Simplifying Obamacare (Continued)

The political hot potato. What about that whole mandate thing?

The ACA recognized that, uniquely, everyone is a healthcare consumer. You don't choose to get sick or not. Your genes can turn on you, even granola crunching tree-huggers aren't immune from cancer. Anyone can fall off a ladder, be attacked by wild dogs, eat tainted veggies, or be hit on the head by a falling anvil.

The logic embedded in the ACA is that all of us, at some point, use the healthcare system, so we should all share in the costs of keeping it running. Thus, the individual mandate, a.k.a. the "shared responsibility requirement."

Re-classified by the Supreme Court as a tax, the provision stipulates that if you don't get insurance from your employer (who will be given tax incentives under ACA to provide it for you), and if you choose not to buy health insurance for yourself, you'll pay a fine that escalates from, frankly not much, to quite a bit over time.

To help low-income working people — the ones most commonly without employer-sponsored plans — to purchase commercial health plans, federal subsidies will assist people whose income ranges from the poverty level up to 400% of federal poverty level. The assistance is on a sliding scale. At the bottom, the most you would pay out-of-pocket for health insurance would be 3% of your income. At the top of the range, this would increase to 9.5% of your income.

To facilitate the purchase of health insurance, every state is required to establish an exchange by 2014. Think of it as a flea market for health insurance. Every plan available to you will be laid out so you can comparison shop using the helpful SBC we talked about before, and figure out which plan makes most sense for you. It's one-stop shopping for both individuals and employers. The plans are all run by private companies. There's no plan controlled or run by the government.

ACA pearls for your next game of Trivial Pursuit

Here are my favorite miscellaneous and unexpected provisions that I discovered while getting to know the law better:

Congress will lose their Cadillac health plan, and members and their families must shop the exchanges like the rest of us. Interestingly, speaking of Cadillac plans, those costing more than 10K per person will pay a 40% excise tax starting in 2018. No wonder congress dropped their own plan.

And speaking of excise taxes, a new excise tax on Pharma companies will be imposed, based on their market share.

But, in a negative for pumpers, most medical devices will be subject to a 2.3% tax at the time of purchase. That would add a couple hundred bucks to the up-front cost of an insulin pump.

Meanwhile, chain restaurants with more than 20 locations will be required to display the calorie content of their foods on menus. Carb counts must be provided on request, but are not required to be on menu. Bummer. So much for easy insulin bolusing when eating out.

And, with the exception of insulin, you won't be able to use funds from a health savings account to pay for over-the-counter drugs.

Speaking of insulin, the ACA authorized the Food and Drug Administration to approve generic versions of biologic drugs, paving the way for generic insulin.

In 2015, physicians' payments from Medicare and Medicaid will switch from pay-for-service to pay-for-performance. This makes the term "paradigm shift" look like a minor adjustment. Since Hippocrates, doctors have charged for what they do, not what they accomplish. In the current model, doctors are like restaurants. Every menu item has a price: an office visit, a lab, a procedure. In the near future they'll only be paid for success. It will no longer be enough for a doc to check your blood sugar and tell you to shape up or you'll die of kidney failure. To be paid, he or she will actually need to show that they succeeded in getting your diabetes in control.

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Last Modified Date: April 23, 2013

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