Health Care Reform
The Affordable Care Act (ACA), signed into law in March of 2010, reformed many aspects of health insurance in the United States. Here are a few key components of the ACA:
- Individual mandate (requires US citizens to carry health insurance; penalties outlined below)
- Creation of state health Exchanges from which insurance may be purchased by individuals, separate Exchanges created for small businesses to purchase from
- Establishment of Essential Health Benefits (EHB) which must be included in plans offered in each state. EHBs are further defined state-by-state through selection of a benchmark plan. Click here for more information about benchmark plans, including an audiology-specific benefit analysis
- Requires companies with 50 or more employees to offer coverage
- Medicaid expansion
For a more in-depth summary of the provisions included in the ACA, click here.
Implementation dates were staggered but full compliance for these reforms is called for by January 1, 2014:
- Non-discrimination in health care. Prohibits plans from discriminating against health care providers acting within their scope of practice.
- Individual mandate; individuals without acceptable coverage will pay a penalty of $95 in 2014, $325 in 2015, $695 (or up to 2.5% of income) in 2016. Penalty amount is half for each child with a family cap of $2,250.
- Companies with 50 or more employees must offer coverage or pay a penalty of $2,000 per employee after the first 30. DELAYED UNTIL 2015
- Insurers cannot deny coverage for pre-existing conditions and cannot charge higher rates because of health status, gender, etc.
- Health insurance exchanges open in states
- Medicaid eligibility increases to 133% of the poverty level, credits available to those whose income is above Medicaid eligibility and below 400% of the poverty level who do not qualify for other coverage.