Benefits of Healthcare Reform Benefits of Healthcare Reform


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Obamacare FAQ


Is there a difference between healthcare reform, the Affordable Healthcare Act, and Obamacare?

Healthcare in the U.S. by every measure is the most expensive on the planet yet our health outcomes lag considerably behind other developed countries. In a 2011 analysis by the UnitedHealthcare Foundation the U.S. ranks 33rd in life expectancy and 43rd in infant mortality. Healthcare reform aims to improve the health of our nation while driving costs down by minimizing healthcare fraud, waste and abuse of the system. Healthcare reform, Obamacare and the Affordable Care Act are synonymous (same initiative going by different names).  



Will Obamacare cause my health insurance to increase?

By requiring all persons to purchase health insurance the costs for insurance should decrease. By law this is called the “Individual Mandate” which was recently upheld by the U.S. Supreme Court. The effect spreads the cost of care and health insurance among everyone rather than just those with insurance, thereby reducing individual financial impact. According to the Institute of Medicine “regardless of insurance status — virtually all Americans use health care services. Without broad participation in a health care coverage system, health care for all cannot be obtained, let alone sustained.”



Will the Affordable Care Act provide insurance companies a path to dropping coverage on current participants, or place limitations on their coverage?

The ACA prevents insurance companies from denying coverage for those with pre-existing conditions and makes a special provision to obtain insurance for those with pre-existing conditions that have previously been denied. In addition, Obamacare eliminates annual and lifetime benefit maximums. With this provision insurance companies cannot limit benefit coverage for big ticket items like organ transplants. Both these provision stand as defining strengths of healthcare reform under the Affordable Care Act also known as Obamacare.



How will the government help me get affordable health insurance?

The Affordable Care Act provides for entities known as Health Insurance Exchanges. These unique entities provide a menu of insurance products from which small businesses and patients choose.



What is a health exchange?

According to the American Academy of Family Physicians health insurance exchanges provide marketplaces from which individuals and small businesses can compare and purchase private health insurance plans. Health and Human Services will guide the formation of the exchanges, but states have flexibility on how the exchanges operate, what benefits will be included, and how patients and physicians will interact with insurers and their products.



Who gets penalized for not having insurance, and what are the penalties?

The American Medical Association (AMA) has repeatedly upheld the requirement that all persons purchase health insurance or face financial penalties. The American Academy of Family Physicians recently called for the AMA to "continue to support policies that include personal responsibility to participate in private insurance risk-pooling arrangements, including financial disincentives (penalties) on persons who choose to forgo coverage until they are sick."


According to the Kaiser Family Foundation the Individual Mandate penalties have been outlined as follows. The Individual Mandate “Require U.S. citizens and legal residents to have qualifying health coverage. Those without coverage pay a tax penalty of the greater of $695 per year up to a maximum of three times that amount ($2,085) per family or 2.5% of household income. The penalty will be phased-in according to the following schedule:  $95 in 2014, $325 in 2015, and $695 in 2016 for the flat fee or 1.0% of taxable income in 2014, 2.0% of taxable income in 2015, and 2.5% of taxable income in 2016. Beginning after 2016, the penalty will be increased annually by the cost-of-living adjustment. Exemptions will be granted for financial hardship, religious objections, American Indians, those without coverage for less than three months, undocumented immigrants, incarcerated individuals, those for whom the lowest cost plan option exceeds 8% of an individual’s income, and those with incomes below the tax filing threshold (in 2009  the threshold for taxpayers under age 65 was $9,350 for singles and $18,700 for couples).”


Will there be tax credits for small businesses that provide health insurance under Obamacare?

Yes. Here’s what the IRS has to say: "This new credit helps small businesses and small tax-exempt organizations afford the cost of covering their employees and is specifically targeted for those with low- and moderate-income workers. The credit is designed to encourage small employers to offer health insurance coverage for the first time or maintain coverage they already have. In general, the credit is available to small employers that pay at least half the cost of single coverage for their employees. Learn more by browsing our page on the Small Business Health Care Tax Credit for Small Employers "



Will there be provisions for pre-existing conditions that didn’t exist before?

It is unlikely that the law will permit insurance companies to re-define what conditions constitute the meaning of pre-existing conditions. Such actions would rise to the level of healthcare fraud and the imposition of extraordinary fines.



Will there be any provisions for free healthcare?

Just as there is no free lunch, there is no free healthcare. The cost of care in the U.S. is extraordinary. The most common reason for personal bankruptcy in the U.S. is serious illness even in those individuals with health insurance. “Self-pay” status will continue for the foreseeable future, but without sustained healthcare reform  including imposition of the individual mandate we all pay the price of expensive care and unacceptably poor health outcomes .