| Patient
Protection and Affordable Care Act of 2010 The
Patient Protection and Affordable Care Act of 2010, or “Obamacare,” was signed
into law by the President, and is scheduled to start taking effect in 2014, next
year. The overall goals are two-fold: to provide all Americans with affordable
health insurance, and ultimately, to reduce the sky-rocketing health care costs
in the U.S. The intent was to cover the 32 million (or up to 49 million,
depending upon the source) uninsured Americans. What is it and what are the pros
and cons? It is difficult to understand all of the aspects of Obamacare because
it depends, largely, on who you ask. How do you get an unbiased perspective? The
Liberals love it and the Conservatives hate it. What we are going to try to do
is present an unbiased analysis so that you, the reader, have a better idea of
what to expect in a few short months.
What Is It?
Obamacare is health care reform at the national level. It is a
comprehensive plan aimed at providing many more Americans with health insurance
than currently have coverage. It is designed to reduce health care costs and to
regulate the health insurance industry.
What’s Good
What is very good about
Obamacare is that health insurance coverage will be obtainable regardless of the
patient’s income or current health. Whether one is employed or not, well or
sick, he should be eligible for coverage. Co-payments shall be eliminated for
preventative care and lifetime limitations shall be phased out. Requirements for
doctor referrals will be eliminated. Children 25 years old or younger will be
covered by their parents’ policy. There will be no caps on coverage for medical
procedures, and no pre-existing condition exclusions.
Medicaid will be
expanded to cover anyone who is employed and earning under $16,000.00 per year,
which increases the income limit substantially. The idea is that if you are an
American you will have access to quality health care. Theoretically, those who,
normally, would have to resort to hospital emergency rooms would have health
insurance coverage, either through employers or on their own through the Health
Insurance Marketplace, explained further, below.
What’s Not So
Good
The biggest problem is the cost: there will be huge tax hikes,
21 separate increases and 75% will affect the middle class. Medicare premiums
will increase. In addition, healthy individuals will wind up paying higher
premiums than sick ones. Of course, it will be one of the biggest spending
programs in history at a time when the economy is struggling and the notion of
deficit reduction is important to many. Unemployment remains high, and home
purchasers are having great difficulty obtaining mortgages.
Basically, by 2015,
employers who have more than 50 full-time employees have a choice: either
provide health insurance coverage to them or pay a penalty for not doing so in
the amount of $2,000.00 per employee. This is known as the Employer Mandate. The
monies derived from the penalties will be used to offset the health insurance
cost for those employees who must purchase their own health insurance through
public health insurance exchanges, or the “Health Insurance Marketplace.” The
website is already up and running, so if you are interested, you can start your
research by visiting
www.healthcare.gov/marketplace/individual. These health insurance exchanges
are scheduled to open on October 1st of this year. They will be an on-line
source for individuals to purchase health insurance from private providers. Many
states will have their own exchanges, and, as you probably expected, New York is
one of them.
Another down-side is
implementation, which is not at all surprising. The White House is currently
struggling to commence implementation, and has already announced that charging
penalties for large employers who do not provide health insurance coverage shall
be delayed. In New York City, another interesting change will be the application
process for in-home, or community, Medicaid coverage. Local case workers from
Medicaid will no longer make home visits to evaluate the applicant for in-home
Medicaid coverage. Going forward, it will be the providers who will evaluate the
application and not an agent from Medicaid. Such a change will probably impact
the applicant negatively, but the true impact will not be known immediately. The
Lombardi program (Nursing Home Without Walls) will be discontinued entirely;
that is unfortunate because it provided care in the home for the Medicaid
eligible who were chronically ill and disabled, and did not wish to reside in a
facility. The consequences remain to be seen.
We will keep you
posted as updates and changes are announced by the White House. We invite you to
email any questions or areas of concern with respect to Obamacare, and we will
do our best to address each email.
The above list is for general information purposes
only. It is not intended to constitute individual legal advice or a specific
recommendation to any particular client./font>
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