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