2.  Members  Dixie Howell – Question 1, Slides 3-6, Submit project to assignment folder  Elizabeth Kellam – Question 5, Slides 14 – 17  Michelle Pitt – Question 7, Slide 21, Lead & Editor  Djuana Shields – Question 6, Slides 2 & 18–20, IT Support, Publisher, Editor  Joshua Sukmangal – Question 2, Slides 7-10, Jacqueline Sumpter – Question 3 & 4, Slides 11- 13, Editor

3.  The Affordable Care Act, also known as Obamacare, is a federal law intended to improve access to health insurance for US citizens.  Because of ACA, millions of Americans now have coverage.

4. All Americans Includes Young Adults Pre-existing Medical Conditions Early Retirees

5.  Establish a Health Insurance Marketplace so that it will be competitive and easily accessible.  Tax credits allows insurance to be affordable to every individual.

6.  Prohibits insurance companies denying coverage based on pre-existing conditions and gender by not allowing them to charge more based on these factors  Funding to State Medicare allows for preventative care for next to nothing.  Allows early retirees to remain covered under their employers until insurance is more affordable.

7.  Was created through ACA, specifically in relation to Subtitle D-Available Coverage Choices for All Americans.  The core components of the ACA are: ◦ Individual Mandate ◦ State Exchanges

8.  Essentially, organizations that offer price and coverage comparisons for consumers looking to purchase minimum coverage.

9. There are five categories of plans that individuals can access through the Marketplace: ◦ Bronze60/40% ◦ Silver70/30% ◦ Gold80/20% ◦ Platinum90/10% ◦ Catastrophic60/30%

10.  States have two options: State based exchange or federally-run exchange  Exchanges will function as new marketplaces where individuals and small businesses can purchase health insurance  Depending on income, individuals can qualify for premium tax credits and cost sharing subsidies  Individuals may use the exchange to enroll in Medicaid  The U.S. DHHS will operate exchanges in states that have not established their own  In addition to the exchange for the individual market, each state must have an exchange for the small group market, known as a Small Business Health Options exchange

11.  ACA reduces spending through both Medicare and Medicaid by reducing the annual increase to hospital rates.  States choosing not to expand Medicaid coverage have an assumption of more individuals purchasing subsidized insurance through the ACA exchange. This can drop the Medicaid costs.

12.  ACA incorporates and requires:  Two major mandates – individual and employer health insurance coverage  Specific health insurance plans (except grandfathered plans before March 23, 2010) not to make changes to covered benefits, cost sharing, or employee contributions to premiums.  A flat fee on health insurance companies that sell non- ERISA (Employee Retirement Income Security Act) plans that are outside the self-insured market.

13.  Additional fees are imposed on insurers that sell plans through the exchange.  These cost will add to the health insurance premiums.  ACA requires enrollment of young adults be included in parents insurance coverage, which will increase family premiums.  As of 2014, ACA required insurance companies to ensure people with pre-existing conditions without charging them more than anyone else in the same plan.

14.  Pros and Cons of the top three variables include: ◦ Cost – Affordable healthcare or higher tax brackets ◦ Access debate over ACA – no exclusions or inability to find providers ◦ Quality – Services affected by pros and cons

15.  PROS ◦ Affordable healthcare for Americans ◦ Predicted long term reduction in healthcare spending ◦ No out of pocket costs for preventative care  CONS ◦ Higher tax brackets necessary to cover costs ◦ Expensive starting costs ◦ Middle class citizens find ACA difficult to afford

16.  PROS ◦ No exclusions for pre-existing conditions ◦ No exclusions for low income status  CONS ◦ Increased provider to patient ratio leads to inability to find available providers ◦ Lower reimbursement rates

17.  PROS ◦ Hospital shift from fee-for-service to pay-for-performance  CONS ◦ Workforce shortages leads to lower quality of care

18.  Between 2010 and 2013, 21 states enacted laws opting out, opposing or seeking to challenge broad provisions of health reform, related to mandatory provisions on the Affordable Care Act (ACA).  ACA also extends the Children’s Health Insurance Program (CHIP) and states are required to maintain income eligibility through September 2019.

19.  Employment coverage beginning 2014, brought major changes to:  Larger employers (50+ workers) are required to offer coverage to almost all employees.  Small employers (fewer than 50 workers) do not have to “play or pay” but many can apply for tax credit.  Most workers are now required to obtain affordable coverage or face a possible IRS penalty.

20.  On June 25, 2015 the U.S. Supreme court voted 6-3 to uphold health insurance subsidies (King v Burwell) for people who purchased their insurance through a federal health insurance.  As of December 2015, Nine states enacted laws intended to create Interstate Health Compacts allowing a group of states to join together to establish broad health care programs that operate outside of the ACA or other federal law.

21. ACA is good law since it comes with numerous benefits for instance:  It does not increase the cost of Health Insurance  It aims in reducing the Federal Deficit  It has improved Medicare  Positive impact on business In this case, the law increases aggregate utility, and therefore it needs to be sustained. Overall, it is a step towards universal care to provide an answer to the United States fragmented health care system.

22.  Cauchi. R. (2016, March 17). State laws and actions challenging certain health reforms. National Conference of State Legislatures. Retrieved from http://www.ncsl.org/research/health/state-laws-and-actions-challenging-ppaca.aspx http://www.ncsl.org/research/health/state-laws-and-actions-challenging-ppaca.aspx  Department of Health and Human Services(2015). Key Features of the Affordable Care Act by year. Retrieved from: http://www.hhs.gov/healthcare/facts-and-features/key- features-of-aca-by-year/index.htmlhttp://www.hhs.gov/healthcare/facts-and-features/key-  Emanuel, E. J. (2015). Reinventing american health care: how the affordable care act will improve our terribly complex, blatantly unjust, outrageously expensive, grossly inefficient, error prone system  National Conference of State Legislatures(2016, December 01). States consider health compacts to challenge federal PPACA. Retrieved from http://www.ncsl.org/research/health/states-pursue-health-compacts.aspx http://www.ncsl.org/research/health/states-pursue-health-compacts.aspx

23.  National Conference of State Legislatures (2016, December 21). Small and large business health insurance: state and federal roles. Retrieved from http://www.ncsl.org/research/health/small-business-health- insurance.aspx#Large_employer_2015 http://www.ncsl.org/research/health/small-business-health- insurance.aspx#Large_employer_2015  Pratt, L. L. (2012). Let's fix medicare, replace medicaid, and repealthe affordable care act: Here is why and how. Bloomington, Ind: AuthorHouse.  Shi, L. and Singh, D. ( 2015). Delivering health care in america: a systems approach (6th ed.). Burlington, MA: Jones & Bartlett Learning.