STATE & UN

OBAMA STIMULUS DETAILS

OBAMA HEALTH CARE PLAN  

BarackObama.com

Senate Patient Protection & Affordable Care Act
House Reconciliation

• Expansion of Medicaid to cover people making less than 133 percent of the poverty line
• An individual mandate, so that everybody gets into the system shares the costs with fines of no more than $325 in 2015 and waivers for hardships when premiums are more than 8% of income and those below the tax-filing threshold.
• Reforms immediate, limits on out-of-pocket spending with no annual or lifetime limits, no rescission, medical-loss ratio of 85%.
• Investment in primary care and prevention
• Essential Health Benefits Package creates levels of coverage, bronze, silver, gold, or platinum based on actuarial values from 60%-90%.
  
• INSURANCE EXCHANGE
• Subsidies, available to people making up to 400 percent of the poverty line, $88,000 for a family of four.  Sliding scale from 2% - 9.8% of income.
• Guarantees of solid benefits for everybody, with limits on out-of-pocket spending with no annual or lifetime limits.
• Coverage expanded to adult children up to age 26.
• Insurers must provide the percentage of premium that is expended on medical service and non-claim costs.
  
• HIGH RISK POOL (temporary)
• Insurers must provide insurance to people with pre-existing conditions and premiums can only vary based on family structure, geographic region, the actuarial value of benefits provided, tobacco use and by no more than a factor of 3-1 for age.
  
• SMALL BUSINESS
• Small Business Credits - employers with 25 or fewer employees with who pay 50 percent or more of their employees’ health insurance premiums will be permitted to receive tax credits for subsidizing coverage, manager's amendment increases tax credits to six years.
• Self-employed individuals who do not receive credits for purchasing coverage through the Gateway are eligible.
• Scty of HHS will make planning grants for state gateways within 60 days of passage.  Gateways will also provide means to sign up for premium credits, Medicaid, SCHIP, etc.
• Insurance outside the Gateway will operate as it currently does.
• Retiree Reserve Trust Fund to assist employers in providing insurance to those over 55 but not yet eligible for Medicare.
• Assisted Living Benefit set by the Secy of HHS for those who have paid 5 years and the previous 12 months.
• End discriminatory premium increases on women, the sick and elderly.
• Exempt businesses with fewer than 50 employees from mandatory regulations.
  
• SENIORS & MEDICARE

• Begins To Close Donut Hole Beginning in 2010, in order to have their drugs covered under Medicare Part D, manufacturers must provide a 50% discount off the negotiated price for brand-name drugs when middle-income beneficiaries enter the coverage gap also known as the donut hole.
• Makes Preventive Services Free. Medicare beneficiaries will receive free preventive services recommended by the U.S. Preventive Services Task Force (USPSTF). Things like mammograms, vaccinations, and other preventive services and screenings recommended for seniors by the Task Force will be free of charge to Medicare beneficiaries.
• Creates Accountable Care Organizations. Senate health insurance reform legislation encourages groups of health care providers, such as hospitals, primary care physicians, specialists and other providers, to take responsibility for all of their patient’s care and their health. By better coordinating each individual’s health care and health needs, seniors have better health outcomes and Medicare saves money, nearly $5 billion over ten years, according to CBO.
• Reduces Hospital-Acquired Infections, Readmissions by including policies to reduce hospital-acquired infections and to reduce avoidable hospital readmissions for certain high-cost conditions.
  

IMMEDIATE BENEFITS

1) Small Business Tax Credits of up to 35 percent of premiums will be available to firms that choose to offer coverage in 2010, beginning in 2014, the small business tax credits will cover 50 percent of premiums.

2) No Discrimination Against Children with Pre-Existing Conditions, and will extend to everyone in 2014.

3) Help for Uninsured American with Pre-Existing Conditions in a subsidized Interim High Risk Pool until Exchange is Available

4) Ends Recissions Bans insurance companies from dropping people from coverage when they get sick.
5) Begins to Close the Medicare Part D Donut Hole with a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010, institutes a 50 percent discount in 2011; completely closes the donut hole by 2020.

6) Free Preventive Care under Medicare begins Jan 1, 2011

7) Extends Coverage for Young People up to 26th Birthday through Parents' Insurance

8) Reinsurance for Early Retirees

9) Bans Lifetime Limits on Coverage

10) Bans Restrictive Annual Limits on Coverage, defined by HHS until 2014 when all plans will prohibit annual limits.

11) Free Preventive Care under New Private Plans

12) New, Independent Appeals Process

13) Ensures Value for Premium Payments by requiring plans in the individual and small group market to spend 80 percent of premium dollars on medical services, and plans in the large group market to spend 85 percent, or rebate the difference.   Effective Jan 2011

14) Community Health Centers funding increase, beginning in 2011, to allow double the amount of patients sover the next 5 years. 

15) Increases the Number of Primary Care Practitioners

16) Prohibits Discrimination Based on Salary

17) Health Insurance Consumer Information through state offices that will also help people file complaints and appeals, starting in 2011.

18) Holds Insurance Companies Accountable for Unreasonable Rate Hikes by allowing states to require justification of premium increases and denying participation in the Exchange if premiums are excessive.