Basics of Obamacare That You Need to Know

A lot has been said about Obamacare – some of it good, others bad. While there will always be protesters and supporters of this healthcare reform, this post will dwell on the basic things you should know about it.

Obamacare in a Nutshell

While this reform is now commonly known as Obamacare, the use of the term wasn’t meant to be positive. It was coined by opponents of the act and was first seen in print in March 2007 in an article written by healthcare lobbyist Jeanne Schulte Scott in a health industry journal. Mitt Romney was the first person to mention the term in a political campaign in Des Moines, Iowa in May 2007.

The term Obamacare became common by mid-2012 and was used by both supporters and opponents of the law. President Obama has even said: “I have no problem with people saying Obama cares. I do care.”

So What Exactly Is Obamacare?

Put simply, it’s a law. To be more specific, it’s a law to reform the healthcare system in the US. It was signed by President Barack Obama into law on March 23, 2010. The changes outlined in the almost 1,000-page act marked the biggest regulatory overhaul of the healthcare system since Medicare and Medicaid was passed in 1965.

Formally, it is known as the Patient Protection and Affordable Care Act or the Affordable Care Act (ACA). The main goal of the ACA is to increase the number of American citizens covered by health insurance, as well as to decrease healthcare costs.

What Does Obamacare Do?

There’s lots more technicalities involved in what Obamacare actually does for Americans, but the basic gist is this: insurance companies can’t refuse citizens the way they used to.

In the past, people with pre-existing conditions found it hard to get insurance. Even worse, some insurance companies even revoked coverage when the insured gets sick. Also prevalent before the law was passed: adding extra costs because the insured has a pre-existing condition.

While it helps people get insurance, Obamacare doesn’t create health insurance. The ACA is meant to regulate the health insurance industry so that American citizens can get insurance that is of higher quality and is more affordable.

Another major goal of Obamacare is to reduce government spending on healthcare.

How Does Obamacare Promise Affordable Healthcare?

Certain mechanisms were introduced to ensure that Americans got affordable healthcare, and these include mandates, subsidies and insurance exchanges. The ACA requires insurance companies to provide applicants with the minimum requirements for healthcare coverage and offer them at the same rate regardless of whether or not the person applying has or doesn’t have a pre-existing condition.

Obamacare has three main provisions, and they are:

1. Medicaid Expansion.
Medicaid is a federal program providing healthcare coverage for Americans who earn a low income. While this is a provision of the law, not every state has opted to expand their Medicaid program. What this means is that there is quite a large portion of citizens who still aren’t receiving healthcare benefits.

2. Insurance Exchanges.
These are websites like healthcare.gov where those looking to get coverage can browse for the right plan for them. Some of the plans offered on these exchanges offer financial assistance from the federal government.

3. Individual Mandate.
This is the most disputed provision of the law given that it requires most American citizens to have minimum essential health insurance coverage. In fact, this is what sent Obamacare to the Supreme Court in 2012 where it was eventually upheld. The individual mandate took effect beginning January 2014.

Even though the individual mandate states that most citizens should get covered, there are certain exemptions. For example, members of a federally recognized Indian tribe are exempt from Obamacare as are members of religious organizations who don’t support this kind of healthcare coverage.

But other than the provisions, Obamacare is also a work in progress with the ultimate aim of cutting down medical spending. Part of the progress being made is conducting experiments that involve how the government pays doctors.

What Are the Ten Essential Health Benefits?

Insurance companies are required by law to provide for the ten essential health benefit categories, and these include:

  • outpatient care
  • emergency care
  • hospitalization
  • maternity and newborn care
  • mental health services and addiction treatment
  • prescription drugs
  • rehabilitative services and devices
  • lab services
  • pediatric dental and vision
  • free preventive services

What Happens to Those Who Already Have Health Insurance?

The short answer is that they can keep it. But the answer is actually more complicated than that. You can keep it even though it doesn’t comply with the provisions of the ACA but only until 2015. If your plan doesn’t have a grandfathered status and doesn’t meet the requirements set out by the ACA, then you have no choice but to choose a new plan. On that note, it’s best to check with official sites as some states are offering insurance plan holders until 2017 to keep their plans.

What If Someone Wants to Change Their Plan?

Yes, this is possible. However, Obamacare has a certain period of enrollment and those who want to change their health plan should do it within that said period. You can check the official pages of Obamacare to see when the next open enrollment is going to be. Keep in mind that the enrollment period is an annual occasion.

Is Everyone Really Covered By Obamacare?

While it has been called a universal healthcare platform in some cases, the answer is that it’s not truly “universal.” Why is that the case? Take the Medicaid expansion provision for example. Initially, all states were required to expand Medicaid but a Supreme Court ruling found that this might be too much for certain states given that they shoulder the costs for Medicaid. So the courts decided that each state gets to decide whether or not they will expand their Medicaid program.

As of this writing, not every state has agreed to expand their Medicaid programs. And that is where people who can’t afford healthcare will suffer. This segment of the population was expected by Obamacare legislators to be covered by Medicaid expansion, but since the courts ruled that states get to decide on that matter, that leaves the poor out of luck.

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