Summary of Provisions in the 2010 Patient Protection and Affordable Care Act

The law includes numerous health-related provisions to take effect over a four-year period beginning in 2010.
In order of their assessed impact the primary provisions are as follows:
Guaranteed issue and community rating will be implemented nationally so that insurers must offer the same
premium to all applicants of the same age, sex, and geographical location regardless of pre-existing conditions.
Medicaid eligibility is expanded to include all individuals and families with incomes up to 133% of the poverty
level.
Health insurance exchanges will commence operation in each state, offering a market place where individuals
and small businesses can compare policies and premiums, and buy insurance (with a government subsidy if
eligible).
Firms employing 50 or more people but not offering health insurance will pay a "shared responsibility
payment" (a fine) if the government has had to subsidize an employee's health care
Non exempt persons not securing minimum essential health insurance coverage are also fined under the
shared responsibility rules. This requirement to maintain insurance or pay a fine is often referred to as the
individual mandate, though being insured is not actually mandated by law.
[6]
The fine serves to encourage most
people into an insurance pool and to deter healthy individuals from buying insurance only when they become
ill.
Improved benefits for Medicare prescription drug coverage are to be implemented.
Changes are enacted which allow a restructuring of Medicare reimbursement from "fee-for-service" to
"bundled payments".
Establishment of a national voluntary insurance program for purchasing community living assistance services
and support.
Low income persons and families above the Medicaid level and up to 400% of the poverty level will receive
subsidies on a sliding scale if they choose to purchase insurance via an exchange (persons at 150% of the
poverty level would be subsidized such that their premium cost would be of 2% of income or $50 a month for a
family of 4).
Very small businesses will be able to get subsidies if they purchase insurance through an exchange.
Additional support is provided for medical research and the National Institutes of Health.
Enrollment into CHIP and Medicaid is simplified with improvements to both programs.
The law will introduce minimum standards for health insurance policies and remove all annual and lifetime
coverage caps.
The law mandates that some health care insurance benefits will be "essential" coverage for which there will be
no co-pays.
Policies issued before the law came into effect are "grandfathered" and are mostly not affected by the new
rules.
Also
The law is not a universal coverage law.
The law does not create a government-run/-owned insurance system
Private, for-profit insurance companies are not restricted from making profits.
People will be mandated to purchase health insurance from a for-profit insurance company or pay a tax.
There is no provision in the law for the American people to come together as a citizenry to negotiate lower prices with
doctors, hospitals, drug companies, clinics, medical device manufacturers, etc.


Over the past two-and-a-half days of class, we have explored the issue of healthcare in the US and
around the world. Using your notes from class discussions, ideas from the "Emily" story, notes from the
PBS documentary and notes on various economic systems, and the overview of the 2010 Healthcare Law
write a thoughtful response to the following:

1 - What is it about our healthcare system that concerns you the most? (Healthcare costs compared to
the rest of the developed world? Unavailability of coverage to 47 million + Americans? The tax burden?
The for-profit healthcare insurance model? Poor health statistics as compared to the rest of the
developed world? Over 1 million bankruptcies each year due to medical bills? That our
government/private industry has been unresponsive to a critical societal need? etc.) Be specific.

2 - What ideas from other countries healthcare systems featured in the PBS documentary seem to make
the most sense to you, if any? Using these ideas, how might the US fix its current problems most
effectively? Be specific.

3 - Do you think healthcare is a right (something all people deserve) or a privilege (something
only those buy insurance deserve) in a highly-prosperous democratic society? AND What do you think
the role of government should be as it relates to its citizens' healthcare? Consider what role a wealthy
country's government should play in its citizens' healthcare system (compare and contrast free market
approaches and mixed market approaches to healthcare). Explain your answer.

Be sure your response is clear, detailed and be sure it includes details from our class notes, discussions,
interviews with your parents, etc.

NOTE: You must incorporate information from one outside source: an article CQ Researcher or from the
Wendell Potter interview at: (http://www.pbs.org/moyers/journal/07102009/watch2.html)