Affordable Care Act Summary
Provisions of the act are phased in over ten years.
2010
National temporary high risk pool for those denied coverage.
>82,000 previously uninsured persons gained coverage including more than 250 in Nebraska
Young adults up to 26 y.o. covered under parents’ plans.
>3 million previously uninsured young adults covered, including 18,000 in Nebraska
No lifetime or annual limits on coverage
105 million people benefit, including 700,000 in Nebraska
No denial by insurers of children for pre-existing conditions
No co-payments for preventive care
10-12 million have accessed preventive care, including approximately 360,000 in Nebraska
Tax credits for small employers (<25 employees) to provide health care coverage.
An estimated 360,000 small businesses with 2 million employees benefited in 2011
$250 rebate for Medicare beneficiaries in Part D coverage gap (doughnut hole)
4 million seniors benefited in 2010 including 26,072 in Nebraska
Scholarships and loan forgiveness programs for health professionals choosing primary care
Primary care & other health professions training grants
A number of grants have been made to Nebraska institutions
Comparative Effectiveness Research Grants
Prevention Research and Service Grants
A number of these grants have also been made to Nebraska institutions.
2011
Grants to employ and train primary care nurse practitioners
No co-pay for Medicare preventive services including comprehensive risk assessment and prevention plan
In 2011, an estimated 32.5 million people with traditional Medicare or Medicare Advantage received one
or more preventive benefits free of charge. In 2012 alone, >25 million people with traditional Medicare,
including nearly ~250,000 in Nebraska, have received at least one preventive service at no cost to
them.
Requires insurers to maintain Medical loss ratios or 80 (small group) or 85% (large group). Provides for states
to review and approve premium rate increases
12.8 million subscribers received insurance rebates totaling >$1 billion, including $4.8 million for 22,500
Nebraska families. Insurance rate reviews have saved consumers another $1 billion in premium costs.
50% discount on brand name prescriptions filled during Part D coverage gap
Since inception 5.4 million seniors have saved $4.1 billion; in Nebraska seniors have saved $27.5
million since 2010 because of donut hole rebates or discounts.
10% Medicare & Medicaid bonus for primary care physicians and general surgeons in shortage areas
Increase Medicare payments to hospitals in low cost areas
Increased funding for Community Health Centers
Nebraska Community Health Centers have received >$19 million in additional funding
2012
Bonus payments to high quality Medicare Advantage plans
Incentive Medicare and Medicaid payments to Accountable Care Organizations that demonstrate quality and
efficiency. ACOs have been demonstrated to lower annual health care costs for Medicare beneficiaries.
Further shrinking of the Medicare Part D coverage gap
2013
Simplified insurance claims processing and payment
Begin phasing in federal subsidies to close Part D coverage gap
Increased Medicaid payment for primary care
2014
Citizens and legal residents required to have health coverage (phase in penalties for those without)
Employers (>50 employees) who do not offer coverage pay assessment
Employer assessment $2000/employee if no coverage. Employers offering coverage who have
employees using premium credits in an exchange pay the lesser of $3000 for each employee receiving credit
or $2000/employee.
Employers (>200 employees) required to enroll employees automatically in employer coverage.
Employees may opt out of employer coverage
State based health benefit exchanges for individuals and small business (<100 employees); at least two
multistate plans in each exchange
All insurers required to offer essential benefits package
Deductibles for small groups limited to $2000/individual, $4000/family
Insurers required to guarantee issue and renewal—age rating limited to 3:1
Subsidies for premium and out-of-pocket expenses: premiums 133-400% FPL; OOP 100-400% FPL
Members of Congress and their staffs will be phased out of the FEHBP and into the exchanges
Expand Medicaid eligibility to everyone <65 with incomes up to 133% FPL
This was made optional for the states by the Supreme Court decision in June 2012. If Nebraska opts in
approximately 100,000 uninsured Nebraskans will obtain coverage at an estimated cost to the state of
$140-168 million through 2020. But Nebraska will receive $2.9-3.5 billion of federal funds that will
stimulate new economic activity and finance over 10,000 new jobs each year.
Reduce amount eligible for catastrophic coverage in Medicare Part D (till coverage gap eliminated in 2020)
2016
States may form interstate compacts allowing insurers to sell across state lines, thus increasing market
competition for insurance
2018
Taxes on “Cadillac” health care plans— >$10,200 individual; >$27,500 family. Cadillac” plan taxes are indexed
to 2010 dollars
2020
Medicare Part D coverage gap (doughnut hole) phased out
What Health Care Reform is NOT
It is NOT a government takeover of health care. The only government health care programs are those that
already exist
– Medicare
– Medicaid
– Veterans Administration
– Military Health Care
– Indian Health Service
All the rest will be provided by the same insurers or employers (now more regulated) and private and public
providers as now. There will be greater choice of insurers than now.
It is NOT a budget buster.
2012-2019
Net costs of coverage expansion $789 billion
Net revenue and savings 932 billion
Deficit reduction $143 billion
CBO March 2010
The CBO has recently determined that repealing ACA would increase the deficit by $109 million from
2013-2022.
It does NOT
Cut Medicare Benefits
Ration care
Support euthanasia
Provide coverage for illegal immigrants
It is NOT overwhelmingly opposed by the public
Source: Kaiser Family Foundation Health Tracking Poll (June 17-22, 2010)
