Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act (ACA) or "Obamacare" is a United States federal statute signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act, it represents the most significant regulatory overhaul of the country's healthcare system since the passage of Medicare and Medicaid in 1965.

Overview of provisions
The ACA includes numerous provisions that take effect between 2010 and 2020. Policies issued before 2010 are exempted by a grandfather clause from many of the changes to insurance standards, but they are affected by other provisions. Significant reforms, most of which take effect by January 1, 2014, include:
 * Forbidden discrimination of clients, called guaranteed issue, which prohibits insurers from denying coverage to individuals due to pre-existing conditions, and a partial community rating requires insurers to offer the same premium price to all applicants of the same age and geographical location without regard to gender or most pre-existing conditions (excluding tobacco use).
 * Minimum standards for health insurance policies are established.
 * An individual mandate requires all individuals not covered by an employer sponsored health plan, Medicaid, Medicare or other public insurance programs (such as Tricare) to secure an approved private-insurance policy or pay a penalty, unless the applicable individual has a financial hardship or is a member of a recognized religious sect exempted by the Internal Revenue Service. The law includes subsidies to help people with low incomes comply with the mandate.
 * Health insurance exchanges will commence operation in every state. Each exchange will serve as an online marketplace where individuals and small businesses can compare policies and buy insurance (with a government subsidy if eligible). In the first year of operation, open enrollment on the exchanges runs from October 1, 2013 to March 31, 2014, and insurance plans purchased by December 15, 2013 will begin coverage on January 1, 2014.   In subsequent years, open enrollment will start on October 15 and end on December 7.
 * Low-income individuals and families whose incomes are between 100% and 400% of the federal poverty level will receive federal subsidies on a sliding scale if they purchase insurance via an exchange. Those from 133% to 150% of the poverty level will be subsidized such that their premium costs will be 3% to 4% of income. In 2013, the subsidy would apply for incomes up to $45,960 for an individual or $94,200 for a family of four; consumers can choose to receive their tax credits in advance, and the exchange will send the money directly to the insurer every month. Small businesses will also be eligible for subsidies.
 * Medicaid eligibility is expanded to include individuals and families with incomes up to 133% of the federal poverty level, including adults without disabilities and without dependent children. The law also provides for a 5% "income disregard", making the effective income eligibility limit for Medicaid 138% of the poverty level. Furthermore, the State Children's Health Insurance Program (CHIP) enrollment process is simplified. However, in National Federation of Independent Business v. Sebelius, the Supreme Court ruled that states may opt out of the Medicaid expansion, and several have done so.
 * Reforms to the Medicare payment system are meant to promote greater efficiency in the healthcare delivery system by restructuring Medicare reimbursements from fee-for-service to bundled payments. Under the new payment system, a single payment is paid to a hospital and a physician group for a defined episode of care (such as a hip replacement) rather than individual payments to individual service providers. In addition, the Medicare Part D coverage gap (commonly called the "donut hole") will shrink and be completely closed by January 1, 2020.
 * Businesses who employ 50 or more people but do not offer health insurance to their full-time employees will pay a tax penalty if the government has subsidized a full-time employee's healthcare through tax deductions or other means. This is commonly known as the employer mandate.

Links

 * Oops-care by George C. Leef, February 2014
 * Obamacare and Unintended Consequences by Sandy Ikeda, December 2013
 * Obamacare Rationing: It’s Already Here by Terree P. Summer, February 2014
 * A Cure for Obamacare: From Canada with Love by Gregory Cummings, January 2013
 * Some Thoughts on Obamacare, Part I, Part II, Part III by Steven Horwitz, July 2012
 * Obamacare Abominations by John Stossel, February 2012
 * The Effects of the Affordable Care Act on Small Business (pdf, html) by Devon M. Herrick, June 2014
 * Oops-care by George C. Leef, February 2014
 * Obamacare and Unintended Consequences by Sandy Ikeda, December 2013
 * Obamacare Rationing: It’s Already Here by Terree P. Summer, February 2014
 * A Cure for Obamacare: From Canada with Love by Gregory Cummings, January 2013
 * Some Thoughts on Obamacare, Part I, Part II, Part III by Steven Horwitz, July 2012
 * Obamacare Abominations by John Stossel, February 2012
 * The Effects of the Affordable Care Act on Small Business (pdf, html) by Devon M. Herrick, June 2014
 * The Effects of the Affordable Care Act on Small Business (pdf, html) by Devon M. Herrick, June 2014