Summary
Makes health care and health insurance more affordable and available to more people by creating new rules for insurance companies and helping people pay for plans.
What problem does this solve?
Before this law, many people could not get health insurance because it was too expensive or they were denied for having a health problem. This law helps more people get insurance by creating marketplaces to buy plans, giving financial help, and stopping insurance companies from denying coverage for pre-existing conditions.
Who does this affect?
- Uninsured individuals
- Individuals with pre-existing conditions
- Low-income adults
- Small business owners
- Young adults under 26
What does this law do?
Reference
Text:
Section:
Sec. 2704
Header:
Prohibition of preexisting condition exclusions or other discrimination based on health status
Prohibits denying coverage for pre-existing conditions
Stops health insurance companies from refusing to cover people or charging them more because they have a pre-existing health condition.
Requires individuals to have health insurance
Requires most Americans to have a basic level of health insurance coverage, known as the individual mandate, or pay a penalty.
Creates health insurance marketplaces
Establishes state-based health insurance marketplaces, or Exchanges, where individuals and small businesses can shop for and compare private insurance plans.
Reference
Text:
Section:
Sec. 1401
Header:
Refundable tax credit providing premium assistance for coverage under a qualified health plan
Provides financial help to buy insurance
Offers tax credits and subsidies to help lower- and middle-income individuals and families afford the cost of health insurance premiums and out-of-pocket expenses.
Expands medicaid
Expands the Medicaid program to cover more low-income adults, making health care accessible to millions more people.
Allows young adults to stay on a parent's plan
Permits young adults to remain on their parents' health insurance plan until they turn 26 years old.
Eliminates lifetime and annual dollar limits
Prevents insurance companies from setting lifetime or unreasonable annual dollar limits on essential health benefits.
Covers preventive care at no extra cost
Requires most health plans to cover a set of preventive services, like shots and screening tests, without charging a copayment or deductible.
Requires large employers to offer coverage
Requires employers with 50 or more full-time employees to offer affordable health insurance or pay a penalty.
Ensures value for premium payments
Requires insurance companies to spend at least 80-85% of premium dollars on medical care and quality improvements, rather than on administrative costs and profits.
What is the real world impact?
•
Expands access to health insurance
Aims to make health insurance available to nearly all Americans, especially those who were previously uninsured due to high costs or pre-existing health conditions, improving overall public health.
•
Forces individuals to purchase health insurance
Requires most Americans to have health insurance or pay a penalty. Some view this as government overreach forcing people to buy a private product.
When does this start?
This law has many different start dates for its various parts, with major provisions taking effect between 2010 and 2014.
Reference
Text:
Section:
Sec. 1101(a)
Header:
Immediate access to insurance for uninsured individuals with a preexisting condition
Temporary high-risk pool
Establishes a temporary high-risk health insurance pool for uninsured individuals with pre-existing conditions within 90 days of March 23, 2010.
Dependent coverage to age 26
Health plans must allow children to stay on their parent's plan until age 26, effective for plan years starting on or after September 23, 2010.
Major insurance market reforms
Prohibits denial of coverage for pre-existing conditions and sets new rules for insurance premiums, effective for plan years starting on or after January 1, 2014.
Health insurance marketplaces open
State-based health insurance marketplaces must be established and operational by January 1, 2014.
Reference
Text:
Section:
Sec. 2001(a)(1)(C)
Header:
Medicaid coverage for the lowest income populations
Medicaid expansion
Expands Medicaid eligibility to adults with incomes up to 133% of the poverty level, beginning January 1, 2014.
Individual mandate
Requires most individuals to obtain health insurance coverage starting in 2014.