The New York Times reported this month that after the contentious arguments before the Supreme Court, the future of President Obama's Affordable Care Act is far from certain. It is enormously complex, but at its center is a controversial requirement that all Americans purchase health insurance. The justices will decide if this individual mandate is constitutional, and if not, whether the entire law must be overturned.
"If implemented, it would be the most important health care law since the enactment of Medicaid and Medicare in 1965", says Jonathan Oberlander, Professor of Social Medicine and Health Policy management at UNC, Chapel Hill. It brings us closer to the ideal that all Americans should have access to care regardless of income or health status.
Numerous provisions will take effect over several years and many provisions have been enacted since 2010. Health insurance providers must offer the same premium to all applicants of the same age and geographical location without regard to most pre-existing conditions, for example. Lifetime caps will be banned. Preventative services such as mammograms and colonoscopies must be covered without requiring a deductible or co-payment. Low income persons and families above the Medicaid level and up to 400% of the federal poverty level will receive federal subsidies if they choose to purchase insurance via an exchange. Small businesses may also be eligible for subsidies. Medicaid eligibility will be expanded to include all individuals and families with incomes up to 133% of the poverty level and will simplify the enrollment process.
The Act's provisions are intended to be funded by a variety of taxes and offsets. Major sources of new revenue include a much broadened Medicare tax on incomes over $200,000 and $250,000 for individual and joint filers respectively. There will be an annual fee for insurance providers and a 40% tax on "Cadillac" insurance policies. There will also be taxes on pharmaceuticals, high-cost diagnostic equipment and a 10% federal sales tax on indoor tanning services.
In June, the Supreme Court is likely to announce its decision. The next big month will be November - election month. If the law survives these big challenges both legal and political, the next big year for implementing big changes is 2014. According to Jonathan Oberlander, while not an ideal solution, "we will build on our existing system - it's what we have, and it is too difficult to move away from it."
Health care reform will remain an important news topic in the near future because of the importance to the American public. Keep your eyes and ears open and be sure to stay informed.
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