What is Obamacare?
Obamacare is the Patient Protection and Affordable Care Act (ACA) implemented by the ex-president, Barack Obama, in 2010. The goal was to reform healthcare in the United States and the way healthcare is being delivered. Before the ACA/Obamacare, insurance companies would have several terms and conditions like excluding people with pre-existing diseases. Because of this, people with chronic, pre-existing diseases had really high health expenses. They would have to go without health insurance or settle for a policy that did not cover a pre-existing disease. This put a lot of the financial burden on the patient because patients could not afford regular doctor visits, tests and treatments. Due to this, patients often required emergency medical care. The ACA/Obamacare implemented some rules for the insurance companies to follow. Insurance companies could no longer turn down patients based on pre-existing diseases, such as diabetes. This significantly reduced healthcare expenses for the patients. Obamacare allows people with pre-existing conditions to have health insurance and cover the costs for these conditions. This helps people to afford preventive care, reduces hospital visits and slows the increase in healthcare costs.
How does Obamacare work?
The main goal was to slow the rapidly increasing cost of healthcare by making health insurance more available and affordable to those who need it the most. The act also says that everyone is required to have health insurance for at least 9 out of 12 months in a year or they face a tax penalty. Obamacare also helps those who cannot afford to buy a health insurance plan.
There are several different insurance plans and the terms and conditions of these plans vary. The insurance plans are divided into four "metal tiers," starting from bronze to platinum. Each category varies in price and the cost-sharing percentages (the amount covered by the insurance and the amount paid by the patient). Bronze plans are the cheapest and cover 60 percent of the medical costs whereas platinum plans are the most expensive and cover 90 percent of the medical costs.
Obamacare also aims to make health insurance more affordable by subsidizing the cost for lower-income groups below the federal poverty level. Medicaid was extended to those who earn up to 138 percent of the federal poverty level. Although, as of 2020, 14 states have chosen not to expand Medicaid, limiting accessibility for their residents. The 14 states are
- South Carolina
- North Carolina
- South Dakota
Essential services covered in Obamacare
Under the ACA, insurance plans are required to allow parents to include their children in their insurance plans up to age 26. The following essential services must be provided
- Preventive and wellness visits
- Ambulatory patient serviced
- Chronic disease management
- Pregnancy and maternity care
- Newborn care
- Pediatric (child) care
- Mental and behavioral health care
- Services and devices to treat injuries, disabilities or chronic conditions
- Laboratory tests
- Prescription medication
- Outpatient care (clinic visits)
- Emergency room services
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