Straight Talk on Obamacare (The Affordable Care Act)

1. Straight TalkonObamacare(The Affordable Care Act)

2. The Affordable Care Act • Signed March 2010, it affects: • States – Employers • Insurance Providers – Individuals • Implemented in stages: • 2010: coverage for children with preexisting conditions & appeals of coverage denials • 2011: spending caps, preventative care & prescription coverage • 2012: doctors can join Accountable Care Organizations, report racial disparities, electronic records • 2013: Medicaid can cover preventative care, increasing Medicaid payments, Bundled payments between practitioners • 2014: Individual mandates & exchanges, Medicaid expansions

3. State Medicaid Expansion • ACA: States getting federal Medicaid funding must expand coverage: • Includes for the first time non-disabled, non-pregnant adults up to 133% of the poverty line • Approximately 17 million new people • 100% federally funded through 2016, then states must pay up to 10% of additional costs in 2020 • Supreme Court: Tying old money to new mandates is coercive to the states • Federal government can refuse to give new money, but not take away current funding • States may opt in to Medicaid Expansion • Michigan is on the fence

4. Private Insurance Providers • Cannot deny coverage for pre-existing conditions • Must allow children to stay on their parents plan until age 26 • Cannot place lifetime limits on coverage • Must include preventative care in plans • Must spend 80% of premiums on actual care • 20% for overhead, salaries, advertising, etc. • Glenn Smith

5. Employer Obligations • Large Employer Obligations (> 50 Full Time Employees) • Must automatically enroll new full-time employees in health insurance • Full Time > 30 hours per week • Must offer “affordable” health insurance to employees (< 9.5% of income) • Based on lowest cost self-only coverage • Must offer coverage for children up to age 26 (but not spouses) • May charge higher premiums for spouses, dependents • If employees instead apply for Tax Credits or to Exchanges, employers must pay a fine • = Cost of Employee's Tax Credit x Number of employees • Employers can avoid penalty based on the employee's W-2 earnings • Small Businesses (<25 Employees) • If they offer health insurance are entitled to tax credits up to 35% now, increases to 50% in 2014 • Starting 2014, can participate in Co-op Insurance Plans and Exchanges

6. Individual Mandate • Requires most people to maintain minimum health insurance coverage for themselves & their dependents. • Exemptions: • Undocumented immigrants • Religious objectors • Incarcerated people • Can be satisfied through • Employer-provided insurance • Individual Insurance Plans • Health Insurance Exchanges • Government Sponsored Coverage (Medicaid/Medicare) • 9 out of 10 non-elderly people would see no change because they are already covered or exempt • Failure to be covered causes a tax liability that grows over the years • But not criminal prosecution for tax evasion • But not if employer self-only coverage is > 8% of household income

7. Health Insurance Exchanges • Almost anyone can apply to participate in exchanges • U.S. citizen or national (or lawfully present) • Living in the U.S. • Not incarcerated • Low-income individuals may be eligible for tax credits and/or price caps on their premiums • Must not be entitled to “affordable” insurance from any other source (employer, Medicaid) • Income is based on adjusted household income (even if only 1 member of the household is applying)

8. Health Insurance Premiums

9. Questions? Civil Rights ● Family ● Criminal 248-764-8584 www.schmidtlawservices.com Special Thanks to: Glenn Smith, InSphere Insurance Solutions Amber Colegrove, UAW