Key Provisions of the 2010 Affordable Care Act (“ObamaCare”)
- No Discrimination against Preexisting conditions: Prohibits insurance companies from denying coverage or charging higher premiums due to preexisting conditions.
- No Lifetime Limits on Benefits: To protect people with chronic and acute conditions, insurance plans are prohibited from capping lifetime benefits.
- Medicaid Expansion for Low-Income Americans: Individuals and families below 133% of poverty ($33,534 for a family of 4) are entitled to Medicaid health coverage, which charges no premiums. Available in States that have accepted the federally-funded Medicaid expansion. Applies to citizens and legal immigrants.
- Premium Subsidies for Low- and Middle-Income Americans: For individuals and families above the Medicaid threshold and up to 400% of poverty, federal income-based subsidies are provided for premiums and cost-sharing. Applies to citizens and legal immigrants.
- Essential Health Benefits: requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits, which include items and services in the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services.
- Employers with 50 or more employees must offer coverage to employees — or pay a penalty of $2000 – $3000 per employee to help cover the cost of the Federal subsidies.
- Small Employers (25 or fewer) entitled to a tax credit up to 50% of employer’s contribution.
- Private Sector Health Insurance – Competitive Marketplace: States to set-up health care “Exchanges” where people purchase private health insurance (with subsidies if they are low income); and a Federal health insurance exchange for States that do not establish their own.
- Children up to Age 26: can remain on their parents’ plans.
Nonpartisan Resources and Reports:
