Summer 2013 Newsletter

Summer 2013
Inside This Issue
Patient Protection and Affordable Care Act of 2010
Patient Protection and Affordable Care Act of 2010 The Patient Protection and Affordable Care Act of 2010, or “Obamacare,” was signed into law by the President, and is scheduled to start taking effect in 2014, next year. The overall goals are two-fold: to provide all Americans with affordable health insurance, and ultimately, to reduce the sky-rocketing health care costs in the U.S. The intent was to cover the 32 million (or up to 49 million, depending upon the source) uninsured Americans. What is it and what are the pros and cons? It is difficult to understand all of the aspects of Obamacare because it depends, largely, on who you ask. How do you get an unbiased perspective? The Liberals love it and the Conservatives hate it. What we are going to try to do is present an unbiased analysis so that you, the reader, have a better idea of what to expect in a few short months.

What Is It?
Obamacare is health care reform at the national level. It is a comprehensive plan aimed at providing many more Americans with health insurance than currently have coverage. It is designed to reduce health care costs and to regulate the health insurance industry.

What’s Good
What is very good about Obamacare is that health insurance coverage will be obtainable regardless of the patient’s income or current health. Whether one is employed or not, well or sick, he should be eligible for coverage. Co-payments shall be eliminated for preventative care and lifetime limitations shall be phased out. Requirements for doctor referrals will be eliminated. Children 25 years old or younger will be covered by their parents’ policy. There will be no caps on coverage for medical procedures, and no pre-existing condition exclusions.

Medicaid will be expanded to cover anyone who is employed and earning under $16,000.00 per year, which increases the income limit substantially. The idea is that if you are an American you will have access to quality health care. Theoretically, those who, normally, would have to resort to hospital emergency rooms would have health insurance coverage, either through employers or on their own through the Health Insurance Marketplace, explained further, below.

What’s Not So Good 
The biggest problem is the cost: there will be huge tax hikes, 21 separate increases and 75% will affect the middle class. Medicare premiums will increase. In addition, healthy individuals will wind up paying higher premiums than sick ones. Of course, it will be one of the biggest spending programs in history at a time when the economy is struggling and the notion of deficit reduction is important to many. Unemployment remains high, and home purchasers are having great difficulty obtaining mortgages.

Basically, by 2015, employers who have more than 50 full-time employees have a choice: either provide health insurance coverage to them or pay a penalty for not doing so in the amount of $2,000.00 per employee. This is known as the Employer Mandate. The monies derived from the penalties will be used to offset the health insurance cost for those employees who must purchase their own health insurance through public health insurance exchanges, or the “Health Insurance Marketplace.” The website is already up and running, so if you are interested, you can start your research by These health insurance exchanges are scheduled to open on October 1st of this year. They will be an on-line source for individuals to purchase health insurance from private providers. Many states will have their own exchanges, and, as you probably expected, New York is one of them.

Another down-side is implementation, which is not at all surprising. The White House is currently struggling to commence implementation, and has already announced that charging penalties for large employers who do not provide health insurance coverage shall be delayed. In New York City, another interesting change will be the application process for in-home, or community, Medicaid coverage. Local case workers from Medicaid will no longer make home visits to evaluate the applicant for in-home Medicaid coverage. Going forward, it will be the providers who will evaluate the application and not an agent from Medicaid. Such a change will probably impact the applicant negatively, but the true impact will not be known immediately. The Lombardi program (Nursing Home Without Walls) will be discontinued entirely; that is unfortunate because it provided care in the home for the Medicaid eligible who were chronically ill and disabled, and did not wish to reside in a facility. The consequences remain to be seen.

We will keep you posted as updates and changes are announced by the White House. We invite you to email any questions or areas of concern with respect to Obamacare, and we will do our best to address each email.

The above list is for general information purposes only. It is not intended to constitute individual legal advice or a specific recommendation to any particular client./font>


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