Bantasan, Erljane

Dela cruz, Ma. Florida

Lepting, Jennifer
Sinong, Annie

ObamaCare
I. INTRODUCTION
A. What is “Obamacare”?
 officially known as Affordable Care Act (ACA) or Patient Protection and Affordable Care Act
(PPACA)
 a 906 pages act(official copy) which was signed into law on March 23, 2010
 the term “Obamacare” was originally used by Republicans to mock former president Obama
 the federal government’s most comprehensive revision of the country’s health care system since
the Medicare and Medicaid in 1965
 aims to form the framework for transforming the messy and inefficient U.S. healthcare system
 encourages states to expand their Medicaid programs
 Three Primary Goals:
1. make affordable health insurance available to more people ( subsidies for households
between 100% and 400% of the federal poverty level)
2. expand the Medicaid program to cover all adults with income below 138% of the federal
poverty level
3. support innovative medical care delivery methods

B. Salient Provisions
 Two Key Features:
1. “Individual mandate” - requires anyone to purchase a private health insurance policy from
a list of government-certified packages
2. “Employer mandate” - requires businesses that employ more than 50 people to offer health
insurance coverage for full-time employees
 Penalties for Non-Coverage
 individuals and families with income over $9,500 are required to buy insurance or pay an
annual penalty of $95 for individuals and $285 for families
 employer who do not offer coverage for full-time employees will pay a penalty of $2,000
for each uninsured worker.

C. Highlights
 Access to Affordable Insurance
 Insurance Market Reforms
 Quality Improvement
 Public Health
 Healthcare Workforce
 Medicaid and Medicare Payment
 Overall System Change

II. IMPLEMENTATION OF THE PROGRAM

A. Cost and Funding Mechanisms
 in 2010, the original 10-year cost estimate for ObamaCare was $940 billion
 in 2012, the Congressional Budget Office (CBO) updated that amount to $1.8 trillion for the
period between 2012-2022
 by 2018, total expenses are estimated to be closer to $2.5 trillion

B. Cost, Credits and Subsidies

 insurance premiums, co-pays and out-of-pocket expenses will vary
 Americans will not be required to pay more than 12 % of their incomes on the policies, and
won’t be allowed to pay less than 1.5 %
 the least expensive plan(“bronze-level health plan”) will cost $4,500- $5,000 (individual) and
$12,000-$12,500 (family)
 Obamacare will provide tax credits and cost-sharing subsidies for an estimated 16 million
Americans to help them pay for their health care coverage ($630 billion)
 many American families making less than $250,000 will have up to a $4,000 annual reduction
in their health care costs
 a self-insured family that is could potentially get over 50 % with the available subsidies

C. Uninsured Americans
 Percentages

Uninsured Rates in 2010 15 %

 Uninsured Rates in 2015 9.4 %

 Percentage Point Decrease in Uninsured Rate 6.1%

19,304,000 people gaining coverage (2010 to 2015) 

D. Coverage Gains
 Individual Market Coverage
 133,936,025 individuals with pre-existing condition (2009)
 12,681,874 individuals selecting a marketplace plan (2016)
 9,389,609 individuals receiving tax credits (Q1 2016)
 6,353,551 individuals receiving cost sharing reductions (Q1 2016)
 Employer Coverage

Employer Coverage

53523882 55630409

37803000
Number of People

39534000

27827000 28513725

2008-2010 2013-2015
Year

Children Adult Males Adult Females

Hea lth S p en d in g o f Dev elo ped Co un tries

20%

15%

10%

5%

0%
United States Australia Germany
Countries

E. Medicaid Expansion

State Yes/No State Yes/No State Yes/No

Alabama No Louisiana Yes Oklahoma No

Alaska Yes Maine No Oregon Yes

Arizona Yes Maryland Yes Pennysylvia Yes

 Arkansas Yes Massachusetts Yes Rhode Island Yes

California Yes Michigan Yes South Carolina No

Colorado Yes Minnesota Yes South Dakota No

Connecticut Yes Mississipi No Tennessee No

Delaware Yes Missouri No Texas No

District of Columbia Yes Montana Yes Utah No

Florida No Nebraska No Vermont Yes

Georgia No Nevada Yes Virginia No

Hawaii Yes New Hampshire Yes Washington Yes

Idaho No New Jersey Yes West Virginia Yes

Illinios Yes New Mexico Yes Wisconsin No

Indiana Yes New York Yes Wyoming No

Iowa Yes North Carolina No

Kansas No North Dakota Yes

Kentucky Yes Ohio Yes

III. HISTORY
A. Key events leading up to the passage of Obamacare / The Affordable Care Act
 July 2009
- Speaker of the House Nancy Pelosi and a group of Democrats from the House of Representatives reveal
their plan for overhauling the health-care system. It’s called H.R. 3962, the Affordable Health Care for
America Act.
 August 25, 2009
- Massachusetts senator Ted Kennedy, a leading supporter of health-care reform, dies and puts the
Senate Democrats’ 60-seat supermajority required to pass a piece of legislation at risk.
 September 24, 2009
- Democrat Paul Kirk is appointed interim senator from Massachusetts, which temporarily restores
the Democrats’ filibuster-proof 60th vote.
 November 7, 2009
- In the House of Representatives, 219 Democrats and one Republican vote for the Affordable
Health Care for America Act, and 39 Democrats and 176 Republicans vote against it.
 December 24, 2009
- In the Senate, 60 Democrats vote for the Senate’s version of the bill, called America’s Healthy
Future Act, whose lead author is senator Max Baucus of California. Thirty-nine Republicans vote
against the bill, and one Republican senator, Jim Bunning, does not vote.
 January 2010
- In the Senate, Scott Brown, a Republican, wins the special election in Massachusetts to finish out
the remaining term of US senator Ted Kennedy, a Democrat. Brown campaigned heavily against the
health-care law and won an upset victory in a state that consistently votes in favor of the Democratic
party.
 March 11, 2010
- Senate Democrats decide to use budget reconciliation to get to one bill approved by the House and
the Senate. The use of budget reconciliation only requires 51 Senators to vote in favor of the bill for
it to go to the president’s desk for signature.
 March 21, 2010
- The Senate’s version of the health-care plan is approved by the House in a 219-212 vote. All
Republicans and 34 Democrats vote against the plan.
  March 23, 2010
- President Obama signs the Affordable Care Act into law.

IV. SIMILAR LAWS AND POLICIES

A. ROMNEYCARE
The Massachusetts law was enacted in 2006 under then Governor Mitt Romney. Prior to the
law, which was dubbed “Romneycare” during Romney’s unsuccessful presidential campaign, more
than seven percent of Massachusetts residents lacked health insurance.
 Similarities:
1. State-based exchanges
- Both laws create exchange authorities charged with operating health insurance marketplaces.
- Both laws also require guarantee issue, meaning consumers cannot be denied coverage due to
pre-existing health conditions.
2. Subsidies for lower-income households
- While the amount of individual subsides vary, and the income levels for eligibility differ, both
laws provide financial assistance to lower-income households so that health insurance is
affordable.
3. The individual and business mandates
- Both laws require that individuals who can afford insurance to purchase insurance or face a
financial penalty.
 Differences:
1. Size and scope
- Massachusetts began its reform with a rate of uninsured that was half that of the nation, and it
was written to meet the unique needs of state residents.
- ACA has a much broader scope in that it includes provisions to address healthcare provider
shortages, increase wellness and nutrition programs, bolster community health centers, and
adjust Medicaid and Medicare.
2. Cost sharing for preventative services
- The ACA requires insurance policies cover preventative services, such as cancer screenings,
with no co-pays or deductibles.
- The Massachusetts law allowed insurers to require co-pays for these services.
3. Medicaid expansion
- In Massachusetts, Medicaid was expanded for children, parents, pregnant women and the
long-term unemployed.
- Under the ACA, states have the option of expanding the Medicaid program to all families and
Individuals with incomes up to 138 percent* of the FPL.

B. MEDICARE
 In July 1965, under the leadership of President Lyndon Johnson, Congress enacted Medicare
under Title XVIII of the Social Security Act.

 Medicare is a national health insurance program which primarily provides health insurance for
Americans aged 65 and older, but also for some younger people with disability status as
determined by the Social Security Administration, as well as people with end stage renal
disease and amyotrophic lateral sclerosis.

C. MEDICAID
 President Johnson’s 1965 legislation also included a provision to provide insurance for low-
income individuals.
 Medicaid covers various recipients, such as uninsured expectant mothers, temporarily
unemployed workers and disabled individuals. Recently, new legislation has lowered the
nation’s uninsured rate to under 9-percent, representing the highest coverage rate in U.S.
history.

D. Healthcare Quality Improvement Act of 1986 (HCQIA)

 It provides immunity for medical professionals and institutions during conduct assessments.
 The law originated partially due to a Supreme Court ruling involving abuse of the physician
peer review process
 Legislators enacted the law to protect medical professionals from peer review-related lawsuits
and to encourage physicians to file official complaints after encountering unprofessional and
dangerous peer conduct.

E. Children's Health Insurance Program (CHIP)

 CHIP was passed and signed into law by Bill Clinton on August 5, 1997 as part of the Balanced
Budget Act of 1997.
 It provides low-cost health coverage to children in families that earn too much money to qualify
for Medicaid. In some states, CHIP covers pregnant women. Each state offers CHIP coverage
and works closely with its state Medicaid program.
F. Health Insurance Portability and Accountability Act (HIPAA) of 1996
 It protects American workers by allowing them to carry health insurance policies from job to
job. The program also permits workers to apply to a select group of health insurance plans to
replace lost coverage and adjust for family changes such as marriages, births and adoptions.
 It bars insurers from discriminating against policy applicants due to health problems.
 The act preserves state laws that protect workers’ insurance rights.

G. Patient Safety and Quality Improvement Act (PSQIA) of 2005

 It protects health care workers who report unsafe conditions.
 Legislators created the law to encourage the reporting of medical errors, while maintaining
patients’ confidentially rights.
 The law also authorizes the Agency for Healthcare Research and Quality to publish a list of
patient safety organizations that record and analyze patient safety data. The Office for Civil
Rights enforces the law among national health care facilities.

V. ADVANTAGES AND DISADVANTAGES OF OBAMACARE

A. Advantages
1. Many Americans Now Have Insurance Coverage.
 Over 16 million people obtained a health insurance cover. A large percentage of these
individuals were the young adults.
2. Health Insurance is More Affordable for Many People
 Insurers were prevented from making unreasonable rate increments and instead cared more
about their customers.
3. Limitless Care Time.
 Limits on lifetime benefits have been completely banned and annual limits phased out.
4. More Screenings Are Done.
 Obamacare covers many preventive and screening services.
5. Lower Drug Costs.
 Obamacare promised to make prescription drugs more affordable to many people especially the
senior citizens who are unable to afford all their medications.
6. People with preexisting health conditions can no longer be denied coverage.
 Under the ACA, you can’t be denied coverage because of a preexisting health problem.
7. Subsidies offer financial help.
 Subsidies make purchasing health insurance less expensive for those who qualify.
8. Free preventive care
 All qualified health insurance plans must provide 10 essential health benefits. These benefits
include free preventive care and wellness visits with no copay, deductible, or coinsurance.

B. Disadvantages
1. Increased Premium Costs.
 Since the insurance companies are being forced to cover the costs of individuals with pre-
existing conditions as well as provide a wide range of benefits, people are now being forced to
pay higher premiums.
2. One Can Be Penalized In Case You Are Not Insured.
 The aim of Obamacare is to ensure people are insured all year round.
3. Signing Up Can Be Complicated.
 Obamacare portal had numerous complications when it first launched. This made it very hard
for people to sign up.
4. Taxes are going up as a result of the ACA
 Several new taxes were passed into law to help pay for the ACA, including taxes on medical
device and pharmaceutical sales.
5. Businesses are cutting employee hours to avoid covering employees
 Opponents of Obamacare claimed the legislation would destroy jobs. The number of full-time
jobs has gone up in recent years, but there are still reports of businesses cutting hours from
employee schedules.
6. Looking ahead
 The ACA is subject to changes every year. The legislation can be amended, and budget
decisions can affect how it’s implemented.
7. The cost has not decreased for everyone
 Those who do not qualify for subsidies may find marketplace health insurance plans
unaffordable.
8. Loss of company-sponsored health plans
 Some businesses may find it more cost-effective to pay the penalty and let their employees
purchase their own individual insurance on the exchanges rather than provide employer-
sponsored coverage.

C. Significance of ObamaCare
  The Patient Protection and Affordable Care Act (ACA) has 3 main objectives:
1. To reform the private insurance market—especially for individuals and small-group purchasers,
2. To expand Medicaid to the working poor with income up to 133% of the federal poverty level,
and
3. To change the way that medical decisions are made.
 The Affordable Care Act is improving the quality of our health care while controlling rapidly
rising costs.
 The health law is also improving existing care facilities.
 Health care reform works and has already benefited millions of seniors, women, children, and
young adults.

D. Economic Benefits of the Affordable Care Act

1. Putting more money in families’ pockets, boosting demand, and bringing down unemployment
today.
2. Improving health and making workers more productive.
3. Reducing our long-term deficit and laying the foundation for future growth.

VI. Celebrities who Advocated for Affordable Care Act

1. AIsha Tyler
2. John Legend
3. Trevor Noah
4. Mark Ruffalo
5. Kal Penn

VII. Status of Obamacare under the Trump Administration

 One of the most important legacies of Pres. Barack Obama’s administration is the Affordable Care
Act or Obamacare. It allowed more Americans to gain access to more affordable healthcare through
government-assisted insurance application.
 However, under Trump’s presidency, the Act has been in continuous attacks from the Republicans
who believed that giving social welfare is not the primary duty of the government.
 Trump in particular thinks that Obamacare is a waste of government funds and does not really
address the high cost of healthcare in the US.
 After assuming office, Trump attempted to repeal the Act. However, he did not succeed for the
reason that some Republicans did not support him.
 Amendments to ObamaCare:
1. Repealing the individual mandate which requires people to buy health insurance or pay a tax
penalty. By removing this mandate, people are not encouraged to seek health insurance. It also
resulted in one Texas judge declaring the whole law unconstitutional.
2. Trump also supported small businesses to provide cheap, short-term insurance. Although it
appears to be beneficial, it actually resulted in companies charging higher premiums or deny
coverage based on medical history and pre-existing conditions.
3. Trump also shortened the enrolment period from 90-days to 45-days, resulting in a narrower
time frame for interested applicants to apply.
4. Under Trump, funding for advertisement and budgets for the program was drastically reduced.
Funding was reduced from $62.5 million to $10 million. The advertisement fund was reduced
to 90%. This resulted in about 61% of Americans between 18-60 years old not knowing the
program.
5. He also ended cost-sharing reduction payments which under Obama’s administration aim to
reduce the cost of insurance by providing government-assistance to individuals. This resulted in
companies increasing their premiums to cover losses.
 Just after Trumps election and after he assumed office, the number of uninsured US citizens
increased by 2.8% or about 22 million individuals, with a reduction in the number of new
individuals covered under Obama’s healthcare Act.
 An Alternative Plan
 Trump proposed a new healthcare program which he aims to replace Obamacare.
 However, critics pointed out that the proposed Trumpcare is not a good replacement for the
Obamacare considering that some of its provisions made insurance less affordable to poor
Americans.
 Under Trumpcare, fee increased from 0% to 30%. Instead of income based tax credits, under
Trump it became age-based tax credit.
 Under Trumpcare, Planned Parenthood was defunded and women were banned from using
their tax credits for abortion fees. Trumpcare also increased the older persons are charged 5x
times compared to younger people compared to the 3x under Obamacare.
 It is estimated that Trumpcare will save $337 billion but will leave 52 million individuals with
no healthcare coverage by 2026.