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By Dr. Corey Hebert
Dr. Hebert is available for interviews and speaking engagements on this topic and more. Email us at: firstname.lastname@example.org
Dr. Corey Hebert and a few colleagues have assembled this document from the best internet sources in an attempt to explain the Affordable Care Act, aka “Obamacare”. As physicians in support of the ACA, we felt very strongly that we should try to explain the high points and some obscure details with the hopes of making the general public more aware of the actualities of the plan. There was also a need for debunking the myths of Obamacare so this was addressed as well. This document is a compilation of many citations and references from print sources and internet portals, and is NOT intended for publication for profit but only as a tool for discussion and information purposes. We have compiled this for information purposes only and all information is readily available to the consumer in other outlets and no exclusivity is implied in the document. In this document the term ACA is used interchangeably with Obamacare.
Most middle class Americans are against the Affordable Care Act or Obamacare. In general, higher socioeconomic citizens can afford healthcare and lower socioeconomic status citizens including children have access to some type of subsidized healthcare. I have done lectures around this country and the working middle class are the most venomous opponents because they are sick of the government paying for poor people and they want the downtrodden to pull themselves up “by their boot straps.” THE PROBLEM IS THAT THE MIDDLE CLASS WILL BENEFIT MORE FROM THE ACA THAN ANY OTHER GROUP. Let’s just start with a scenario. Let’s say that you are an accountant and you earn 80,000 dollars per year. You have paid 300 dollars per month for health care for the last 30 years. You now have been diagnosed with lung cancer. Your insurance will now pay for your care. You have a 1200 dollar deductible. And your insurance has an 80/20 split meaning that they pay 80% of your total bill; up to your lifetime maximum. (Yes, there is a lifetime maximum on most insurance policies). After multiple surgeries, radiation, chemo and medications, you are cancer free! Yea! But your split of that 800,000 bill is 160,000. Yes you must pay that, plus your 1200 dollar deductible. That would economically devastate most Americans, but let’s just say that you have 161200 dollars lying around and you pay them. Then your very loyal insurance company cancels your insurance. No other insurance company will enroll you because of your preexisting illness. One year later your cancer recurs and you have no insurance. YOU ARE NOW ECONOMICALLY BANKRUPT and you have cancer. If you were poor, the government would pay. If you were rich then you would pay, but if you are middle class you are economically and physically devastated. The Affordable Care Act (AKA Obamacare) does away with that entire horrible scenario. MIDDLE CLASS WAKE UP AND SUPPORT!!
We have gathered information from the ACA document and several internet blogs and outlets to give you some very important points about Obamacare that you need to know.
-Obamacare halts insurance companies from discriminating against citizens of the US based on disability, or because they were domestic violence victims. (Section 2705)
-Obamacare eliminated lifetime limits on coverage. For example if a baby has a serious illness and has 1 million dollars of healthcare, some insurance carriers have lifetime caps that would preclude that child from getting any healthcare services after the cap. (sec. 2711)
-The ACA will require a limit on what type of insurance accounts can be used to pay for OTC meds without a prescription. (sec. 9003)
-Obamacare allows children to be covered by their parent’s health insurance until the ripe old age of 26 yrs. This is important as the daunting task of paying back student loans or having a low paying job really puts a strain on the ability to pay insurance premiums. (sec. 2714)
-The ACA creates a tax on tanning salons. This is good because we know exposure to tanning beds causes cancer. (sec. 5000B)
-Obamacare does away totally with “pre-existing condition for children less than 19 years of age No more "pre-existing conditions" for kids under the age of 19. (Citation: sec. 2704, sec. 1255)
-People in the "Medicare Part D Coverage Gap" (also referred to as the "Donut Hole") get a rebate to make up for the extra money they would otherwise have to spend. (Citation: sec. 3301)
-Employers will now need to list the benefits they provided to employees on their tax forms. (Citation: sec. 9002)
-Insurers need to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when they're turned down. (Citation: sec. 2719)
-People that make a good living according to US standards (Over 200k yearly) will have an increase in personal taxes which equate to roughly less than one percent of the population(Citation: sec. 9015)
-It allows the Food and Drug Administration to approve more generic drugs (making for more competition in the market to drive down prices and it also increases the rebates on drugs people get through Medicare. (Citation: sec. 2501)
-Medicare patients with chronic illnesses must be monitored more thoroughly.
-Reduces the costs for some companies that handle benefits for the elderly (Citation: sec. 4202)
-Insurance carriers will now be required to disclose the details of the benefits that they provided to their customer as opposed to being intentionally vague about the hidden fees.
-Insurers have less ability to change the dollar amount customers have to pay for their plans. (Citation: sec. 2794)
-A new website is made to give people insurance and health information. (http://www.healthcare.gov/). (Citation: sec. 1103)
-The ACA makes provisions so an insurance carrier can't just cancel a customer’s insurance once they get sick. (Citation: sec. 2712)
-A limit is placed on just how much of a percentage of the money an insurer makes can be profit, to make sure they're not price-gouging customers. (Citation: sec. 1101)
-The ACA attempts to stop waste and fraud which are rampant in the health care system, by increasing anti-fraud funding. (Citation: sec. 6402)
-The ACA requires all national chain restaurants to disclose, as well as display, the caloric content of their food. This should really make it better for consumers that are trying to lead healthier lifestyles. (sec. 4205)
-It creates the PCORI, which is a nonprofit entity to study best practices to see which treatment plans are meritorious and the most cost effective.(Citation: sec. 1181)
-Any new health plans must provide preventive care (mammograms, colonoscopies, etc.) without requiring any sort of co-pay or charge. (Citation: sec. 2713)
January 2014 is when many changes that you hear most about go into effect. See below:
No more "pre-existing conditions". Period. People will be charged the same regardless of their medical history. (Citation: sec. 2704, Page 65, sec. 2701 sec. 1255)
If you can afford insurance but do not get it, you will be charged a fee. This is the "mandate" that people are talking about. Basically, it's a trade-off for the "pre-existing conditions" bit, saying that since insurers now have to cover you regardless of what you have, you can't just wait to buy insurance until you get sick. Otherwise no one would buy insurance until they needed it. You can opt not to get insurance, but you'll have to pay the fee instead, unless of course you're not buying insurance because you just can't afford it.
-Medicaid can now be used by everyone up to 133% of the poverty line (basically, many more poor people can get insurance) (Citation: sec. 2001) (Note: The recent court ruling says that states can opt out of this and that the Federal government cannot penalize them by withholding Medicaid funding. At this time, nothing stops the Federal government from simply just offering incentives to those who do opt to do it)
-Small businesses can get tax credits for two years. (Citation: sec. 1421)
-It makes a "high-risk pool" for people with pre-existing conditions. Basically, this is a way to slowly ease into getting rid of "pre-existing conditions" altogether. For now, people who already have health issues that would be considered "pre-existing conditions" can still get insurance, but at different rates than people without them. (sec. 1101, sec. 2704, sec. 2702)
-Businesses with over 50 employees must offer health insurance to full-time employees, or pay a penalty. (Citation: sec. 4980H)
Question: Can't businesses just fire employees or make them work part-time to get around this requirement? Also, what about businesses with multiple locations?
Answer: Yes and no. Switching to part-time only won't help to get out of the requirement, as the Affordable Care Act counts the hours worked, not the number of full-time employees you have. If your employees worked an equivalent of 50 full-time employees' hours, the requirement kicks in. Really, the only plausible way a business could reasonably utilize this strategy is if they currently operate with just over the 50-employee number, and could still operate with fewer than 50 employees, and have no intention to expand. Also, regarding the questions about multiple locations, this legal website analyzed the law and claims that multiple locations in one chain all count as a part of the same business (meaning employers like Wal-Mart can't get around this by being under 50 employees in one store - they'd have to be under that for the entire chain, which just won’t happen). Independently-owned franchises are different, however, as they have a separate owner and as such aren't included under the same net as the parent company. However, any individual franchise with over 50 employees will have to meet the requirement.
Having said that, the ACA only requires employers to offer insurance to full-time employees, so theoretically they could get out of this by reducing all employees to 29 hours or fewer a week. However, if any employees' hours go above that, their employer will have to provide insurance or pay the penalty. And also, this is putting aside how an employer only offering part-time work with no insurance will affect how competitive they are on the job market, especially when small businesses with 25 or fewer employees actually get that aforementioned tax credit to help pay for insurance if they choose to get it (though they are not required to provide insurance).
-Insurers now can't do annual spending caps. Their customers can get as much health care in a given year as they need. (Citation: sec. 2711)
-Limits how expensive an annual deductible can be to customers. (Citation: sec. 1302)
-Health insurance cannot discriminate against women on pricing or plan availability (Citation: sec. 1557)
-Reduce costs for some Medicare spending, which in turn are put right back into Medicare to increase its solvency. Most notably, this bill reduces the amount that Medicare Advantage pays to be more in line with other areas of Medicare ( Citation: Sec. 3201 and Sec. 3202 ), and reduces the growth of Medicare payments in the future ( Citation: Sec. 3402 ). The non-partisan Congressional Budget Office estimates that between 2012 and 2022, this will amount to $716 Billion in reduced spending (Citation: CBO Estimate). Also $22 Billion is being cut from the Medicare Improvement Fund, most likely because the PPACA has many of the same duties/responsibilities, so that spending would be redundant ( Citation: Sec. 3112 ).
-Place a $2500 limit on tax-free spending on FSAs (accounts for medical spending). Basically, people using these accounts now have to pay taxes on any money over $2500 they put into them. (Citation: sec. 9005)
-Establishes health insurance exchanges and rebates for the lower and middle-class, basically making it so they have an easier time getting affordable medical coverage. (Citation: sec. 1311)
-Congress and Congressional staff will only be offered the same insurance offered to people in the insurance exchanges, rather than Federal Insurance. Basically, we won't be footing their health care bills any more than any other American citizen. (Citation: Page sec. 1312)
-A new tax on pharmaceutical companies.
-A new tax on the purchase of medical devices.
-A new tax on insurance companies based on their market share. Basically, the more of the market they control, the more they'll get taxed.
-Raises the bar for how much personal medical expenses must cost before you can start deducting them from your taxes.
The following mandates will be implemented in 2015-2018
-Doctors' pay will be determined by the quality of their care, not how many people they treat. This is a very controversial issue as there are ways for doctors and patients to get around this one.
-If any state can come up with their own plan, one which gives citizens the same level of care at the same price as the PPACA, they can ask the Secretary of Health and Human Resources for permission to do their plan instead of the PPACA. So if they can get the same results without the mandate, they can be allowed to do so. Vermont, for example, has expressed a desire to just go straight to single-payer (in simple terms, everyone is covered, and medical expenses are paid by taxpayers). (Citation: sec. 1332)
-All health care plans must now cover preventive care (not just the new ones).
-A new tax on "Cadillac" health care plans (more expensive plans for rich people who want fancier coverage).
-The elimination of the "Medicare gap"
POPULAR OBAMACARE MYTHS
Presently in the United States there is so much bipartisan bickering. The Dems and Repubs aren’t working together to get anything done. The most common product of constant bickering is incorrect mythical information that starts to surface to scare the other party’s constituency. The ACA is no exception. There are so many myths so I have compiled a list of questions from online sources to debunk many of the most popular myths.
-Obamacare has death panels: That sounds so evil it must be true, right? Well, no. No part of the bill says anything about appointing people to decide whether or not someone dies. The decision over whether or not your claim is approved is still in the hands of your insurer. However, now there's an appeals process so if your claim gets turned down, you can challenge that. And the government watches that appeals process to make sure it's not being unfair to customers. So if anything, the PPACA is trying to stop the death panels. (Citation: sec. 2719)
-What about the Independent Medicare Advisory Board? Death Panels: The Independent Medicare Advisory Board (which has had its name changed to Independent Payment Advisory Board, or IPAB) is intended to give recommendations on how to save Medicare costs per person, deliver more efficient and effective care, improve access to services, and eliminate waste. However, they have no real power. They put together a recommendation to put before Congress, and Congress votes on it, and the President has power to veto it. What's more, they are specifically told that their recommendation will not ration health care, raise premiums or co-pays, restrict benefits, or restrict eligibility. In other words, they need to find ways to save money without reducing care for patients. (Citation: sec. 3403)
-Obamacare has health care rationing: "Rationing" is just a fancier way of saying "Death Panels". And no, it doesn't.
-Obamacare has an un-elected panel of people who will decide what kind of care citizens can get: Yet another way of saying "Death Panels", albeit a softer way of saying it. It's true that the IPAB is appointed, not elected. However, they are expressly forbidden from reducing or rationing care.
-Obamacare gives free insurance to illegal immigrants: Actually, there are multiple parts of the bill that specifically state that the recipient of tax credits and other advantages of the AHA must be a legal resident of the United States. And while the bill doesn't specifically forbid illegals from buying insurance or getting treated at hospitals, neither did the laws in the US before the PPACA. So even at worst, illegals still have just as much trouble getting medical care as they used to. (Citations: sec. 1402, sec. 1411, sec. 1411, sec. 1412)
-Obamacare uses taxpayer money for abortions: One part of the bill says, essentially, that the folks who wrote this bill aren't touching that issue with a ten foot pole. It basically passes the buck on to the states, which can choose to allow insurance plans that cover abortions, or they can choose to not allow them. Obama may be pro-choice, but that is not reflected in the PPACA. (Citation: sec. 1303)
-Obamacare forces churches/taxpayers to pay for women to have free birth control: This claim refers to sec. 2713, which says that health insurance must include preventive care for women supported by the Health Resources and Services Administration. And that Administration, on the recommendation of the independent Institute of Medicine of the National Academy of Science, has determined that preventive care for women should include access to well women visits, domestic violence screening, and, yes, contraception. So insurers do have to provide these services, and no, they cannot require their insured to pay for them. This is because birth control is very important to the health of some women. "But what if I, as a taxpayer, don't want to pay for it", you ask? You don't. It's provided by the health insurance company, not the government. "But what about employers who provide employee plans? Does that mean a church would have to pay for the birth control of its clergy”, you ask? The answer is "no". On February 10, 2012 (or February 15th, if you go by the header in the document), the Department of Health and Human Services issued this document, detailing its enforcement of that section of the ACA. Kaiser has given their own interpretation of this. The short version is churches and houses of worship are exempt from this rule, period. Other religious employers (like Catholic hospitals) are also exempt until August 2013, by which time insurance providers are to have created special plans specifically for them, that put all the costs of contraception on the insurer, with none on the employee or the employer. So not one cent of taxpayer money is going towards contraception, nor is a single cent of a church's money paying for contraception either. Birth control is to be provided to women by the insurer.
-Obamacare won't let me keep the insurance I have: The PPACA actually very specifically says you can keep the insurance you have if you want. (Citation: sec. 1251)
-Obamacare will make the government get between me and my doctor: The PPACA very specifically says that the Secretary of Health and Human Services (who is in charge of much of the bill), is absolutely not to promote any regulation that hinders a patient's ability to get health care, to speak with their doctor, or have access to a full range of treatment options. (Citation: sec. 1554)
-Obamacare has a public option! That makes it bad! Wrong! The public option (which would give people the option of getting insurance from a government-run insurer, thus the name), whether you like it or not, was taken out of the bill before it was passed. You can still see where it used to be, though. (Citation: sec. 1323)
-Obamacare will cost trillions and put us in massive debt: The PPACA will cost a lot of money. Well initially the cost is $1.7 trillion dollars. But that's just to get the ball rolling. You see, amongst the things built into the bill are new taxes - on insurers, pharmaceutical companies, tanning salons, and a slight increase in taxes on people who make over $200K (an increase of less than 1%). Additionally, the bill cuts some stuff from Medicare that's not really working, and generally tries to make everything work more efficiently. Also, the increased focus on preventative care (making sure people don't get sick in the first place), should help to save money the government already spends on emergency care for these same people. Basically, by catching illnesses early, we're not spending as much on emergency room visits. According to the Congressional Budget Office, who studies these things, the ultimate result is that this bill will reduce the yearly deficit by $109 billion. By the year 2021, the bill will actually have paid itself and started bringing in more money than it cost.
-Obamacare document itself is twice as long as War and Peace: War and Peace is 587,287 words long. The Patient Protection and Affordable Care Act, depending on which version you're referring to, is between 300,000-400,000 words long. Don't get me wrong, it's still very long, but it's not as long as War and Peace. Also, it bears mention that bills are often long. In 2005, Republicans passed the Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users, 2005, which was almost as long as the PPACA, and no one raised a stink about it.
-The people who passed Obamacare didn't even read it: They had been reading it over and over, for a half a year. This thing was being tossed around in debates for ages. And it went through numerous revisions, but every time it was revised, it was just adding, removing, or changing small parts of it, not rewriting the whole thing. And every time it was revised, the new version of the bill was published online for everyone to see. The final time it was edited, there may not have been time to re-read the entire thing before voting on it, but there wasn't a need to, because everyone had already read it all. The only thing people needed to read was the revision, which there was plenty of time to do. Pelosi said something like, "we'll have to pass the bill before reading it": The actual quote is "we have to pass the bill so that you can find out what is in it, away from the fog of controversy", and she's talking about all the lies and false rumors that were being spread about it. Things had gotten so absurd that by this point many had given up on trying to have an honest dialogue about it, since people kept worrying about things that had no basis in reality. Pelosi was simply trying to say that once the bill is finalized and passed, then everyone can look at it and see.
-Obamacare was signed quietly in the middle of the night: This is stretching the truth to the breaking point. The House version of the bill was signed on October 8, 2009 at 12:15 in the afternoon, and the Senate version was signed on December 24, 2009 at 7:05 in the morning. The only vote that you could argue that came close to "the middle of the night" was the House vote on the changes made in the Senate version of the bill, which took place at 10:49 p.m... on March 21, 2010, three months later. It wasn't a vote on anything anyone hadn't seen before, but on the version of the legislation passed in the Senate. 431 of the 435 men and women in the House of Representatives voted on it. (Citation: govtrack.us).
-Obamacare is a government takeover of the health industry: What do you mean by "takeover"? Like, for example, do you believe that because the FDA regulates food to make sure that it's safe to eat, that we've had a government takeover of food? By the same right, the Affordable Care Act adds a lot of regulations saying how health insurers should do business, in order to make sure that more people have insurance and that their insurance works in a way that's fair and reliable... but the government themselves isn't taking over insurance. They're not selling us that insurance - the Public Option, which would have made a government-run insurance plan to compete with private plans, never got passed. So government isn't taking over your insurance any more than they've taken over your food.
-Obamacare cuts $700 Billion dollars from Medicare: Not really. What the Affordable Care Act actually does is brings Medicare Advantage costs back in line with regular Medicare (Citation: Sec. 3201 and Sec. 3202), limits the growth of certain parts of Medicare where our spending is outpacing what we're actually required to spend (Citation: Sec. 3402), and replaces some parts of Medicare with better, more cost-effective substitutes (Citation: Sec. 3112). These accusations are based on a report by the non-partisan Congressional Budget Office showing the reduction of Medicare costs from 2012-2022. However, the accusations fail to mention that those "cuts" will not result in reduced care, reduced enrollment, or reduced anything really, other than reduced costs to the taxpayers... which both Democrats and Republicans agree is a good idea.
-Obamacare takes money from Medicare to pay for Obamacare: It absolutely does not. Every penny saved by changes the Affordable Care Act makes to Medicare goes back into Medicare. The bill itself specifically says that any of these savings must be used to increase Medicare solvency, improve its services, or reduce premiums (Citation: Sec. 3601).
-Obamacare is going to make hospitals drop support for Medicare and Medicaid: Some doctors and hospitals are worried about some of the big changes being made to how they're paid. Specifically, that Medicare and Medicaid are changing from compensating them for the number of patients they see to compensating them for how well they treat those patients. Some doctors have even threatened to stop accepting Medicare and Medicaid. But these threats seem weak when you realize that, according to the American Hospital Association, "Medicare and Medicaid account for 56 percent of all care provided by hospitals. Consequently, very few hospitals can elect not to participate in Medicare and Medicaid." Now, granted, reimbursements to hospitals under Medicare are in many cases less than the cost of care, but much of what the ACA does is to seek to reduce the cost of care, particularly by reducing recidivism (patients going back to the hospital to be treated for the same thing because they didn't get the right treatment the first time). And alarmists warning about "cuts made to Medicare" can look back above - it's not being cut, it's having its growth rate reduced, and any savings go back into Medicare.
-Obamacare allows Barack Obama to create a secret health care army: There are actually people out there claiming this. It is pertaining to Page 562 of the bill, specifically sections 5209, 5210, and 203, which reduce limits on the United States Public Health Service Commissioned Corps, and creates the Regular Corps and the Ready Reserve Corps. What the claim gets right is that these are enlisted uniformed services. However, what the Corps does is respond to disasters like hurricane Katrina and the Haiti earthquake. They are enlisted medical professionals that can be called up in a time of crisis. In fact, the United States Public Health Service Commissioned Corps was involved in the assistance with both of those emergencies... but at that time, it was limited in size to only 2800 people. This section of the bill removes those limits so we are better-equipped to respond to emergencies like this in the future.
I want to thank all of the internet outlets and bloggers whose work contributed to this document and I hope after reading this you feel a lot different about the Affordable Care Act. It might just save your life and your bank account one day!