Thu, May 23

What the health care law says

Insurance is required:

Beginning in 2014 most Americans would have to purchase health care insurance or be forced to pay a fine. You may keep existing insurance programs.

New plans would be regulated by the federal government requiring a minimum of benefits, consumer protections and an appeals process for consumers who dispute an insurance company's decision. New plans must cover checkups and other preventative care without co-pays.

A temporary high-risk pool will be set up to cover adults with pre-existing conditions. Health care exchanges will eliminate the program in 2014.

Lifetime caps on the amount of insurance an individual can have will be banned. Annual caps will be limited, and banned in 2014.


Each state would have a health care insurance exchange by 2014 so that any individual can purchase health insurance. The plans would have to meet federal regulations not to discriminate based on pre-existing exclusions, to spend a high percentage of premiums on actual care and to follow certain consumer protection laws.Plans could no longer limit how much costs they are willing to cover.

Individuals currently covered by an employer-provided plans could not purchase from the exchange, nor couldundocumented immigrants. The Secretary of Health and Human Services will set up a web site to allow anyone in any state to seek out affordable health insurance options.

Large business requirements:

If a business has over 50 full-time employees they will be forced to offer health care coverage.

Employers are hit with a fee if the government subsidizes their workers' health insurance coverage. The $2,000-per-employee fee would be assessed on the company's entire work force, minus an allowance. Companies with 50 or fewer workers are exempt from the requirement. Part-time workers are included in the calculations.

Initially small businesses would receive a tax credit for up to 35 percent of the money they pay to purchase health insurance for their employees. By 2014 that percentage would increase to 50 percent.

The bill establishes a temporary program for companies that provide early retiree health benefits for those ages 55â64 in order to help reduce the often-expensive cost of that coverage.


The proposal would set up a board that to research and propose solution to reduce the costs of Medicare. It would be prohibited from proposing anything that would ration care for the elderly. Instead the proposal would focus on reducing waste and fraud while making Medicare more efficient.

Medicare payment protections will be extended to small rural hospitals and other health care facilities that have a small number of Medicare patients.

Closes the "doughnut hole" health insurance coverage gap in the Medicare prescription drug benefit that seniors fall into once they have spent $2,830. When the gap is completely eliminated in 2020, seniors will still be responsible for 25 percent of the cost of their medications until Medicare's catastrophic health insurance coverage kicks in.

A twoâyear temporary credit (up to a maximum of $1 billion) is in the bill to encourage investment in new therapies for the prevention and treatment of diseases.


Expands Medicaid to all under the age of 65 to include 133-percent of federal poverty level (which is $29,327 for a family of four). Currently the poverty level is around $18,000 for a family of three.

Requires states to expand Medicaid to include childless adults starting in 2014.

Federal Government pays 100 percent of costs for covering newly eligible individuals through 2016.

Illegal immigrants are not eligible for Medicaid.

Individuals who make between 100 percent-400 percent above the federal poverty level would be eligible to receive credits to assist them in purchasing health care insurance.They cannot be eligible for Medicare, Medicaid and cannot be covered by an employer. Eligible buyers receive premium credits and there is a cap for how much they have to contribute to their premiums on a sliding scale.

The aid is available on a sliding scale for households making up to four times the federal poverty level, $88,200 for a family of four. Premiums for a family of four making $44,000 would be capped at around 6 percent of income.

How its paid for:

Cadillac plan tax. If an insurance plan costs $8,500 for an individual or $23,000 for family it would be taxed at 40 percent for any amount above those amounts. Most health care plans cost much less than those amounts in premiums.

Taxes on health insurance companies, pharmaceuticals, and medical supply companies. Each of these companies would be assessed fees. Pharmaceuticals would pay $2 billion, medical supply companies would pay $2.3 billion, and health insurance companies would pay $2 billion starting in 2011 and increasing to $10 billion by 2017.

Increased efficiency and reduced waste in Medicare to offset some of the other costs. Overall the bill was projected to save a little over $100 billion in the first ten years of its existence and well over $700 billion after that. Those projections were done by the non-partisan Congressional Budget Office.