The Patient Protection and Affordable Care Act (2010) requires all Americans to have comprehensive health care insurance from their choice of private health care insurance provider. At the same time, a health care insurance provider can no longer refuse coverage on the basis of pre-existing medical conditions.
Under PPACA, all American citizens and resident aliens are required to have comprehensive health care insurance. If they are not covered by an employer-sponsored health plan, Medicaid, or Medicare, they must purchase a plan individually.
All young adults who have not been offered health care insurance by their employer will be able to stay on a parent’s insurance coverage until their 27th birthday. Young adults will also have the option to purchase catastrophic health insurance, with the equivalent of a $6,000 deductible.
The requirement to purchase comprehensive health care insurance can be waived for people in extreme financial hardship. Anyone who is incarcerated is also exempt.
= Religious exemption =
A few religious sects are also exempted, on the basis of their doctrine. These religious groups have not yet been specified. However, under section 1402(g)(1) of the Internal Revenue Code, which is referenced by the PPACA, only religious sects whose members also do not accept any kind of Social Security whatsoever need apply.
The Amish will almost certainly qualify for an exemption. In fact, the clause was specifically written back in the 1950s to cover Old Order Amish, who refuse to participate in any government social assistance program, either to pay or to receive. On the other hand, Muslims will not be exempted from the requirement to have comprehensive health care insurance. Some Muslims do object to non-mandatory insurance as a form of gambling, but that is not enough to qualify for a religious exemption.
The same premium for the same basic care
Insurers are required to offer the same premium to all applicants of the same age and geographical location without regard to pre-existing medical conditions. Insurers may discriminate on any other basis, including smoking. Insurers may also customize the plan, although certain minimum standards must be met.
A few restrictions on plans have been banned entirely. There are no more lifetime coverage caps. Co-payments, co-insurance, and deductibles are also eliminated, but only for specified acute and preventative health care, which is now part of an “essential benefits package” for Level A and Level B preventative care.
Medicaid now includes all individuals and families with incomes of up to 133% of the local poverty level. Those who make too much to qualify for Medicaid but do not earn more than 400% of the local poverty level will be eligible for government subsidies to assist with health insurance payments. These are scheduled to begin in 2014.
What is expected of employers?
All firms employing 50 or more people are required to offer a comprehensive health care insurance package to their employees. Businesses with fewer than 50 full-time employees are not required to offer a health care insurance package to their employees.
Very small businesses and self-employed people may be eligible for subsidies to cover insurance costs. Self-employed people will also be able to shop for health care insurance at health insurance exchanges.
Refusal to have comprehensive health care insurance will be subject to a penalty. The non-insuree will be required to pay the greater of $695 per uninsured adult in the household or 2.5% of all household income which exceeds the threshold income for filing a tax return. This penalty will be completely phased in by 2016.
Businesses with more than 50 full-time workers which do not offer health insurance will have to pay a shared responsibility requirement if the government has had to subsidize the health care of any of their employees. The penalty is $2,000 per full-time employee above the threshold.
Non-compliance will never be subject to any criminal punishment. Liens and seizures cannot be carried out to meet the penalty. A non-compliant person cannot be imprisoned.