ObamacareObamacareWhat is in it for millions of poor American?What is in it for millions of poor American?

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Obamacare

“The Patient Protection and Affordable Care Act (PPACA)” signed into law on March 23, 2010

Nickname (!)

“Obamacare” !!

Obamacare

Just look at the Title once again!!“The Patient Protection and Affordable Care

Act”

`Patient Protection’`Affordable Care’

The fact is that the Patients were not ‘protected’The fact is that the Care was not `Affordable’

Medicaid and Medicare

Two such Laws still exists in the US, created in 1965

Medicaid Medicare

Medicaid: Coverage and costCoverage Medicaid provides comprehensive inpatientand outpatient health care coverage, including many services and costs Medicare does not cover, most notably, prescription drugs, diagnostic and preventive care, and eye glasses

Coverage varies from state to state Medicaid can pay Medicare deductibles and 20% portion of charges not paid by Medicare Medicaid can also pay the Medicare premium

Medicaid: Coverage and cost

CostIn some states, Medicaid charges small amounts for certain services

Beneficiaries Total number of Medicaid beneficiaries: 70.4 million (2011)

Medicare: Coverage and costMedicare A Federal Program covering almost everyone 65 or over Certain people on Social Security disability Some people with permanent kidney failure

Medicare: Coverage and costCoverage Medicare hospital insurance (Part A) provides basic coverage for hospital stays and post- hospital nursing facility and home health care Medicare medical insurance (Part B) pays most

basic doctor and laboratory costs, and some outpatient medical services, including medical equipment and supplies, home health care, and physical therapy. Medicare prescription drug coverage (Part D) pays some of the costs of prescription medications.

Medicare: Coverage and costCost One must pay a yearly deductible for both Medicare Part A and Part B, and make hefty copayments for extended hospital stays. Under Part B, you must pay the 20% of doctors'

bills Medicare does not pay, and sometimes up to 15% more.

Medicare: Coverage and cost Part B also charges a monthly premium. Under Part D, you must pay a monthly premium, a

deductible, copayments, and all of your prescription drug costs over a certain yearly amount and up to a ceiling amount, unless you qualify for a low-income subsidy

BeneficiariesTotal number of Medicare beneficiaries: 48.84 million (2011)

Understanding ObamacareEssential Features  

Expanded coverage In 2010, there were 50 million people left

without any health insurance The new Law will provide coverage to as

many as 32 million people by the year 2019, according to Congressional Budget Office (CBO)

However, the fact is that about the CBO predicts that about 23 million will still be uninsured in 2019

Expanded coverageThe expanded coverage comes through two major ways:• 16 million will be included in the Medicaid expanding the

definition of ‘Low-income’ and by including those without children

• Another 16 million will buy insurance from ‘Online Market’ that provides them broad choices: `Bronze’, `Silver’, `Gold’, `Platinum’ and `Catastrophic’

• Federal Government will provide some subsidy to help families with income as high as $88,000

• Employers with more than 49 people on the payroll must provide health insurance

• The Law offers tax credit to smaller companies

Insurance Regulation• Prohibits bad practices of Insurance Companies

`denying’ medical bills• The practice of denying coverage based on pre-existing

conditions – a medical condition that existed before some applies or enrolls in a new health insurance policy – is not confined to only serious diseases; it can also include relatively minor conditions such as asthma or a previous sports injury.

• “Guaranteed issue”- Insurance companies are requires to issue, or renew, a policy to anybody, regardless of any ‘pre-existing conditions’

Insurance Regulation• But buying an ‘insurance plan’ is not mandatory, quite

contrary to other industrialized countries

• In fact, Obama called this Reform not as ‘Healthcare Reform’ rather as ‘Health Insurance Reform’!!

• Unlike other industrialized countries, US Insurance companies are still allowed to `deny’ claims but they are required to Report, how many claims they reject each year

Funding The new Law is projected to cost at least

$940 billion over the 10 years (2010 to 2020)

New taxes and fees are imposed on big winners of current health care system- drug companies, medical device makers, Insurance companies etc.

Others Subsidies will be provided for senior

citizens who can’t afford to pay for their prescriptions under Medicare

To encourage more medical students into family practice, the law is supposed to-

pay the medical school debt of primary care doctors

sharply raises Medicaid payments for primary care

Interrogating `Obamacare’ Can `Obamacare’ solve the American health care

problem?Generally speaking:The PPACA is designed to attain to major objectives:

Extending the insurance coverage to millions (perhaps 32 only!) still uninsured

To end some of the insurance companies’ harsher practices

Interrogating `Obamacare’ What about “Universal Health coverage”? What about “non-profit health insurance

system’?What about ‘cost control’? What about ‘equal access to health services’?

Unfortunately- Obamacare is quite silent in responding to these questions raised by

many Americans!!

Interrogating `Obamacare’ The PPACA reveals the fact that “an

unfettered market is not the ultimate solution to human problem”!!

“Even with this ambitious reform, the United States will still have the most complicated, the most expensive, and the most inequitable healthcare system of any developed nation.”

What do you think?

Thank you