Health Care Reform

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:

  1. Individual mandate (requires US citizens to carry health insurance; penalties outlined below)
  2. Creation of state health Exchanges from which insurance may be purchased by individuals, separate Exchanges created for small businesses to purchase from
  3. 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
  4. Requires companies with 50 or more employees to offer coverage
  5. 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.