HLTH 385 Lecture Notes - Lecture 16: Guaranteed Issue, Community Rating, Adverse Selection

two more pages of elaboration to how Trumpcare and Obamacarerelates to health care finance. 30 resources

Obamacare, also known as the Affordable Care Act (ACA), waspassed in 2010 as a health care insurance plan for all Americans.The law made many changes to the existing minimum coverage ininsurance, and increase the federal subsidies for the middle-incomehouseholds of the country. Trumpcare, also known as the AmericanHealth Care Act (AHCA), is a replacement health insurance plandesigned to partly repeal the existing ACA. The new healthcarebill, is one step closer to repealing . The nonpartisanCongressional Budget Office (CBO) has an estimate with ACA as thelaw of the land, the uninsured Americans would be 28 million willremain stable for the next decade. The analysis of an earlierversion of the bill, there is an estimate of 54 million could beuninsured by 2026 in case of implementation of the AHCA. The ACAhave provision to impose penalty on consumers who can afford to buyhealth insurance but do not do so, known as the individual mandatepayment. it’s paid when you file your federal tax return. Thispenalty can be either 2.5% of income up to the totalyearly premium or $695 per person up to $2,085, whichever ishigher. AHCA eliminates the individual mandate and offers anincentive to consumers who maintain insurance coverage: insurancecompanies can charge a 30% penalty who buy health insurance afterhad a gap in required coverage exceeding 63 days. The 30% penaltywould apply for 12 months. The ACA requires that all major healthpolicies sold to consumers offer coverage for 10 categories ofessential health benefits: Outpatient services, Emergency services, Maternity and newborn care, Hospitalization. Prescriptionmedication , Mental health and substance abuse services, Laboratoryservices. Pediatric services, Rehabilitation services, includingvision and oral. Preventative, wellness, and chronic diseasemanagement services. The AHCA eliminates these protections bygiving a waiver to define what they consider essential healthbenefits. States could allow insurance companies to sell plans thatdo not cover prescription drugs or maternity care. The ACA and AHCAhave the same rules for newborns. A baby can be added to familyexisting health insurance plan or can buy a new plan to give coverthe baby. AHCA is making major changes in the health insurance byreducing the requirements and making change in the structure oftotal offered government subsidies. On the analysis, the CBO hasreported the current changes would make health insurance moreaffordable for few customers. Obamacare: The ACA increased Medicaretaxes for the households having incomes above $250,000. Thelegislation gave some tax credits to middle-income earners to helpthem pay out-of-pocket health expenses. The AHCA repeals taxes ofprevious insurance plan. It was mandatory for the companiesemploying more than 50 employees to offer health insurance or pay apenalty. Trumpcare: The mandatory insurance of employees andpenalty has been repealed under Senate plan. Insurance fordependents under 26 (Obamacare) : It requires insurer that thechildren under the age of 26 are allowed to be covered under theparent's policy. Trumpcare: Well this requirement is not repealedby trump care. Trumpcare: Pre-existing condition coverage(Obamacare):The insurer is prohibited fromdenying coverage or charging more to individuals whohave pre-existing medical conditions. Trumpcare: Gives states theability to opt-out of requirements that insurers charge the samepremiums for healthy and sick customers. Women care (Obamacare): Itis mandatory for the insurance companies to provide core servicesincluding maternity care and contraceptives and the insurancecompanies are prohibited from charging women more than men for thesame health plan. Planned Parenthood receives federal funding forfamily planning and other medical services used by Medicaidrecipients. Abortion cannot be funded with federal dollars.Trumpcare: Insurance companies prohibited from charging women morefor health insurance, but states could apply for waivers that allowthem to drop coverage for maternity care and contraceptives. Thebill also bans women from using government money to buy plans thatcovers abortion and ends non-abortion Medicaid reimbursement toPlanned Parenthood, a non-profit group that provides abortionservices in some of its clinics, for one year. Older Americans(Obamacare):The insurer are not allowed to charge the olderAmericans more than three times the cost for younger Americans.Trumpcare: States can receive waivers to allow them to charge olderAmericans more. Insurance marketplaces (Obamacare) : The Obamacaremarketplaces, such as HealthCare.gov, enable people who don't gethealth benefits at work to compare plans, just as they mightcompare hotel rooms or airline tickets online. All plans on themarketplaces must offer a basic set of benefits, such as hospitalcare, mental health services and prescription drugs. Trumpcare:Under both the House and Senate bills, it is unclear how themarketplaces would work because insurers might potentially offerhealth plans that do not offer the same set of benefits.