25 employees or less that provide insurance can qualify for a tax credit of 35% which rises to 50% in 2014. Businesses that offer health insurance to early retirees age 55-64 may qualify for Federal aid.
Title I requires insurance companies to provide safeguards and additional benefits:
- Parents can add children up to age 26 to their plans.
- Insurance companies can't drop people if they get really sick. They also can't put a ceiling on lifetime coverage.
- They can't deny coverage to those with pre-existing conditions (children immediately, adults in 2014).
- New plans must cover 100% of wellness or pregnancy exams.
- Companies must spend at least 80% of premiums on medical services, or rebate the rest back to policyholders. They must submit justification for rate hikes to states for approval.
Title II. The Role of Public ProgramsIn 2014, the Act extends Medicaid coverage to anyone whose income is below 133% of the Federal poverty level. This typically allows states to cover low income adults without children. The Federal government will pay 100% until 2017, and the states will have to chip in 10% of the program's cost after that. Five states have already taken advantage of a pilot program, adding 500,000 families to Medicaid. (Source: Ezra Klein, Wonkbook, Obamacare Medicaid Expansion, July 3, 2012)
The Act maintains the Children's Health Insurance Program (CHIP). On October 1, 2015 it raises the Federal matching rate to 93%. It also provides $40 million in federal funding to promote Medicaid and CHIP enrollment. (Source: CHIP)
Title III. Improving the Quality and Efficiency of Health CareThe Act closes the gap in prescription drug coverage, known as the donut hole, in Medicare Part D. In 2010, seniors received $250; in 2011, a 50% discount on brand-name prescription drugs, and 7% on generic drugs. By 2020, the donut hole will be eliminated. The Act also provides wellness and preventive care visits for those on Medicare for free.
Title IV. Prevention of Chronic Disease and Improving Public HealthThe Act established the National Prevention, Health Promotion, and Public Health Council. It's overall goal is to support preventive health care. It is chaired by the Surgeon General, and composed of the heads of 17 Federal agencies. It will coordinate Federal health efforts around seven priority areas:
- Tobacco free living.
- Preventing drug abuse and excessive alcohol use.
- Healthy eating.
- Active living.
- Injury and violence-free living.
- Reproductive and sexual health.
- Mental and emotional health.
Title V. Health Care WorkforceThe Act funds scholarships and loans to increase the number of primary care physicians, nurses, physician assistants, mental health providers, and dentists. Its goal is to double the number of patients treated in five years.
Title VI. Transparency and Program IntegrityThe Act requires doctors to report on financial interest they have with imaging companies, etc., and provide a list of alternative service providers to patients. It requires medical device makers, drug companies, etc., to reveal financial arrangements they have with doctors. Companies that manage the prescription drug portion for Medicare or the state exchanges are required to report any financial concessions they receive from drug companies. (Source: White House, Title VI.
Title VI provides training and requires background checks for nursing home staff to reduce elder abuse.
The Title also cracks down on fraud by identifying high-risk providers, and preventing them from setting up in another state. It gives states the ability to test legal reforms to reduce enhance patient safety, encourage efficient resolution of disputes, and improve access to liability insurance.
Title VII. Improving Access to Innovative Medical TherapiesThe Act gives drug discounts to hospitals that serve low-income patients. It also requires competitive pricing for vaccines and hormone therapies.
Title VIII. Community Living Assistance Services and Supports Act (CLASS Act)The CLASS Act allows Americans who are or become disabled to receive a $50 daily payment to put toward assisted living. They must pay premiums for five years, and work for three of those years. The daily payment can go toward home health care, adult day care, and other services to allow them to stay in their homes. It can also go toward assisted living facilities, nursing homes and group homes. It would have been self-funded, and was estimated to reduce the Federal deficit by $70.2 billion over the next 10 years as it allows people to keep working and stay out of nursing homes and the hospital. It became effective on January 1, 2011, but by October 1 it was determined to be unworkable. Basically, it could not compete with private sector plans that offered better benefits. (Source: Kaiser, Health Care Reform and the CLASS Act; Home Health Care Agencies)
Title IX. Revenue ProvisionsThe Act raises Medicare taxes to 2.35% on incomes above $200,000 for individuals or $250,000 per family. They would also pay 3.8% Medicare taxes on the lesser of dividends, capital gains, rent and royalties or income above the limits stated. These taxes will help to lower the budget deficit by $143 billion over the next 10 years. For more, see Medicare Tax.
Title X. Reauthorization of the Indian Health Care Improvement ActThus modernizes health care services for 1.9 million Native Americans. It is implemented in consultation with the Indian Health Service.
Read the full Obamacare bill at HealthCare.gov. Article updated October 1, 2013
More on Obamacare
- How Does Obamacare Work?
- Obamacare Pros and Cons
- Summary: How Obamacare Affects You
- The 2012 Supreme Court Ruling on Obamacare
- Obamacare Taxes
- Obamacare Explained
- The True Cost of Obamacare to the Nation
- Repeal Obamacare?
- Health Care Reform Timeline
- Why Health Care Should Be Reformed
- CBO Report on Obamacare