Chicks with MDs, January 2017.

The Goal is to get you to respond with emotion and not thought, understanding, purpose and intent.

What is the Affordable Care Act (Obamacare)?

The Patient Protection and Affordable Care Act (PPACA)

United States Federal Statute

Enacted March 23, 2010 by Former President Barack Obama

What do you need to know about the current law?

How is it Funded?

Individual Mandate

For tax year 2016, the penalty will rise to 2.5% of your total household adjusted gross income, or $695 per adult and $347.50 per child, to a maximum of $2,085. For tax year 2017 and beyond, the percentage option will remain at 2.5%, but the flat fee will be adjusted for inflation.

You’ll pay 1/12 of the total fee for each full month in which a family member went without coverage or an exemption. 

ObamaCare Individual Mandate

Dan Mangan | @_DanMangan
Monday, 20 Jul 2015 | 5:03 PM ET

‘About 7.5 million taxpayers so far have paid a penalty on their taxes for failing to have health insurance last year, as required for the first time by the Affordable Care Act, officials said Monday. That number is well in excess of original projections by officials.
The average penalty paid was about $200 per person, and in all $1.5 billion was collected by the Internal Revenue Service in these fines. However, officials stressed that “the vast majority”—85 percent—of people who paid the fines nonetheless ended up with a net tax refund from the IRS.’

http://www.cnbc.com/2015/07/20/irs-more-paid-obamacare-fine-than-expected.html

Additional Fees/Taxes that Fund the ACA

+.9% Increase in Medicare Tax Rate (plus next item…)  
 3.8% New Tax on unearned income for high-income taxpayers= $210.2 billion ($200,000 for individual and $250,000 for joint filers) 
 New Annual Fee on health insurance providers = $60 billion (For calculation – Sec 9010 (b) of the PPACA.)[1]
 40% New Tax on health insurance policies which cost more than $10,200 for an individual or $27,500 for a family, per year = $32 billion (inland tax as opposed to an importation tax)
 New Annual Fee on manufacturers and importers of branded drugs = $27 billion (For calculation – Sec 9008 (b) of the PPACA)[2]
 2.3% New Tax on manufacturers and importers of certain medical devices = $20 billion
 +2.5% Increase (7.5% to 10%) in the Adjusted Gross Income floor on medical expenses deduction = $15.2 billion
 Limit annual contributions to $2,500 on flexible spending arrangements in cafeteria plans (plans that allow employees to choose between different types of benefits) = $13 billion
 All other revenue sources = $14.9 billion
• 10% New Tax imposed on each individual for whom “indoor tanning services” are performed.
• 3.8% New Tax on investment income. Includes: gross income from interest, dividends, royalties, rents, and net capital gains. Investment income does not include interest on tax-exempt bonds, veterans’ benefits, excluded gain from the sale of a principle residence, distributions from retirement plans, or amounts subject to self-employment taxes. (The lesser of net investment income or the excess of modified Adjusted Gross Income over a the dollar amount at which the highest income tax bracket, typically $250,000 for married filing jointly and $200,000 filing as an individual). 

Where Does the Money Go?

Medicaid Expansion: The PPACA gives money to States to expand Medicaid eligibility to Americans under the age of 65 who are below 133% of the federal poverty limit, but states can decline without losing existing funding. The Act gives States 100% Federal funding for the first 3 years for newly eligible individuals, beginning January 1, 2014 and ending December 31, 2016. January 1, 2017 the funding will be decreased to 95% with the next 2 years each decreasing by 1% until the year 2020 which will be decreased to 90%. [3]

Tax Credits: Tax credits will be available for individuals and families with incomes up to 400 percent of the federal poverty level ($43,420 for an individual or $88,200 for a family of four) that are not eligible for Medicaid

This means that these tax credits are for individuals and families who obtain health insurance from the state run Health Insurance Exchanges. 

“Individuals with incomes below 400 percent FPL who purchases coverage in the Exchange are not required to spend more than a set percentage of their income on health insurance. If they cannot find coverage at a price that falls below this threshold, they are then eligible for a premium credit to ensure they do not spend more than a certain percentage of their income on health insurance coverage.”

Cost-Sharing Subsidies: The cost-sharing subsidy applies to individuals and families who enroll in a qualified health plan in the silver level of coverage in the individual market offered through an exchange and whose household income is between 100 – 400 percent of the poverty level for a family.[7]  (Persons who are offered coverage through their employer also may be eligible for the subsidies provided through the exchange if their employer’s plan premium would exceed 9.5 percent of the employee’s income.) [8]
These subsidies are meant to limit out of pocket costs before the insurance companies pay for all medical expenses. It helps reduce out of pocket cost significantly for low to middle class. If you are 200% below the Federal Poverty Level, your out of pocket costs will be reduced by two-thirds. They’ll be decreased by half for persons below 300% and one-third for persons below 400% FPL. [9]
Both premium credits and cost-sharing subsidies are refundable tax credits paid in advance directly to the health insurer. Any costs above and beyond what the credits and subsidies do not cover are the responsibility of the individual or family

Federal Agencies’ Administrative Costs:

http://www.alignamerica.com/node/62

Your Rights Under the Affordable Care Act:

1. End to Lifetime and Yearly Limits
2. Requires Insurers to cover People with Pre-Existing Health Conditions, Including Pregnancy, without Charging More.
3. Young Adult Coverage Under Parent Insurance Until Age 26.
4. Prevent Cancellation of your Policy by Your Insurer
5. Protects You from Employer Retaliation-Fire or Retaliation Because You Get a Premium Tax Credit When You Buy a Health Plan in the Marketplace
6. Grandfathered Plans-Health Plans that Were in Existence on March 23, 2010 and Haven’t Been Changed in Ways that Substantially Cut Benefits or Increase Cost. It is Possible that You May Not Get Some Rights and Protections of Other Plans.
7. Rate Review- helps protect you from unreasonable rate increases. Insurance companies must now publicly explain any rate increase of 10% or more before raising your premium. This does not apply to grandfathered plans
8. The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs. If Your Insurer Does Not Meet the 80/20 Rule, You May Get Back Some of the Premium You Paid…..Direct Refund…..Rebate Check…..Reduction in Future Premium…..Employer May Use Rebate in Variety of Ways that Directly Benefits the Employee
9. Guarantees Your Right to Appeal of Denied Payments/Coverage
10. Covers Preventive Care at No Additional Cost to You
11. Removes Insurance Company Barriers to Emergency Service Coverage that is Out of Network
12. Individual Mandate/Tax. If You Do Not Sign Up for Coverage, the Penalty is 2.5% of Your Combined Family Annual Income
13. The Current Open Enrollment Period Ends January 31, 2017
14. The Preventive Care Coverage Listed Below is Verbatim from the Department of Health and Human Services:
Preventive Services Covered Under the Affordable Care Act
If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a copayment or co-insurance or meet your deductible. This applies only when these services are delivered by a network provider. 
• Covered Preventive Services for Adults
• Covered Preventive Services for Women, Including Pregnant Women
• Covered Preventive Services for Children
15 Covered Preventive Services for Adults
1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
2. Alcohol Misuse screening and counseling
3. Aspirin use for men and women of certain ages
4. Blood Pressure screening for all adults
5. Cholesterol screening for adults of certain ages or at higher risk
6. Colorectal Cancer screening for adults over 50
7. Depression screening for adults
8. Type 2 Diabetes screening for adults with high blood pressure
9. Diet counseling for adults at higher risk for chronic disease
10. HIV screening for all adults at higher risk
11. Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:
o Hepatitis A
o Hepatitis B
o Herpes Zoster
o Human Papillomavirus
o Influenza (Flu Shot)
o Measles, Mumps, Rubella
o Meningococcal
o Pneumococcal
o Tetanus, Diphtheria, Pertussis
o Varicella
Learn more about immunizations and see the latest vaccine schedules.
12. Obesity screening and counseling for all adults
13. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
14. Tobacco Use screening for all adults and cessation interventions for tobacco users
15. Syphilis screening for all adults at higher risk
22 Covered Preventive Services for Women, Including Pregnant Women
The eight new prevention-related health services marked with an asterisk ( * ) must be covered with no cost-sharing in plan years starting on or after August 1, 2012.
1. Anemia screening on a routine basis for pregnant women
2. Bacteriuria urinary tract or other infection screening for pregnant women
3. BRCA counseling about genetic testing for women at higher risk
4. Breast Cancer Mammography screenings every 1 to 2 years for women over 40
5. Breast Cancer Chemoprevention counseling for women at higher risk
6. Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women*
7. Cervical Cancer screening for sexually active women
8. Chlamydia Infection screening for younger women and other women at higher risk
9. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs*
10. Domestic and interpersonal violence screening and counseling for all women*
11. Folic Acid supplements for women who may become pregnant
12. Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes*
13. Gonorrhea screening for all women at higher risk
14. Hepatitis B screening for pregnant women at their first prenatal visit
15. Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women*
16. Human Papillomavirus (HPV) DNA Test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older*
17. Osteoporosis screening for women over age 60 depending on risk factors
18. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
19. Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
20. Sexually Transmitted Infections (STI) counseling for sexually active women*
21. Syphilis screening for all pregnant women or other women at increased risk
22. Well-woman visits to obtain recommended preventive services*
Learn more about Affordable Care Act Rules on Expanding Access to Preventive Services for Women.
(Effective August 1, 2012)
26 Covered Preventive Services for Children
1. Alcohol and Drug Use assessments for adolescents
2. Autism screening for children at 18 and 24 months
3. Behavioral assessments for children of all ages
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
4. Blood Pressure screening for children
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
5. Cervical Dysplasia screening for sexually active females
6. Congenital Hypothyroidism screening for newborns
7. Depression screening for adolescents
8. Developmental screening for children under age 3, and surveillance throughout childhood
9. Dyslipidemia screening for children at higher risk of lipid disorders
Ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
10. Fluoride Chemoprevention supplements for children without fluoride in their water source
11. Gonorrhea preventive medication for the eyes of all newborns
12. Hearing screening for all newborns
13. Height, Weight and Body Mass Index measurements for children
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
14. Hematocrit or Hemoglobin screening for children
15. Hemoglobinopathies or sickle cell screening for newborns
16. HIV screening for adolescents at higher risk
17. Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
o Diphtheria, Tetanus, Pertussis
o Haemophilus influenzae type b
o Hepatitis A
o Hepatitis B
o Human Papillomavirus
o Inactivated Poliovirus
o Influenza (Flu Shot)
o Measles, Mumps, Rubella
o Meningococcal
o Pneumococcal
o Rotavirus
o Varicella
Learn more about immunizations and see the latest vaccine schedules.
18. Iron supplements for children ages 6 to 12 months at risk for anemia
19. Lead screening for children at risk of exposure
20. Medical History for all children throughout development
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
21. Obesity screening and counseling
22. Oral Health risk assessment for young children
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.
23. Phenylketonuria (PKU) screening for this genetic disorder in newborns
24. Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk
25. Tuberculin testing for children at higher risk of tuberculosis
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
26. Vision screening for all children

What Are the Exemptions from the Affordable Care Act (Obamacare)?

Here are the ways you can be exempt from the requirement to buy health insurance:
• Your lack of insurance coverage was for three months or less.
• You aren’t required to file a tax return because your income is too low.
• You are incarcerated.
• You are in the U.S. illegally.
• You are part of a Native American tribe.
• The least expensive health insurance available to you costs more than 8.13% of your 2016 income in premiums.
• You are a member of a health care sharing ministry.
• Your religion objects to insurance.
• You qualify for a hardship exemption.

No Health Insurance? You May Qualify for an Obamacare Exemption

 

What has transpired, since the Inauguration, that will change the landscape and impact of your healthcare?

A. Trump Executive Order:

1. “pending such repeal, it is imperative for the executive branch to ensure that the law is being efficiently implemented, take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the act, and prepare to afford the states more flexibility and control to create a ‘more free’ and open health care market.”
2. work to create a system that allows the sale of health insurance across state lines, which Republicans have long proposed as the centerpiece of an alternative to the law.
3. officials should try to reduce costs and burdens on consumers.
4.  gave federal agencies wide latitude to change, delay or waive provisions of the law that they deemed overly costly for insurers, drug makers, doctors, patients or states, suggesting that it could have wide-ranging impact, and essentially allowing the dismantling of the law to begin even before Congress moves to repeal it.

B. SENATE VOTE REGARDING THE AFFORDABLE CARE ACT

By a final vote of 51-48, the Senate approved a budget resolution that sets the stage for broad swaths of the Affordable Care Act to be repealed through a process known as budget reconciliation. The resolution now goes to the House, where leaders are hoping to approve it by the end of the week.

The powerful tool sets up a fast track for repealing large parts of Barack Obama’s major domestic achievement; the best guess is that the Senate is still several weeks away from largely repealing Obamacare. But as the process continues, large questions still loom over how — and when – Republicans will replace the health care law.

What the Future Will Hold?

The House of Representatives Will Vote on Budget Provisions Regarding the Current Health Care Law.

*We Will Keep You Updated as the Revisions Are Released to the Public*

What can you do?

1. Know What Coverage You Have Under Your Current Policy.

2. Contact Your State and Local Representative and Let Them Know Where You Stand on the Current Law

3. Attend Local Town Hall Meetings

4. VOTE

https://www.senate.gov/senators/contact/

What resources are at your disposal?

1. Subscribe and participate in the websites listed below

2. Viable News Outlets that Report News, Rather than Commentary…..CSPAN…..CNBC….Bloomberg News……BBC……1010Wins

Key Websites to Know and Use:

https://www.healthcare.gov

https://www.healthcare.gov/health-care-law-protections/rights-and-protections/

https://www.healthcare.gov/health-care-law-protections/grandfathered-plans/

https://www.whistleblower.gov

https://www.cms.gov

https://www.hhs.gov/healthcare/about-the-law/index.html

https://www.hhs.gov/healthcare/facts-and-features/fact-sheets/preventive-services-covered-under-aca/

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Recommendations:

1. Know the Insurance Provider Representative/Region Assigned to Your Specific Plan. Contact Your, phone number/website on Your Insurance Card.
2. Know the Stipulations of Coverage of Your Specific Plan
3. Subscribe to https://cms.gov and https://hhs.gov for Updates Regarding Your Health Care Rights and the Current Law

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Midterms are coming…….

Be Well. Be Safe. Stay informed.

Lisa Whitty Bradley, M.D., FACS
CEO & Founder
Chicks With MDs, LLC
WWW.CHICKSWITHMDS.COM
@chickswithmds

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