Independent Payment Advisory Board
The ACA created a 15 member board called the Independent Payment Advisory Board . The IPAB is appointed by the President and confirmed by the Senate to serve six-year terms. The purpose of the board is to oversee Medicare costs and to lower the per capita growth rate of Medicare spending.
The ACA recovered tens of billions of dollars from fraudulent Medicare and Medicare Advantage payments since the bill was signed into law in 2010.
Obamacare Taxes Still In Effect
Even though the mandate no longer applies, there are still some taxes related to Obamacare:
- If you make more than $200,000 a year: Taxes increased in 2013 for individuals making more than $200,000 a year or $250,000 for married couples, some health care providers, and other health-related businesses.
- If you’re a business owner: If you have 50 or more employees, you must provide insurance to at least 95% of full-time employees or pay a fine.
The Aca Medicare: Value
ObamaCares Medicare reform enacts a Value-Based Payment Provision. The Medicare provision states Hospitals can gain or lose 1% of Medicare funding or gain a 1% increase depending on 20 factors that gauge quality vs. quantity care.
Specifically, the factors include quality measures related to the treatment of patients with heart attacks, heart failures, pneumonia and certain surgical issues, as well as patient satisfaction.
In other words, if a hospital has a high re-admittance rate or poor treatment they can lose a percentage of funding whereas if they have a low re-admittance rate they can gain funding.
Some hospitals have already been hurt, while some have gained significant funding. Although the drawbacks are obvious in the short term, it has created an incentive to improve the quality of care in hospitals.
ACA Medicare penalties and rewards will rise over the next two years to a total of 2%.
During the last half of 2012, CMS reports that hospital readmissions dropped by 70,000 for the first time on record.
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The Difference In The Plans Effective Date
Individuals apply for the ACA plans during the open enrollment period that in most states fall from November 1 to December 15 but the plans become effective from January 1 of the following year. For example, if an individual enrolled in a plan during the 2020 open enrollment period, then the plan will become effective from the January 1, 2021. The plans effective date will differ if an individual has enrolled in a plan during the special enrollment period. In the case of Medicaid plans, there is no waiting period and the coverage of this plan starts immediately after enrolling in the plan.
Obamacare Vs Canada: Five Key Differences
This article was published more than 8 years ago. Some information may no longer be current.
A doctor holds a stethoscope.
Despite the partisan war in Washington that shut down the federal government this week, President Barack Obama has succeeded in implementing the first major health reform in the United States in nearly 50 years, as the Patient Protection and Affordable Care Act goes into effect. Even though its most virulent critics raise the spectre of “Canadian-style” health care, “Obamacare” does little to change the enduring differences between the two health care systems. What, exactly, does “Obamacare” look like compared to Canada?
Not single-payer: Canadian critics tend to rail against “two-tiered” medicine, but in fact, the U.S. has a multi-tiered system. And despite the hype on both sides of the Congressional aisles, Obamacare keeps the same complex structure in place, while adding another layer through the introduction of health care “exchanges” for uninsured Americans. But the majority of Americans will continue to access care through a variety of health insurance plans made available or subsidized by their employer nearly 50 million elderly and disabled through the federal Medicare program another 60 million lowest-income through state-federal Medicaid arrangements.
Antonia Maioni is an associate professor at McGill University
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You Can Be Fined If You Dont Have Insurance
The goal of Obamacare is for people to be insured year round. If youre uninsured and dont obtain an exemption, you must pay a modest fine. Recent events have changed this fine, and beginning with the tax year 2019 it will be eliminated.
Some people think its intrusive for the government to require health insurance. ACA supporters argue that not having insurance passes your healthcare costs on to everyone else.
More Screenings Are Covered
The ACA covers many screenings and preventive services. These usually have low copays or deductibles. The hope is that if youre proactive in your healthcare, you can avoid or delay major health problems later.
Healthier consumers will lead to lower costs over time. For example, a diabetes screening and early treatment may help prevent costly and debilitating treatment later.
The ACA is going to help all Americans have higher quality and less costly healthcare in the decades to come, says Dr. Christopher Lillis, an internist in Virginia and a member of Doctors for America.
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When Youre Ready To Cancel Your Exchange Plan:
If youre enrolled in a plan through HealthCare.gov, you can follow these directions for canceling your exchange plan so you can transition to Medicare. Or you can remove only yourself from the policy if you have other family members who need to stay on the exchange plan.
If youre in a state with a state-run exchange, youll need to follow the steps outlined by your exchange. Regardless of what state youre in, if in doubt, ask for help. Contact the exchange call center or your broker if you have one. Document the call and keep a record of your cancellation request.
Canceling your exchange coverage to switch to Medicare should be relatively simple, but we have seen cases where cancellation requests werent transmitted to the carrier in a timely manner. For that reason, it may be wise to switch from bank draft to paper billing prior to submitting your cancellation request.
That way, if something goes wrong when the cancellation request is being processed, you wont end up with premiums being auto-drafted from your bank account after your coverage was supposed to be terminated.
Obamacares Survival Is Now Assured But It Still Has One Big Problem
Twelve states have refused to expand Medicaid, leaving millions of poor Americans without health coverage and Democrats divided over how to respond.
- Read in app
By Sarah Kliff
Some Democrats are eager to build on their Affordable Care Act victories in the Supreme Court by filling a gaping hole created along the way: the lack of Medicaid coverage for millions of low-income Americans in 12 states.
But so far, Republican leaders in those states are refusing to use the health law to expand Medicaid, despite considerable financial incentives offered under the law and sweetened under the Biden administration. Some are trying to defy the will of their own voters, who passed ballot initiatives calling for expansion.
And in Washington, Democrats who want to act are divided about when and how.
Democratic House members from states that have not expanded have begun to push for the federal government to intervene and provide coverage to the four million Americans shut out of Medicaid expansion.
We cannot wait anymore, said Representative James Clyburn, Democrat of South Carolina, one of the holdout states. The states didnt do it. We in Congress have got to move.
There are many competing priorities, said Representative Lloyd Doggett, Democrat of Texas, who introduced Medicaid expansion legislation this month.Im not opposed to doing the other things, which are also very expensive, but just saying dont leave out the economically disadvantaged.
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Frequently Asked Questions About Medicaid Expansion
A centerpiece of the Patient Protection and Affordable Care Actoften referred to as Obamacareis the expansion of Medicaid eligibility to people with annual incomes below 138 percent of the federal poverty level, or $26,347 for a family of three and $15,417 for an individual. Despite the fact that the Affordable Care Act was passed into law in 2010 and was subsequently upheld by the U.S. Supreme Court in the summer of 2012, many questions persist about the law, particularly as it relates to Medicaid expansionwhat that expansion actually means, who it will cover, what it will cost, and more.
As we mark the third anniversary of the passage of the Affordable Care Act, it is important not to lose perspective about what Medicaid expansion actually means for the millions of people it will help to insure, as well as the economic benefits it will bring to states and local economies. Here are the 10 questions about Medicaid expansion under the law that are asked most frequently and are too often answered incorrectly.
Legislation To Expand Medicaid
Lawmakers in the states that havent expanded Medicaid have continued to introduce legislation each year in an effort to expand coverage. In 2018, Virginia lawmakers passed a budget that includes Medicaid expansion, with coverage that took effect in January 2019. By June 2021, more than 555,000 people had gained coverage in Virginia under Medicaid expansion .
Georgia enacted legislation in 2019 that allowed the state to submit a Medicaid expansion proposal to CMS, but only for people earning up to 100% of the poverty level . As described above, CMS approved the partial expansion to take effect in mid-2021, but rejected the states request for full Medicaid expansion funding. Now that the Biden administration has indicated that the associated work requirement approval might be rescinded, the future of Georgias partial Medicaid expansion is uncertain.
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Obamacare And Medicare Advantage
Medicare Advantage is a private coverage option which has driven profits of private health insurance companies up, yet puts a larger burden on the government to fund Medicare. While some seniors may personally benefit from a Medicare Advantage plan, they have created some cost issues which the Affordable Care Act addresses in its long list of Medicare reforms. Luckily for beneficiaries and taxpayers the Affordable Care Act make some much-needed reforms to Medicare Advantage including the ones discussed on this page ensuring Medicare Advantage remains a viable supplement to Original Medicare.
When Should You Cancel Your Plan
The standard advice is to avoid any gaps in coverage. So if your Medicare will start August 1, you would schedule your exchange plan to terminate July 31. But while thats undoubtedly the safest course of action, some people feel comfortable taking a gamble during their last month or two before Medicare kicks in, and they cancel their coverage early.
Be cautious about this approach if you have pre-existing conditions, however. If youre going to enroll in Medicare A and B, youre probably going to want a Medigap plan to supplement your coverage. Medigap plans are guaranteed issue during your initial six-month enrollment period, but they can impose a pre-existing condition waiting period if youve had a gap in prior coverage of more than 63 days.
Once youve taken steps to enroll in Medicare and schedule the cancellation of your exchange plan, take some time to familiarize yourself with the various coverage options that can improve upon the basic coverage provided by Medicare. And then enjoy your Medicare youve earned it!
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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The Pros And Cons Of Obamacare
The Affordable Care Act
The Affordable Care Act , also known as Obamacare, was signed into law in 2010.
The act aimed to provide affordable health insurance coverage for all Americans. The ACA was also designed to protect consumers from insurance company tactics that might drive up patient costs or restrict care.
Millions of Americans have benefitted by receiving insurance coverage through the ACA. Many of these people were unemployed or had low-paying jobs. Some couldnt work because of a disability or family obligations. Others couldnt get decent health insurance because of a preexisting medical condition, such as a chronic disease.
The ACA has been highly controversial, despite the positive outcomes.
Conservatives objected to the tax increases and higher insurance premiums needed to pay for Obamacare. Some people in the healthcare industry are critical of the additional workload and costs placed on medical providers. They also think it may have negative effects on the quality of care.
As a result, there are frequent calls for the ACA to be repealed or overhauled.
Heres a look at some of the pros and cons of Obamacare.
Option : Get Around Stubborn States By Letting Cities Expand Medicaid
Instead of centralizing the approach, this next idea goes even more local. The COVER Now Act, introduced by Rep. Lloyd Doggett, D-Texas, would empower local jurisdictions to expand Medicaid. So, if you live in Austin, Texas, maybe you could get Medicaid, even if someone in Lubbock still couldn’t.
The political and logistical challenges would be tough, policy analysts say. Logistically, such a plan would require counties and cities to create new infrastructure to run a Medicaid program, Rudowitz notes, and the federal government would have to oversee how well these new local programs complied with all of Medicaid’s rules.
“It does not seem feasible politically,” Michener says. “The legislators who would have to vote to make this possible would be ceding quite a bit of power to localities.” It also might amplify geographic equity concerns, she says. People’s access to health insurance would not just “be arbitrarily based on what state you live in which is the current state of affairs It’s also going to be arbitrary based on what county you live in, based on what city you live in.”
What’s next: Doggett introduced the bill earlier this month. There’s no guarantee it would get a vote on the House floor and even if it did it wouldn’t survive a likely filibuster in the evenly divided Senate.
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Medicare And The Affordable Care Act: Medicare May Cost You Less
The federal government pays for most Medicare costs. Affordable Care Act plans are usually offered by private health insurance companies. So, Medicare generally costs you less.
Medicare, of course, is mainly for people 65 and over, although some people qualify through disability.
It used to be that if you were only enrolled in Medicare Part B, you might have to pay a tax penalty. Having only Medicare Part B doesnt meet the minimum essential coverage requirements. However, the penalty expired as of 2019, according to CNBC.
Even if youre only enrolled in Medicare Part B, you shouldnt sign up for a Marketplace plan if you already have Medicare coverage. In fact, the government tries to prevent the sale of Marketplace plans to anyone who is a Medicare beneficiary.
Most people dont pay a Medicare Part A premium, but some people do. If you need to pay a premium for Medicare Part A, make sure you enroll when you were first eligible. If you dont, you may have to pay a separate late-enrollment penalty for Part A when you do sign up.
How The Obamacare Tax Penalty Worked
To make sure insurance companies could afford to add patients with preexisting conditions, the ACA initially required everyone to have health insurance for at least nine months out of every 12, or be subject to a tax.
In December 2017, Congress repealed the penalty, effective in 2019, with the Tax Cuts and Jobs Act. Even before that happened, many groups had successfully petitioned Congress so they could be exempt from Obamacare.
Since the subsidies remain in place, it also made sure the government would pick up a percentage of the rising costs.
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The Aca And Medicare Costs For High
The formula for Medicare part B is unaffected by the ACA and most seniors wont see a rise in the prices they pay. However, Medicare recipients with higher incomes have historically paid more for their Part B coverage, which is the medical insurance portion of the program and helps pay for outpatient medical care such as doctor visits, lab tests, and durable medical equipment. High-income seniors may still continue to pay higher rates despite the changes to Medicare.
Public Support For Medicaid Expansion
Public support for Medicaid expansion is relatively strong, even in Conservative-leaning states: In Wyoming , 56 percent of the public are in favor of Medicaid expansion. But the Republican-led legislature in Wyoming has consistently rejected Medicaid expansion, despite Republican former Governor Matt Meads support for expansion.
Voters in Utah, Idaho, and Nebraska all conservative-leaning states approved Medicaid expansion ballot initiatives in the 2018 election. And the same thing happened in Missouri and Oklahoma in 2020.
In Texas home to more than a quarter of those in the coverage gap nationwide a board of 15 medical professionals appointed by then-Governor Rick Perry recommended in November 2014 that the state accept federal funding to expand Medicaid, noting that the uninsured rate in Texas was unacceptable. But no real progress towards Medicaid expansion has been made since then, and U.S. census data indicated that 18.4 percent of Texas residents were uninsured in 2019 the highest rate in the country
There are several other states where the legislature or the governor or both are generally opposed to the ACA, but where Medicaid expansion has been actively considered, either by the governor or legislature or in negotiations with the federal government. These include Kansas, North Carolina, and Tennessee.
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