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Summary of the Patient Protection and Affordable Care Act

Dear Reader,

I attempted to read all 234,812 words of the Patient Protection and Affordable Care Act. (By comparison, Harry Potter and the Order of the Phoenix clocks in at 257,000 words.) Even with a strict Catholic primary education and two college degrees, I found it nearly completely incomprehensible. What follows is one of the most succinct summaries we could find. –Editor


Immediate Improvements in Health Care Coverage for All Americans

Expand Coverage/Improve Access

  • Mandate that employers with more than 200 employees automatically enroll employees in health insurance plans offered by the employer (employees may opt out). (2014) Companies with 50 or fewer employees are exempt from fees.
  • Those with fewer than 200 employees do not have to offer coverage; however, those with more than 50 employees must pay a fee ($2,000 for each full-time employee excluding the first 30) if even one of their full-time employees is receiving a government subsidy for private insurance. Employers with more than 50 employees that offer coverage and have employees receiving subsidies can pay the lower of $3,000 per employee receiving a subsidy or $2,000 per full-time employee. 
  • Provide tax credits to smaller employers (25 or fewer employees and average annual wages of less than $50,000) for purchasing employee health insurance (2010-2013). The employer must contribute at least 50% of total premium cost or an amount to be established by the government. The size of the credit will vary based on company size, i.e., companies with 10 or fewer employees and average annual wages of less than $25,000 get a credit equal to 35% of the employer’s contribution to insurance costs. In 2014 and beyond, the tax credit increases to a maximum of 50% of the employer’s contribution.
  • Limit the deductible in insurance plans for small groups to no more than $2,000 for individuals and $4,000 for families unless offset by contributions offered by the insurance plan. (2014)
  • Prohibit cancellation of private insurance coverage except in cases of fraud. (September 2010)
  • Prohibit denial of coverage based on a pre-existing condition.
  • Prohibit insurers from refusing coverage for patients who have “consumed” a dollar value of services greater than a pre-determined lifetime limit. (2014)
  • Expand Medicaid to all individuals under 65 with incomes at or below 133% of the Federal Poverty Level ($10,830 for individuals and $22,050 for a family of four). (Prior to this legislation, not all low-income individuals could avail themselves of Medicaid and eligibility varied from state to state.)
      • Provide premium credits and cost-sharing subsidies to individuals and families who fall below 400% of the Federal Poverty Level, with some restrictions. (2014)
  • Establish state-based health exchanges to allow individuals and businesses with fewer than 100 employees to pool together to purchase insurance (2014), with larger businesses (100+ employees) able to participate in 2017. The Federal Government will also offer subsidies to low-income individuals to purchase insurance through the exchanges.
  • Offer (Federal government through private insurers) at least two multi-state health insurance plans in each state health insurance exchange, with at least one being a non-profit entity. (2014)
  • Allow parents to keep their children on their health insurance plans up to age 26. (September 2010)