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ObamaCare: Insurance Facts Over Fiction

President Obama signed the Patient Protection and Affordable Care Act (PPACA), or Affordable Care Act (ACA), which came to be known as Obamacare. The Supreme Court upheld this Act in 2012. The aim of the Act was to help more people get affordable healthcare.

Zanny Mintton Bedoes, the Editor-in-chief at The Economist said that the system before Obama Care was a ‘messed up system’, with 50 million people uninsured. Obama Care has gone on to get more people under the health insurance umbrella; it has been useful for people with pre-existing conditions.

Critics argue that the reality on the ground has been somewhat different. Few insurers participate in the insurance marketplace. The New York Times reports the concerns of the man after who the Act is informally referred to –Obama-had to say in The Journal of the American Medical Association, “Too many Americans still strain to pay for their physician visits and prescriptions, cover their deductibles or pay their monthly insurance bills; struggle to navigate a complex, sometimes bewildering system; and remain uninsured,”.

Hilary Clinton, the Presidential hopeful feels the government needs to play a still greater role to ensure that more people are insured and that they get quality healthcare. Donald Trump, the Republican nominee espouses private insurers must be able to compete across state lines.

Obamacare aims at helping the poorest, with the government taking the load of premium from them; individual insurers higher up the income scale do not see a great benefit from it. The government hopes to regulate the insurance market place more and offer insurance as a provider, since it feels private insurers are not participating as it should. Private insurers feel that this would give the government an unfair advantage. There is further concern that the bill in its current form will not withstand in the insurance market for long. What is unanimous though is that a greater clarity on what the Bill is about is required before debating it.

Obamacare: What is it about really?

The salient points of Obamacare are :

  • Compulsory insurance coverage
  • Penalty for non-compliance that will be collected while filing taxes
  • Unbiased material and customer support regarding insurance plans
  • Insurance plans can be signed up for on online market exchanges or offline at Federal marketplaces.
  • Individuals cannot be discriminated upon based on gender or age.
  • Pre-existing conditions must be covered by Health insurance; companies cannot deny insurance on this basis.
  • Choice of primary doctor and assured preventive care
  • Allows emergency care outside hospitals covered in your plan
  • If the insurance company claims any marketing/administrative cost it must then refund that amount to the insured customer.
  • No lifetime limits on benefits are not allowed
  • Companies must state why they are hiking premiums.
  • No cancellation of coverage for minor errors by customers.
  • Simple to the point agreements to be given by insurer to those insured under their plan.
  • The government will subsidise the premium for the poorest of the poor. It will do so by collecting taxes from the healthcare industry, wealthy Americans will be paying more into Medicare; hospitals and insurance companies participating in Medicare will get paid lesser by the government.
  • Children will get the benefits of the health insurance of their parents until they are 26.
  • Companies with 50 or more employees must provide full medical coverage for them.
  • Governors of each state can decide if they would like to be a part of Medicaid or not, as per a Supreme Court ruling.
  • Plans are segregated into bronze, silver, gold and platinum plans
  • In counties which do not have insurance market places or do not intend to open them, the Federal government will do so itself.

Look at this video by the White House to understand the basic premise of ObamaCare.

White House White Board: What ObamaCare Means For You from The White House on Vimeo.

To apply for Health Insurance in 2017 at a health insurance marketplace, the following points need to be remembered:

  • Information about your household size.
  • Spouse, dependent children, siblings, dependent relatives, dependent parents, children under 21 all come under the insurance coverage.
  • Addresses and birth dates of all persons to be covered. Social Security Numbers.
  • Information about the professional helping you apply. (if you’re getting help completing your application).
  • Document information for legal immigrants.
  • Policy numbers for any current health insurance plans covering members of your household.
  • A completed “Employer Coverage Tool” for every job-based plan.

Important dates for Insurance coverage in 2017:

Date Activity
Nov 1, 2016 Open Enrollment begins
Dec 15, 2016 Last date of enrollment or change to different plan.
Jan 1, 2017 Coverage starts for those who enrolled by Dec 15
Jan 31, 2017 Open enrollment ends. Changes take effect from March 1st for enrollments between Jan 16th and 31st.

What has Obamacare meant for the American population?

The percentage of uninsured citizens has fallen from 2013 to 2015 according to this infographic by the Commonwealth fund.

obamacare2

This spurt of enrollments has been fuelled by middle and lower income groups, African-Americans and Latinos, senior citizens and a group that generally does not take insurance, young adults in their 30’s. (Source: The Commonwealth Fund)

While it is true that Obama Care is a big step in the right direction to ensure that all American citizens avail health care, that the law needs a review to iron out its structural and technical problems is also true. The government has to update the law to ensure insurers do not lean into loopholes to not provide coverage to those who need it most. Quality access for all seems to the mantra for the future of Obama Care, with strong marketplaces and more insurance companies and counties participating in them.

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