Group 1
Kyle, Nic, Jocelyn, Brittni
Overview of the PPACA’s approach to expanding coverage
Requires a majority of citizens and residents to have health insurance
Violations will induct a tax penalty
Creates a system in which to provide cost-sharing credits to individuals and
families whose income is between 133-400% of the federal poverty level.
Requires employers to pay penalties depending upon whether or not their
employees are receiving tax credits for health insurance.
Small businesses have exemptions
Expands Medicaid to 133% of the federal poverty level.
Nic Mattieson
Individual Mandate
Requires citizens to have health insurance
A tax penalty will be implemented on those without qualified coverage.
The penalty will be based on a flat fee or percent of taxable income, beginning in 2014.
The penalty paid will be the higher of the two, the percentile reaching a maximum of $695.
Year
Percent of taxable income
Flat fee
The max penalty of $695 may fluctuate after 2016 due to inflation.
2014
1%
$95
2015
2%
$325
2016
2.5%
$695
Nic Mattieson
Exemptions to Mandate
Exemptions to the tax will be granted to the following:
financial hardship
religious objections
Native Americans
populace that remain uninsured for under three months
undocumented immigrants
incarcerated individuals
those whose income remains under the tax filing threshold
for those whom the lowest costing plan costs greater than 8% of their income
Nic Mattieson
Employer obligations
Require employers to offer health insurance
Any employer with 50 or more full-time employees, at least one of which receiving a premium tax
credit, and does not offer coverage will be fined $2000 per full-time employee (excluding first
30 employees).
Any employer with 50 or more full-time employees, at least one of which receiving a premium tax
credit, and does offer coverage will be fined the lesser of either:
$3000 per employee receiving a premium tax credit
$2000 per full-time employee (excluding first 30 employees).
Employers with less than 50 full-time employees are exempt from the fines.
Mattieson
Employers with more than 200 full-time employees must automatically Nic
enroll
Controversies to the Mandate and Employer Obligations
Conflicts with one’s individual liberty
May or may not be constitutional
Deemed constitutional in 2012
Creates too many expenses for businesses
May be detrimental to the job market
Nic Mattieson
Jocelyn- Treatment of Medicaid
Medicaid is helping the poor people afford health-care
expands medicaid for anyone under the age of 65
allows states to opt-in or out of the expansion package
Jocelyn- Reasons to expand Medicaid
Example: Delaware expanded Medicaid
Some reasons why a state should expand Medicaid
a.
It will free up spending that currently went into health care spending
b.
it could help low profit hospitals keep emergency departments open
c.
it will reduce the number of uninsured adults within the state
d.
it will help individuals with mental illness
e.
it will allow women to get more health benefits
Jocelyn-Reasons for no expansion of Medicaid
states can say no to the money for expanding medicaid
Example: Wisconsin did not
Walker calls this a bait and switch which means the federal government baits the state into expanding
the program and then switches the funding putting it back on the state.
Their will be less doctors because a study in health affairs in 2011 found that ⅓ of doctors would not
accept new medicaid patients because medicaid pays the doctors $0.52 per $1 that a private insurer
would pay them, so the doctor is losing out $0.48 which would make them not want to be one.
Jocelyn-Treatment of Medicaid
The government will begin funding which starts out at 100% in 2014 then goes
to 95% in 2017, 94% in 2018, 93% in 2019, and 90% in 2020 and this trend
will continue to go down in the following decades.
This is what Governor Walker meant by baiting and switching, so the federal government gives
us funding for more poor people then basically it gives you lower funding for the states over
time and they have to somehow have to find a way to pay for this program that is larger than it
originally was.
Jocelyn-Treatment of CHIP
CHIP stand for Children’s Health Insurance Program
A state can not change its rules to make less people eligible for the program
Eligibility
-To be eligible for premiums and cost-sharing subsidies in the Affordable Care Act
you must fit the qualifications for many of the government's guidelines.
-Some qualifications are being an American citizen, below 65 years of age, and
not falling below 133% on the Federal Poverty Level.
-Employes who are offered coverage by an employer are not eligible for premium
credits unless the employer plan does not have an actuarial value of at least 60%
or if the employee share of the premium exceeds 9.5%.
Kyle
Premium Credits
-Premium is what you pay to your insurance company each month.
-People who who hover above the poverty line don’t qualify for medicaid
but can qualify for premium subsidies.
-Premium subsidies is what the government will pay for you so you can
buy health insurance.
Up to 133% FPL: 2% of income, 133-150% FPL: 3-4% of income
150-200% FPL: 4-6.3% of income, 200-250% FPL: 6.3-8.05% of income,
250-300% FPL: 8.05-9.5%
Federal Poverty level chart
Kyle
Cost-Sharing Subsidies
-When you require any medical assistance the insurance company will only pay
for so much,deductible, and you have to pay the rest.
-People who hover just above the poverty line and need help paying the rest of
their bill are eligible for cost-sharing subsidies.
-The government will help pay for the rest of your cost.
100-150% FPL: 94%, 150-200% FPL: 87%
200-250% FPL: 73%,250-400% FPL: 70%
Kyle
Verification
-To apply for the Affordable Care Act you need to fill out a lot of paperwork.
-You can apply through phone, internet, face to face or by mail.
-The government will do a thorough back ground to see if you apply for it and are
not cheating the system.
-They will look at your tax returns, American citizenship,
spouse,age, and where you work.
Kyle
Subsidies and Abortion Coverage
-People can’t use premium subsidies or cost-sharing subsidies for abortions.
-Patients can if they were raped or if a pregnant mother is endangered.
-You can choose insurance plans that cover abortion, but if you have an abortion
you need to pay the full premium amount for that month and all the cost sharing
subsidies for the surgery.
Kyle
Kyle
Britt- Small Business Tax Credits
❖ Provides small employers with:
➢ no more than 25 employees
➢ average annual wages of less than $50,000
➢ health insurance for employees with a tax credit
Phase 1: 2010 through 2013
❖ provide a tax credit up to 35% of the employer’s contribution toward the
employee’s health insurance premium
➢ Health insurance premium is the periodic payment made on insurance.
➢ Tax credit is an amount of money that can be offset against a tax liability.
➢ Full credit goes to employers with
■ 10 employees or less
■ average annual wages less than $25,000
➢ As amount of people increase and wages go up, the credit phases-out, meaning they no
longer get full credit
Phase 2: 2014 to now
❖ eligible for small business that purchase coverage through the state
Exchange
❖ provide a tax credit of up to 50%
❖ credit is available for 2 years
❖ eligible for tax credits of up to 35%
❖ full credit for employers with
➢ 10 or less people
➢ average annual wages less than $25,000
Reinsurance Program
❖ creates a temporary reinsurance program for employers providing health
insurance to retirees over the age of 55 and not eligible for Medicare
➢ Medicare is a federal system of health insurance for people over 65 years of age and for
certain younger people with disabilities.
❖ reimburses employers for 80% of retirees fees between $15,000 and $90,000
Two Methods of Reinsurance
❖ Facultative Reinsurance
➢ negotiated separately for each insurance policy that is reinsured
➢ normally purchased by companies for individual risks not covered, or insufficiently covered, by
their reinsurance treaties
❖ Treaty Reinsurance
➢ the ceding company and the reinsurer negotiate and execute a reinsurance contract which the
reinsurer covers the specified share of all the insurance policies issued by the ceding company
which come within the scope of that contract
■ Ceding company is an insurance company that passes the part or all of its risks from its
insurance policy to a reinsurance firm.
Work Cited
"Eligibility." Eligibility. Medicaid.gov, n.d. Web. 12 Jan. 2016.
"2015 Federal Poverty Level Income Chart." Comrade Financial Group, 23 July 2015. Web. 11 Jan. 2016.
Hee Lee, Michelle Ye. "Does Obamacare Provide Federal Subsidies for Elective Abortions?" Washington Post. The Washington Post,
26 Jan. 2015. Web. 12 Jan. 2016.
Huston, James. "Help with This Assignment." Bloomer High School, Bloomer. 8 Jan. 2016. Lecture.
"Obamacare - Top 20 Views, Obamacare T-shirts - How Does Obamacare Work??" 'Road To Success - Media Watch Dog Anti PEDs and for
Honesty in Government' N.p., 22 Oct. 2013. Web. 11 Jan. 2016.
"Summary of the Affordable Care Act." The Henry J. Kaiser Family Foundation. Kff.org, 25 Apr. 2013. Web. 07 Jan. 2016.
"Why Is Obamacare so Controversial?" BBC News. Bbc.com, n.d. Web. 12 Jan. 2016.
www.healthlaw.org/publiccations/50-reasons-medicaid-is-good-for-your-state