The Last Two Months Have Been Overloaded with News Reports, Executive Orders and Congressional Acts Focused on the ‘Repeal and Replace’ of the Affordable Care Act/OBAMACARE.


But What Does this Mean for You As An American Citizen and Health Care Recipient???


This Post Will Cover the Essentials of What is Currently Covered Under the Current Health Care Law, The Affordable Care Act/OBAMACARE, and What is Being Proposed Under the Republican Administration’s Plan for Future Health Care Coverage in the United States of America.


The Most Important Thing is to Stay Informed and Be Involved in the Process of Determining How Our Healthcare Dollars are Spent and Allocated.


Let’s Get Started…….


What Do You Need to Know Right Now?


  1. Your Rights Under the Current Law, Affordable Care Act/Obamacare

2. What Coverage Rights Are at Risk with the Proposed New Law, The American Health Care Act          (AHCA/TRUMPCARE/RYANCARE)?

First, Let’s Review the Current Health Care Law…..

What is the Affordable Care Act (Obamacare)?

The Patient Protection and Affordable Care Act (PPACA)

United States Federal Statute

Enacted March 23, 2010 by Former President Barack Obama


What do you need to know about the current law (OBAMACARE/THE AFFORDABLE CARE ACT)?

How is it Funded?

1.Individual Mandate (3 Billion)

For tax year 2016, the penalty will rise to 2.5% of your total household adjusted gross income, or $695 per adult and $347.50 per child, to a maximum of $2,085. For tax year 2017 and beyond, the percentage option will remain at 2.5%, but the flat fee will be adjusted for inflation.

You’ll pay 1/12 of the total fee for each full month in which a family member went without coverage or an exemption.


Dan Mangan@_DanMangan

Monday, 20 Jul 2015 | 5:03 PM ET


‘About 7.5 million taxpayers so far have paid a penalty on their taxes for failing to have health insurance last year, as required for the first time by the Affordable Care Act, officials said Monday. That number is well in excess of original projections by officials.

The average penalty paid was about $200 per person, and in all $1.5 billion was collected by the Internal Revenue Service in these fines. However, officials stressed that “the vast majority”—85 percent—of people who paid the fines nonetheless ended up with a net tax refund from the IRS.’


2. Additional Fees/Taxes that Fund the ACA

+.9% Increase in Medicare Tax Rate

  3.8% New Tax on unearned income for high-income taxpayers= $210.2 billion ($200,000 for individual and $250,000 for joint filers)

  New Annual Fee on health insurance providers = $60 billion (For calculation – Sec 9010 (b) of the PPACA.)[1]

  40% New Tax on health insurance policies which cost more than $10,200 for an individual or $27,500 for a family, per year = $32 billion (inland tax as opposed to an importation tax)

  New Annual Fee on manufacturers and importers of branded drugs = $27 billion (For calculation – Sec 9008 (b) of the PPACA)[2]

  2.3% New Tax on manufacturers and importers of certain medical devices = $20 billion

  +2.5% Increase (7.5% to 10%) in the Adjusted Gross Income floor on medical expenses deduction = $15.2 billion

  Limit annual contributions to $2,500 on flexible spending arrangements in cafeteria plans (plans that allow employees to choose between different types of benefits) = $13 billion

  All other revenue sources = $14.9 billion

  • 10% New Tax imposed on each individual for whom “indoor tanning services” are performed.
  • 3.8% New Tax on investment income. Includes: gross income from interest, dividends, royalties, rents, and net capital gains. Investment income does not include interest on tax-exempt bonds, veterans’ benefits, excluded gain from the sale of a principle residence, distributions from retirement plans, or amounts subject to self-employment taxes. (The lesser of net investment income or the excess of modified Adjusted Gross Income over a the dollar amount at which the highest income tax bracket, typically $250,000 for married filing jointly and $200,000 filing as an individual).



Where Does the Money Go?

1.Medicaid Expansion: The PPACA gives money to States to expand Medicaid eligibility to Americans under the age of 65 who are below 133% of the federal poverty limit, but states can decline without losing existing funding. The Act gives States 100% Federal funding for the first 3 years for newly eligible individuals, beginning January 1, 2014 and ending December 31, 2016. January 1, 2017 the funding will be decreased to 95% with the next 2 years each decreasing by 1% until the year 2020 which will be decreased to 90%. [3]


Tax Credits: Tax credits will be available for individuals and families with incomes up to 400 percent of the federal poverty level ($43,420 for an individual or $88,200 for a family of four) that are not eligible for Medicaid

****This means that these tax credits are for individuals and families who obtain health insurance from the state run Health Insurance Exchanges****


“Individuals with incomes below 400 percent FPL who purchases coverage in the Exchange are not required to spend more than a set percentage of their income on health insurance. If they cannot find coverage at a price that falls below this threshold, they are then eligible for a premium credit to ensure they do not spend more than a certain percentage of their income on health insurance coverage.”



2.Cost-Sharing Subsidies: The cost-sharing subsidy applies to individuals and families who enroll in a qualified health plan in the silver level of coverage in the individual market offered through an exchange and whose household income is between 100 – 400 percent of the poverty level for a family.[7]  (Persons who are offered coverage through their employer also may be eligible for the subsidies provided through the exchange if their employer’s plan premium would exceed 9.5 percent of the employee’s income.) [8]
These subsidies are meant to limit out of pocket costs before the insurance companies pay for all medical expenses. It helps reduce out of pocket cost significantly for low to middle class. If you are 200% below the Federal Poverty Level, your out of pocket costs will be reduced by two-thirds. They’ll be decreased by half for persons below 300% and one-third for persons below 400% FPL. [9]
Both premium credits and cost-sharing subsidies are refundable tax credits paid in advance directly to the health insurer. Any costs above and beyond what the credits and subsidies do not cover are the responsibility of the individual or family

3.Federal Agencies’ Administrative Costs:


Your Rights Under the Affordable Care Act:

  1. End to Lifetime and Yearly Limits
  2. Requires Insurers to cover People with Pre-Existing Health Conditions, Including Pregnancy, without Charging More.
  3. Young Adult Coverage Under Parent Insurance Until Age 26.
  4. Prevent Cancellation of your Policy by Your Insurer
  5. Protects You from Employer Retaliation-Fire or Retaliation Because You Get a Premium Tax Credit When You Buy a Health Plan in the Marketplace
  6. Grandfathered Plans-Health Plans that Were in Existence on March 23, 2010 and Haven’t Been Changed in Ways that Substantially Cut Benefits or Increase Cost.  It is Possible that You May Not Get Some Rights and Protections of Other Plans.
  7. Rate Review– helps protect you from unreasonable rate increases. Insurance companies must now publicly explain any rate increase of 10% or more before raising your premium. This does not apply to grandfathered plans
  8. The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs.  If Your Insurer Does Not Meet the 80/20 Rule, You May Get Back Some of the Premium You Paid…..Direct Refund…..Rebate Check…..Reduction in Future Premium…..Employer May Use Rebate in Variety of Ways that Directly Benefits the Employee
  9. Guarantees Your Right to Appeal of Denied Payments/Coverage
  10. Covers Preventive Care at No Additional Cost to You
  11. Removes Insurance Company Barriers to Emergency Service Coverage that is Out of Network
  12. Individual Mandate/Tax.  If You Do Not Sign Up for Coverage, the Penalty is 2.5% of Your Combined Family Annual Income
  13. The Current Open Enrollment Period Ends January 31, 2017
  14. The Preventive Care Coverage Listed Below is Verbatim from the Department of Health and Human Services:


Preventive Services Covered Under the Affordable Care Act

If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a copayment or co-insurance or meet your deductible. This applies only when these services are delivered by a network provider.

15 Covered Preventive Services for Adults

  1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
  2. Alcohol Misuse screening and counseling
  3. Aspirin use for men and women of certain ages
  4. Blood Pressure screening for all adults
  5. Cholesterol screening for adults of certain ages or at higher risk
  6. Colorectal Cancer screening for adults over 50
  7. Depression screening for adults
  8. Type 2 Diabetes screening for adults with high blood pressure
  9. Diet counseling for adults at higher risk for chronic disease
  10. HIV screening for all adults at higher risk
  11. Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:
  12. Obesity screening and counseling for all adults
  13. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
  14. Tobacco Use screening for all adults and cessation interventions for tobacco users
  15. Syphilis screening for all adults at higher risk


***22 Covered Preventive Services for Women, Including Pregnant Women***

The eight new prevention-related health services marked with an asterisk ( * ) must be covered with no cost-sharing in plan years starting on or after August 1, 2012.

  1. Anemia screening on a routine basis for pregnant women
  2. Bacteriuria urinary tract or other infection screening for pregnant women
  3. BRCA counseling about genetic testing for women at higher risk
  4. Breast Cancer Mammography screenings every 1 to 2 years for women over 40
  5. Breast Cancer Chemoprevention counseling for women at higher risk
  6. Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women*
  7. Cervical Cancer screening for sexually active women
  8. Chlamydia Infection screening for younger women and other women at higher risk
  9. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs*
  10. Domestic and interpersonal violence screening and counseling for all women*
  11. Folic Acid supplements for women who may become pregnant
  12. Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes*
  13. Gonorrhea screening for all women at higher risk
  14. Hepatitis B screening for pregnant women at their first prenatal visit
  15. Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women*
  16. Human Papillomavirus (HPV) DNA Test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older*
  17. Osteoporosis screening for women over age 60 depending on risk factors
  18. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
  19. Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
  20. Sexually Transmitted Infections (STI) counseling for sexually active women*
  21. Syphilis screening for all pregnant women or other women at increased risk
  22. Well-woman visits to obtain recommended preventive services*

Learn more about Affordable Care Act Rules on Expanding Access to Preventive Services for Women.
(Effective August 1, 2012)

26 Covered Preventive Services for Children

  1. Alcohol and Drug Use assessments for adolescents
  2. Autism screening for children at 18 and 24 months
  3. Behavioral assessments for children of all ages
    Ages: 0 to 11 months1 to 4 years5 to 10 years11 to 14 years15 to 17 years.
  4. Blood Pressure screening for children
    Ages: 0 to 11 months1 to 4 years5 to 10 years11 to 14 years15 to 17 years.
  5. Cervical Dysplasia screening for sexually active females
  6. Congenital Hypothyroidism screening for newborns
  7. Depression screening for adolescents
  8. Developmental screening for children under age 3, and surveillance throughout childhood
  9. Dyslipidemia screening for children at higher risk of lipid disorders
    Ages: 1 to 4 years5 to 10 years11 to 14 years15 to 17 years.
  10. Fluoride Chemoprevention supplements for children without fluoride in their water source
  11. Gonorrhea preventive medication for the eyes of all newborns
  12. Hearing screening for all newborns
  13. Height, Weight and Body Mass Index measurements for children
    Ages: 0 to 11 months1 to 4 years5 to 10 years11 to 14 years15 to 17 years.
  14. Hematocrit or Hemoglobin screening for children
  15. Hemoglobinopathies or sickle cell screening for newborns
  16. HIV screening for adolescents at higher risk
  17. Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
  18. Iron supplements for children ages 6 to 12 months at risk for anemia
  19. Lead screening for children at risk of exposure
  20. Medical History for all children throughout development
    Ages: 0 to 11 months1 to 4 years5 to 10 years11 to 14 years15 to 17 years.
  21. Obesity screening and counseling
  22. Oral Health risk assessment for young children
    Ages: 0 to 11 months1 to 4 years5 to 10 years.
  23. Phenylketonuria (PKU) screening for this genetic disorder in newborns
  24. Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk
  25. Tuberculin testing for children at higher risk of tuberculosis
    Ages: 0 to 11 months1 to 4 years5 to 10 years11 to 14 years15 to 17 years.
  26. Vision screening for all children


What Are the Exemptions from the Affordable Care Act (Obamacare)? 


Here are the ways you can be exempt from the requirement to buy health insurance:

  • Your lack of insurance coverage was for three months or less.
  • You aren’t required to file a tax return because your income is too low.
  • You are incarcerated.
  • You are in the U.S. illegally.
  • You are part of a Native American tribe.
  • The least expensive health insurance available to you costs more than 8.13% of your 2016 income in premiums.
  • You are a member of a health care sharing ministry.
  • Your religion objects to insurance.
  • You qualify for a hardship exemption.




What is the American Health Care Act (AHCA)?

Bill put forth by the Current Republican Administration to ‘Replace and Repeal’ the Affordable Care Act/Obamacare.

  1. What is Preserved from the ACA/Obamacare?      


  1. Coverage for Pre-Existing Conditions
  2. Coverage Under Parental Insurance Until Age 26
  3. Gender Neutral Policies
  4. Tax Credits for Low Income
  5. HSA (Health Savings Accounts)
  6. Health Marketplaces
  7. Open Enrollment Period(OE)…..November 1-December 15
  8. Special Enrollment Period(SEP)…..60 Day Grace Period to Obtain Health Coverage, If the Following Qualifying Events Occur….Losing Health Insurance Coverage, Moving, Having a Baby or Adopting a Child.


How Does THE AMERICAN HEALTH CARE ACT (AHCA) Differ from The Affordable Care Act/Obamacare?

  1. Repeals the Following (Which Are Currently Covered Under the ACA/Obamacare):


  1. Individual Mandate (Tax){3 Billion}…..However, it is Replaced with a 30% Surcharge Called the ‘Continued Care Penalty’.
  2. Funding of Planned Parenthood
  3. The Medical Device Tax (20 Billion)
  4. Eliminates Requirement for Businesses with at Least 50 Employees to Provide Health Insurance
  5. 3.8% Medicare High Income Tax on Individuals Grossing >200K and Joint Filing >250K (210 Billion)…..Would Reduce the Tax Rate to 2.9% to coincide with the Medicare Tax Rate for the General Population.
  6. Funding for Prevention and Public Health Fund…..Which Includes the Following….Research….Surveillance and Tracking….Public Health Infrastructure….Immunization and Screening….Tobacco Prevention…..Public Health Workforce and Training
  7. Standards for healthcare actuarials (Average Amount/Estimate for How Much Health Plans will Pay for Insurance Coverage vs. Out of Pocket Expenses….It is a Theoretical Projected Range, Not an Absolute.
  8. Premium and cost sharing subsidies


What Elements are New Under the Proposed American Health Care Act?

  1. Late Enrollment Penalty for those who do not stay continuously covered
  2. Establish State Patient and State Stability Funds…..Subsidies……115 Billion over 9 years…..States Have Discretionary Utilization of Funds…..Preventive Health….High Risk Patients…..Cost Sharing Subsidies


  1. Will Phase Out Federal Medicaid Funding to the States, Placing a Larger Percentage of the Financial Burden on Already Cash Poor States (337 Billion Federal Savings Over Next Decade)…..Per Capita Allotment…..with the option for State Block Grants. Limit Enhanced FMAP(Federal Medical Assistance Percentage).  To Explain:  Currently, Medicaid is Dually Funded by Federal and State Funds. The Federal government currently pays states for a specified percentage of program expenditures. Varies by states based on criteria, such as per capita income. The regular state FMAP is 57%, but ranges from 50%, in wealthier states, to 75% in poorer states (The maximum regular FMAP is 82%). FMAPs  are adjusted for each state on a three year cycle to account for fluctuations in the economy.

3. State Option to Require Work as a Requirement for Medicaid Eligibility for Nondisabled, NonElderly,  NonPregnant Adults

How is the American Health Care Act Funded?




How is the Funding Dispersed?






What is the CBO?


The Congressional Budget Office (CBO)


CBO provides Congress with nonpartisan analyses for economic and budget decisions and with estimates required for the Congressional budget process.





What were the Findings of the CBO Regarding the American Health Care Act (AHCA)?

  1. The AHCA Would Reduce the Federal Deficit by 337 Billion over the Coming Decade
  2. In 2018, 14 Million More People Would Be Uninsured Under the AHCA
  3. Later, after additional changes to subsidies for insurance purchased in the nongroup market and to the Medicaid program took effect, the increase in the number of uninsured people would rise to 21 million in 2020 and then to 24 million in 2026.
  4. Average premiums would rise by as much as 20 percent in 2018 and 2019 before falling, by 10%, in later years





What Can We Do to Be Involved????


  1. Contact Your State Representative and Inform Them of Your Support, or lack thereof, Regarding Changes in the Health Care Law.



  1. VOTE…..You Elect State Representatives to Speak for You in Washington, D.C.


  1. Review Your Health Insurance Policy and Insure that Your Current Rights Are Being Upheld and Your Health Care Preserved.



RESOURCES/Critical Websites:


  6. S. CBO (@USCBO) · Twitter


****As Always, Consult Your Physician, or Health Care Provider (HCP), Regarding Specific Questions About Your Health and Coverage****








Be Sure to Keep Abreast of News Regarding the Active and Continuous Changes in Health Care Reform.


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As Always,


Be Well. Be Safe. Stay Informed. Take Care.


Lisa Whitty Bradley, M.D., FACS

CEO & Founder

Chicks With MDs, LLC