Health Care Reform Facts
The Patient Protection and Affordable Care Act was signed into law by President Barack Obama on March 23, 2010. Its purpose is to modernize the health care and health insurance delivery system and stands to insure more than 32 million Americans.
Here are the main health care reform facts:
- 32 million uninsured Americans will get health insurance.
Uninsured citizens will be newly covered through private and public health insurance options.
The individual insurance mandate will require people to purchase insurance or pay a fine.
Subsidies provided by the government will help Americans afford health insurance coverage in the private market.
Medicaid will be expanded across the nation to provide low-income adults without children coverage.
Health insurance exchanges set up by reform will help people find if they are eligible for Medicaid, subsidies and help people find affordable coverage.
Health care reform requires health insurance companies to offer consumers free preventive services such as routine check-ups, physicals and wellness care. These services will help detect diseases and conditions early for many Americans. Seniors will also have access to preventive services at no-cost.
Health insurance companies will have to follow a national medical loss ratio (MLR). The MLR will require insurers to spend 80 to 85 percent of premiums on medical care for consumers. Only 15 to 20 percent of premiums can be spent on administrative costs.
Health care reform will also be providing states with $250 million over the next five years in grants to help states review health insurance rates. States will be able to adapt regulations and rules on increasing rates and will have power to deny any rates that are not justified. Health insurers will be required to post justifications for rate increases online.
The individual health insurance mandate is one of the most controversial pieces of health care reform. The mandate will require individuals to purchase health insurance by 2014 or pay a fine.
In 2014, the fine for not having insurance will be either $95 or 1 percent of income, whichever is greater. Then in 2015, the mandate fine will be $325 or 2 percent of income and in 2016, the fine will be $695 of 2.5 percent of income. After 2016, the fine will be decided by a cost-of-living adjustment each year.
Benefits for the original Medicare program administered by the federal government won't see any changes from reform. However, seniors with Medicare Advantage may see changes in their benefits and/or rises in their health insurance premiums from health care reform.
Medicare Advantage is administered private health insurers. In reform, the government will be reimbursing the private insurers less over time. This will result in either higher premiums for Medicare Advantage recipients or fewer benefits.
Even though health insurance companies will be regulated heavily, health costs are expected to rise. As a result of all the new laws, experts believe premiums will go up by at least 1 percent — most likely more. There will be many new insurance benefits for consumers but those benefits will raise premiums for many.
Although many people will receive subsidized coverage, that coverage cannot be used to obtain an elective abortion. Companies are allowed to still cover abortions but funds must be held in separate, private accounts and cannot be paid for with taxpayer funds.
Illegal immigrants cannot participate in the exchanges even if the policies are unsubsidized and paid completely out-of-pocket. They will also not be eligible for new Medicaid programs.
The Congressional Budget office estimates that the cost of reform will be around $1 trillion in the next 10 years and is expected to reduce the deficit over $100 billion. Reform is also expected to extend the Trust Fund of Medicare by 12 years.
The health care legislation takes measures to stop and decrease fraud for private plans and Medicare plans. Reform will implement new systems to reduce the criminal activity and save on health care costs associated with fraud, which is roughly $100 billion a year. Over the new few years it is expected that more legislation will be introduced to fight this problem.
How did the health care bill become law?
Through a procedural rule called "budget reconciliation," the U.S. Senate approved the bill with a majority vote and sent it back to the U.S. House of Representatives for final approval. The legislation was approved in the House by seven votes — 219 votes for and 212 votes against.
Voting was sharply split between party lines — not a single Republican voted for the health care bill and 34 Democrats voted against it.
For more information visit our health care reform information center.