March | April 2017


Guide to Health Care Reform

By Mary Branham, CSG Managing Editor


The Patient Protection and Affordable Care Act, sometimes referred to as “Obamacare,” has been taking effect slowly since its passage in February 2010. Changes have been made to state Medicaid programs and requirements for insurance companies.

Imapact on Medicaid

Dual Eligibles
Cutting Costs
The Affordable Care Act included several provisions aimed at cutting the cost of providing health care to those who qualify for Medicaid.
Points of Service
Home and Community-Based Services
Health Homes

Medicaid and Health Exchanges


Did You Know?
The ACA required the Department of Health and Human Services to set up a website——to help consumers identify health coverage options.
Help for Coverage
Everyone has to buy health insurance or face a penalty. Medicaid expansion in some states will help to cover those up to 138 percent of the federal poverty level.
U.S. citizens and legal immigrants who buy coverage in the exchange and who have incomes up to 400 percent of the federal poverty level are eligible for tax credits. They can’t get the credits if they are eligible for public coverage or have access to health insurance through an employer.
Federal Poverty Level
The federal poverty level—approximately $14,000 for an individual and $29,000 for a family of four—is used to determine who is eligible for Medicaid and subsidies to buy health insurance.
Costs and Savings
The Congressional Budget Office says implementing the health care law will cost $938 billion over the next 10 years. But it also says the law will cut the federal deficit about $124 billion over that same time period.
Kid Stuff
The health reform law allows parents to keep their children on their insurance policies until the age of 26.
The law does not allow insurers to deny coverage to people with pre-existing conditions starting Jan. 1, 2014, and eliminates the lifetime limits on health care coverage.
An Ounce of Prevention
The law requires private health insurers to cover recommended preventive services without any copays or deductibles for the patient. This includes screenings for such things as diabetes, obesity, cholesterol and various types of cancers.
The law requires private insurance companies to cover a range of preventive service, including Pap tests, cancer screenings, diabetes screening and prenatal care without copays. It also requires coverage of some brands and methods of birth control.

Changes for Employers

The federal government will oversee the health care law in Missouri, Oklahoma, Texas and Wyoming after those states told the U.S. Department of Health and Human Services they couldn’t or wouldn’t implement the new rules. Source: Politico
Individual Mandate
If you can afford to buy health insurance—that is, if it wouldn’t cost more than 8 percent of your monthly income and if you earn above the federal poverty line—the Affordable Care Act requires you to do so. If you don’t, you could owe a tax, administered by the IRS. The penalty wouldn’t be enforced until 2016.

Key Dates in History


Key Dates for Implementation