Understanding the Patient Protection and Affordable Care Act and Its Impact on Individuals and Small Businesses

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1 Understanding the Patient Protection and Affordable Care Act and Its Impact on Individuals and Small Businesses Drew Feeley Adjunct Scholar Alabama Policy Institute February 2014

2 Alabama Policy Institute 402 Office Park Drive, Suite 300 Birmingham, AL

3 Understanding the PPACA

4 TABLE OF CONTENTS

5 Understanding the PPACA 1 INTRODUCTION

6 2 Understanding the PPACA WHAT IS THE PPACA? The Alabama Policy Institute

7 Understanding the PPACA 3 WHAT DOES THE PPACA MEAN FOR INDIVIDUALS AND FAMILIES? How Does the Online Marketplace Work for Individuals?

8 4 Understanding the PPACA How Does the PPACA Change Medicaid? Penalties: What Is the Individual Mandate and How Does it Affect Individuals? The Alabama Policy Institute

9 Understanding the PPACA 5 Exceptions to the Individual Mandate

10 6 Understanding the PPACA Will I Lose My Existing Health Coverage? The Alabama Policy Institute

11 Understanding the PPACA 7 Will I Keep My Doctor?

12 8 Understanding the PPACA HOW DOES THE PPACA IMPACT SMALL BUSINESSES? Businesses with Fewer Than 50 Full-Time Employees: Exemption and Benefits Under the PPACA The Alabama Policy Institute

13 Understanding the PPACA 9 Businesses with 50 to 99 Full-Time Employees: Provisions and Penalties Starting in

14 10 Understanding the PPACA Non-Discrimination Ban for Group Health Plans Impacts All Businesses The Alabama Policy Institute

15 Understanding the PPACA 11 ADDITIONAL IMPORTANT TAXES/FEES

16 12 Understanding the PPACA New Taxes Directly on High Income Individuals The Alabama Policy Institute

17 Understanding the PPACA 13 CONCLUSION

18 1 The Budget and Economic Outlook , Congress of the United States Congressional Budget Office, p. 112, (Last visited February 5, 2014). 2 Nicole Wyatt, Alabamians surveyed do not feel well-informed on health reform, January 8, 2014, available at alabamians-surveyed-do-not-feel-well-informed-on-health-reform 3 Minimal Essential Coverage, U.S. Department of Health and Human Services Trends in Health Care Cost Growth and the Role of the Affordable Care Act, whitehouse.gov, p.1, 5 Affordable Care Act: The New Health Care Law at Two Years, whitehouse.gov, (Last visited January 31, 2014). 6 Supra note 5 at p.3. 7 at p.1. 8 at p.2. 9 at p National Federation of Independent Business, et al. v. Sebelius, et al., No at 39 (U.S. June 28, 2012), 11 How does the health care law protect me?, U.S. Department of Health and Human Services, healthcare.gov, 12 Supra, note Federal Register, Vol. 78, No. 47, Monday, March 11, 2013, p , (Last visited January 31, 2014). 14 What is the health insurance marketplace?, U.S. Department of Health and Human Services, healthcare.gov, 15 Governor Bentley Announces Alabama Will Not Set up State Insurance Exchange, November 13, 2012, (Last visited January 31, 2014). 16 Health Insurance Marketplace, Healthcare.gov (Last visited February 6, 2014). 17 United States Census, Minimal Essential Coverage, U.S. Department of Health and Human Services, Essential Health Benefits, U.S. Department of Health and Human Services, Supra note Open Enrollment Period, U.S. Department of Health and Human Services, How can I get coverage Outside of Open Enrollment?, U.S. Department of Health and Human Services, How can I save money on Marketplace coverage?, U.S. Department of Health and Human Services, Premium Tax Credit, U.S. Department of Health and Human Services, (Last visited January 31, 2014). 26 Questions and Answers on the Premium Tax Credit, Internal Revenue Service, Supra at note 1 p What income and household information do I provide when I apply for Marketplace coverage?, U.S. Department of Health and Human Services, (Last visited January 31, 2014). 30 Supra note Supra note Matthew Herper, Obamacare Raises Health Insurance Premiums, Especially for the Young, Forbes, December 5, 2013, available at (Last visited February 5, 2014). 34 Supra note 33.

19 35 What if my state is not expanding Medicaid?, U.S. Department of Health and Human Services, Supra note Supra note Where the States Stand on Medicaid Expansion, The Advisory Board Company, January 24, 2014, 40 Supra note 1 at p Governor Bentley s 2014 State of the State Address, January 14, 2014, governor.alabama.gov, 43 Supra note Supra note State General Fund Comparison Sheet: SGF FY 2014 Enacted, Legislative Fiscal Office, available at (Last visited February 6, 2014). 46 Medicaid In Alabama: A Primer, Alabama Policy Institute, February 28, 2013, available at Medicaid-Primer.pdf (Last visited February 6, 2014). 47 Supra note What if someone doesn t have health coverage in 2014?, U.S. Department of Health and Human Services, Supra note Questions and Answers on the Individual Shared Responsibility Provision, Internal Revenue Service, irs.gov, 51 Supra note Qualifying Life Event, U.S. Department of Health and Human Services, (Last visited January 31, 2014). 56 Supra note C.F.R (c) 58 Exemptions, U.S. Department of Health and Human Services, Supra note Mike Patton, Obamacare: Penalties and Exemptions, Forbes, October 28, 2013, available at 62 What if I have a grandfathered health plan?, U.S. Department of Health and Human Services, Supra note Keeping Your Health Plan, factcheck.org, November 11, 2013, 66 Ashley Parker and Robert Pear, Obama Moves to Avert Cancellation of Insurance, The New York Times, November 14, 2013, available at 67 Brent Godwin, Thousands of Alabama Blue Cross policy holders could have plan cancelled, Birmingham Business Journal, October 30, 2013, available at (Last visited February 5, 2014). 68 Insurance Standards Bulletin Series - Information, Centers for Medicare & Medicaid Services, November 21, 2013, 69 Yann Ranaivo, BCBS of Alabama decides against renewing canceled plans, Birmingham Business Journal, November 20, 2013, available at (Last visited February 5, 2013). 70 Supra note Options Available for Consumers with Cancelled Policies, Centers for Medicare and Medicaid Services, 72 Can I buy a catastrophic plan?, U.S. Department of Health and Human Services, Supra note

20 75 Supra note Can I keep my own doctor?, U.S. Department of Health and Human Services, Sandhya Somashekhar and Ariana Eunjung Cha, Insurers restricting choice of doctors and hospitals to keep costs down, The Washington Post, November 20, 2013, available at 79 Supra note Supra note Small Business Trends, Small Business Administration, January 2012, (Last visited January 31, 2014). 83 Small Business Profile: Alabama, Small Business Administration, (Last visited February 14, 2014). 84 Affordable Care Act 101: What the Healthcare Law Means for Small Businesses, Small Business Administration, p.2, (Last visited January 31, 2014) Supra note Healthcare Reform for Small Businesses, p. 2, Supra note 84, p at p Supra note 1 at pp at Affordable Care Act Tax Provisions for Small Employers, Internal Revenue Service, Supra note 84 at p What is the SHOP Marketplace?, U.S. Department of Health and Human Services, Supra note Direct new path to SHOP Marketplace, U.S. Department of Health and Human Services, November 27, 2013, Jason Millman, Online SHOP Marketplace Delayed by One Year, Politico, November 27, 2013, available at FAQs on New Enrollment Process for the Federally Facilitated SHOP Marketplace, p.1, U.S. Department of Health and Human Services, November 2013, Supra note 102 at p at p Will I qualify for small business health care tax credits?, U.S. Department of Health and Human Services, Supra note Fact Sheet, Final Regulations Implementing Employer Shared Responsibility Under the Affordable Care Act (ACA) for 2015, The U.S. Treasury Department, (Last visited February 12, 2014). 109 Analysis of the Administration s Announced Delay of Certain Requirements Under the Affordable Care Act, Congressional Budget Office, July 30, 2013, Supra note Employers with 50 or More Employees; Small Business Administration, Supra note 111.

21 113 Supra note 84 at p at p at p at p at p Ann B. DeBellis, Navigating the Affordable Care Act, Birmingham Medical News, November 13, 2013, available at (Last visited February 6, 2013) Robert Pear, Rules for Equal Coverage by Employers Remain Elusive Under Health Law, The New York Times, January 18, 2014, available at Supra note Karen E. Klein, Obamacare Still Lets Employers Discriminate For Now, Bloomberg Businessweek, August 29, 2013, available at Supra note The Impact of ACA Taxes and Fees, Center for Healthcare Research & Transformation, August 30, 2013, Indoor Tanning Services Tax Center, Internal Revenue Service, Tanning-Services-Tax-Center 127 Sarah Kliff, Delaying Obamacare Reinsurance Fee Would be a Win for Insurers, The Washington Post, October 15, 2013, available at (Last visited January 31, 2014). 128 Supra note Keith Wagstaff, Obamacare s Big Millennial Problem, The Week, November 15, 2013, available at Supra note Reinsurance, Risk Corridors, and Risk Adjustment Final Rule, p.7, Centers for Medicare and Medicaid Services, March 2012, Supra note Jake Sherman and Jennifer Haberkorn, Paul Ryan: Obamacare Could Come up in Debt Talks, Politico, January 23, 2014, available at A Large New Tax on Small Business, The Wall Street Journal, December 29, 2013, available at Supra note U.S. Congress Joint Committee on Taxation, Letter to the Honorable Jon Kyl, June 3, 2011, p.5, available at Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, J.D. Harrison, Health Insurance Tax Scares the Daylights Out of Some Small Business Owners, The Washington Post, May 12, 2013, available at Supra note Cynthia Magnuson, Small Businesses to Bear Most of Health Insurance Tax Losses, National Federation of Independent Business, May 9, 2013, available at The Library of Congress, Bill Summary & Status, 113 th Congress ( ), H.R. 3367, available at Excise Tax on High-Cost Coverage (Cadillac Tax), UnitedHealthcare, Supra note Reed Abelson, High End Health Plans Scale Back to Avoid Cadillac Tax, The New York Times, May 28, 2013, available at Supra note 148.

22 150 Supra note Questions and Answers for the Additional Medicare Tax, Internal Revenue Service, Employed/Questions-and-Answers-for-the-Additional-Medicare-Tax 152 Increase the Payroll Tax Rate for Medicare Hospital Insurance by 1 Percentage Point, Congressional Budget Office, November 13, 2013, Supra note Congressional Healthcare Caucus, New 3.8% Medicare Tax on Unearned Net Investment Income, p. 1, Supra note Andrew Dugan, Majority of Americans Still Disprove of Healthcare Law, Gallup, February 4, 2014, available at (Last visited February 5, 2014).

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