On My Way

big thanks to reddit user CaspianX2 for typing all this out!

What people call “Obamacare” is actually the Patient Protection and Affordable Care Act. However, people were calling it “Obamacare” before everyone even hammered out what it would be. It’s a term mostly used by people who don’t like the PPaACA, and it’s become popularized in part because PPaACA is a really long and awkward name, even when you turn it into an acronym like that.

Anyway, the PPaACA made a bunch of new rules regarding health care, with the purpose of making health care more affordable for everyone. Opponents of the PPaACA, on the other hand, feel that the rules it makes take away too many freedoms and force people (both individuals and businesses) to do things they shouldn’t have to.

So what does it do? Well, here is everything, in the order of when it goes into effect (because some of it happens later than other parts of it):

Already in effect:

• It allows the Food and Drug Administration to approve more generic drugs (making for more competition in the market to drive down prices)

• It increases the rebates on drugs people get through Medicare (so drugs cost less)

• It establishes a non-profit group, that the government doesn’t directly control, to study different kinds of treatments to see what works better and is the best use of money.

• It makes chain restaurants like McDonalds display how many calories are in all of their foods, so people can have an easier time making choices to eat healthy.

• It makes a “high-risk pool” for people with pre-existing conditions. Basically, this is a way to slowly ease into getting rid of “pre-existing conditions” altogether. For now, people who already have health issues that would be considered “pre-existing conditions” can still get insurance, but at different rates than people without them.

• It renews some old policies, and calls for the appointment of various positions.

• It creates a new 10% tax on indoor tanning booths.

• It says that health insurance companies can no longer tell customers that they won’t get any more coverage because they have hit a “lifetime limit”. Basically, if someone has paid for life insurance, that company can’t tell that person that he’s used that insurance too much throughout his life so they won’t cover him any more. They can’t do this for lifetime spending, and they’re limited in how much they can do this for yearly spending.

• Kids can continue to be covered by their parents’ health insurance until they’re 26.

• No more “pre-existing conditions” for kids under the age of 19.

• Insurers have less ability to change the amount customers have to pay for their plans.

• People in a “Medicare Gap” get a rebate to make up for the extra money they would otherwise have to spend.

• Insurers can’t just drop customers once they get sick.

• Insurers have to tell customers what they’re spending money on. (Instead of just “administrative fee”, they have to be more specific).

• Insurers need to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when they’re turned down.

• New ways to stop fraud are created.

• Medicare extends to smaller hospitals.

• Medicare patients with chronic illnesses must be monitored more thoroughly.

• Reduces the costs for some companies that handle benefits for the elderly.

• A new website is made to give people insurance and health information.

• A credit program is made that will make it easier for business to invest in new ways to treat illness.

• A limit is placed on just how much of a percentage of the money an insurer makes can be profit, to make sure they’re not price-gouging customers.

• A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs without a prescription. Basically, your insurer isn’t paying for the Aspirin you bought for that hangover.

• Employers need to list the benefits they provided to employees on their tax forms.

8/1/2012

• Any health plans sold after this date must provide preventative care (mammograms, colonoscopies, etc.) without requiring any sort of co-pay or charge.

1/1/2013

• If you make over $200,000 a year, your taxes go up a tiny bit (0.9%)

1/1/2014

This is when a lot of the really big changes happen.

• No more “pre-existing conditions”. At all. People will be charged the same regardless of their medical history.

• If you can afford insurance but do not get it, you will be charged a fee. This is the “mandate” that people are talking about. Basically, it’s a trade-off for the “pre-existing conditions” bit, saying that since insurers now have to cover you regardless of what you have, you can’t just wait to buy insurance until you get sick. Otherwise no one would buy insurance until they needed it. You can opt not to get insurance, but you’ll have to pay the fee instead, unless of course you’re not buying insurance because you just can’t afford it.

• Insurer’s now can’t do annual spending caps. Their customers can get as much health care in a given year as they need.

• Make it so more poor people can get Medicare by making the low-income cut-off higher.

• Small businesses get some tax credits for two years.

• Businesses with over 50 employees must offer health insurance to full-time employees, or pay a penalty.

• Limits how high of an annual deductible insurers can charge customers.

• Cut some Medicare spending

• Place a $2500 limit on tax-free spending on FSAs (accounts for medical spending). Basically, people using these accounts now have to pay taxes on any money over $2500 they put into them.

• Establish health insurance exchanges and rebates for the lower-class, basically making it so poor people can get some medical coverage.

• Congress and Congressional staff will only be offered the same insurance offered to people in the insurance exchanges, rather than Federal Insurance. Basically, we won’t be footing their health care bills any more than any other American citizen.

• A new tax on pharmaceutical companies.

• A new tax on the purchase of medical devices.

• A new tax on insurance companies based on their market share. Basically, the more of the market they control, the more they’ll get taxed.

• The amount you can deduct from your taxes for medical expenses increases.

1/1/2015

• Doctors’ pay will be determined by the quality of their care, not how many people they treat.

1/1/2017

• If any state can come up with their own plan, one which gives citizens the same level of care at the same price as the PPaACA, they can ask the Secretary of Health and Human Resources for permission to do their plan instead of the PPaACA. So if they can get the same results without, say, the mandate, they can be allowed to do so. Vermont, for example, has expressed a desire to just go straight to single-payer (in simple terms, everyone is covered, and medical expenses are paid by taxpayers).

2018

• All health care plans must now cover preventative care (not just the new ones).

• A new tax on “Cadillac” health care plans (more expensive plans for rich people who want fancier coverage).

2020

• The elimination of the “Medicare gap”

.

Aaaaand that’s it right there.

The biggest thing opponents of the bill have against it is the mandate. They claim that it forces people to buy insurance, and forcing people to buy something in unconstitutional. Personally, I take the opposite view, as it’s not telling people to buy a specific thing, just to have a specific type of thing, just like a part of the money we pay in taxes pays for the police and firemen who protect us, this would have us paying to ensure doctors can treat us for illness and injury.

Plus, as previously mentioned, it’s necessary if you’re doing away with “pre-existing conditions” because otherwise no one would get insurance until they needed to use it, which defeats the purpose of insurance.

What’s at Stake for Women as Supreme Court Weighs Health Reform?

In the coming days, the Supreme Court is expected to issue its ruling on the constitutionality of the Affordable Care Act (ACA).  The National Center for Transgender Equality, along with other LGBT organizations, strongly believes that the ACA’s passage was instrumental in creating new health care rights for transgender and LGB community members.  Not only does the ACA expand coverage for all Americans, but protects a vulnerable and disproportionately uninsured (and underinsured) population.  Here is a quick reminder of what is at stake:

• Protection from sex discrimination in health care. The National Transgender Discrimination Survey found high rates of discrimination in a variety of health care settings, and shocking 19% of respondents reported being denied health care outright due to bias. For the first time, the Affordable Care Act prohibits discrimination based on sex – including gender identity – by any health care entity that receives federal funds. This critical new protection covers hospitals, clinics, doctor’s offices, and other health care facilities and programs that accept Medicare or Medicaid. You can report discrimination to the HHS Office for Civil Rights. You can read more about this part of the law in NCTE’s resource, “Health Care Rights and Transgender People.”

• Protection from being denied or dropped from insurance. Prior to passage of the Affordable Care Act, insurers  refused to issue insurance to individuals because they were transgender, or because of a medical condition such as HIV/AIDS. No wonder that the National Transgender Discrimination survey found transgender people were less likely to be insured.Plans could also decide to cancel a person’s coverage at the very moment they most needed medical care. Starting in 2014, the health care law will ban these unfair practices, and these protections are already in place for those under 19. In addition, the law allows young people to stay on their parent’s plan until they are 26, provides premium credits to help individuals buy insurance, and expands the Medicaid program to ensure access for those who can’t afford it.

• No-cost preventive care. Half of respondents in the National Transgender Discrimination Survey reported they had delayed preventive care because of cost – including 37% of those with private insurance. Under the Affordable Care Act, insurance plans must cover a range of key preventive services, from vaccinations, to blood pressure, cholesterol and osteoporosis screenings, to mammograms and pelvic exams, to testing and counseling for HIV and sexually transmitted infections – without no cost-sharing.

• Ensuring access to HIV and AIDS treatment. Numerous studies confirm that transgender people are disproportionately impacted by HIV/AIDS; in the National Transgender Discrimination Survey, more than 2.6% respondents reported they were HIV-positive, compared to 0.6 for the general population. The Affordable Care Act expands access to coverage and care for people living with HIV and AIDS in numerous ways: by making it illegal to deny or cancel coverage to people with HIV or AIDS or charge them higher premiums; by eliminating annual and lifetime limits that keep people from getting the care they need; by making private insurance more affordable; expanding Medicaid; and closing the Medicare donut hole that has made medications unaffordable for many.  NCTE and 15 other groups submitted anamicus brief to the Supreme Court arguing that the law is absolutely critical in the fight against HIV/AIDS.

• Supporting providers for our communities. The law increases support for community health centers across the country, including the growing number of federally-qualified health centers that serve the LGBT community. The law also invests in the health care workforce, nearly tripling the size of the National Health Service Corps, whose members provide primary care to communities that need it most and are now receiving training on better serving LGBT patients.

• Collecting data on LGBT health. One of the biggest obstacles to improving health for trans and all LGBT people is the lack of high-quality data on the health of our populations.. The health care law calls for expanding the collection of demographic data in federal health surveys, to help better understand the scope, causes and solutions to health disparities affecting different populations. In implementing the law, the Administration has already moved to include questions related to sexual orientation in major surveys, and has committed to develop questions on gender identity for use in the coming years.