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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

Alabama Policy Institute 402 Office Park Drive, Suite 300 Birmingham, AL 35223 205.870.9900 info@alabamapolicy.org www.alabamapolicy.org

Understanding the PPACA

TABLE OF CONTENTS

Understanding the PPACA

INTRODUCTION

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Understanding the PPACA

WHAT IS THE PPACA?

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Understanding the PPACA

WHAT DOES THE PPACA MEAN FOR INDIVIDUALS AND FAMILIES?

How Does the Online Marketplace Work for Individuals?

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Understanding the PPACA

How Does the PPACA Change Medicaid?

Penalties: What Is the Individual Mandate and How Does it Affect Individuals?

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Understanding the PPACA

Exceptions to the Individual Mandate

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Understanding the PPACA

Will I Lose My Existing Health Coverage?

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Understanding the PPACA

Will I Keep My Doctor?

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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

Understanding the PPACA

Businesses with 50 to 99 Full-Time Employees: Provisions and Penalties Starting in 2016

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Understanding the PPACA

Non-Discrimination Ban for Group Health Plans Impacts All Businesses

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Understanding the PPACA

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ADDITIONAL IMPORTANT TAXES/FEES

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Understanding the PPACA

New Taxes Directly on High Income Individuals

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Understanding the PPACA

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CONCLUSION

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The Budget and Economic Outlook 2014-2024, Congress of the United States Congressional Budget Office, p. 112, www.cbo.gov, http://www.cbo.gov/sites/default/files/cbofiles/attachments/45010-Outlook2014.pdf (Last visited February 5, 2014). 2 Nicole Wyatt, Alabamians surveyed do not feel well-informed on health reform, January 8, 2014, available at http://www.uab.edu/news/latest/item/4022alabamians-surveyed-do-not-feel-well-informed-on-health-reform 3 Minimal Essential Coverage, U.S. Department of Health and Human Services www.healthcare.gov, https://www.healthcare.gov/glossary/minimum-essentialcoverage. (Last visited January 31, 2014). 4 Trends in Health Care Cost Growth and the Role of the Affordable Care Act, whitehouse.gov, p.1, http://www.whitehouse.gov/sites/default/files/docs/healthcostreport_final_noembargo_v2.pdf (Last visited January 31, 2014). 5 Affordable Care Act: The New Health Care Law at Two Years, whitehouse.gov, http://www.whitehouse.gov/sites/default/files/uploads/careact.pdf, (Last visited January 31, 2014). 6 Supra note 5 at p.3. 7 Id. at p.1. 8 Id. at p.2. 9 Id. at p.2. 10 National Federation of Independent Business, et al. v. Sebelius, et al., No. 11-393 at 39 (U.S. June 28, 2012), http://www.supremecourt.gov/opinions/11pdf/11-333339393c3a2.pdf393c3a2.pdf 11 How does the health care law protect me?, U.S. Department of Health and Human Services, healthcare.gov, https://www.healthcare.gov/how-does-thehealth-care-law-protect-me/#part=2 (Last visited January 31, 2014). 12 Supra, note 11. 13 Federal Register, Vol. 78, No. 47, Monday, March 11, 2013, p. 15411, http://www.gpo.gov/fdsys/pkg/FR-2013-03-11/pdf/2013-04902.pdf (Last visited January 31, 2014). 14 What is the health insurance marketplace?, U.S. Department of Health and Human Services, healthcare.gov, https://www.healthcare.gov/what-is-the-healthinsurance-marketplace (Last visited January 31, 2014). 15 Governor Bentley Announces Alabama Will Not Set up State Insurance Exchange, November 13, 2012, http://governor.alabama.gov/newsroom/2012/11/governor-bentley-announces-alabama-will-not-set-up-state-insurance-exchange/ (Last visited January 31, 2014). 16 Health Insurance Marketplace, Healthcare.gov (Last visited February 6, 2014). 17 United States Census, www.census.gov. http://www.census.gov/hhes/www/hlthins/data/incpovhlth/2012/figure08.pdf (Last visited January 31, 2014). 18 Minimal Essential Coverage, U.S. Department of Health and Human Services, www.healthcare.gov, https://www.healthcare.gov/glossary/minimumessential-coverage (Last visited January 31, 2014). 19 Essential Health Benefits, U.S. Department of Health and Human Services, www.healthcare,gov, https://www.healthcare.gov/glossary/essential-healthbenefits/ (Last visited January 31, 2014). 20 Supra note 19.
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Open Enrollment Period, U.S. Department of Health and Human Services, www.healthcare.gov, https://www.healthcare.gov/glossary/open-enrollmentperiod/ (Last visited January 31, 2014). 23 How can I get coverage Outside of Open Enrollment?, U.S. Department of Health and Human Services, www.healthcare.gov, https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/ (Last visited January 31, 2014). 24 How can I save money on Marketplace coverage?, U.S. Department of Health and Human Services, www.healthcare.gov., https://www.healthcare.gov/howcan-i-save-money-on-marketplace-coverage/ (Last visited January 31, 2014). 25 Premium Tax Credit, U.S. Department of Health and Human Services, www.healthcare.gov, https://www.healthcare.gov/glossary/premium-tax-credit/ (Last visited January 31, 2014). 26 Questions and Answers on the Premium Tax Credit, Internal Revenue Service, www.irs.gov, http://www.irs.gov/uac/Newsroom/Questions-and-Answers-onthe-Premium-Tax-Credit (Last visited January 31, 2014). 27 Supra at note 1 p. 65.
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What income and household information do I provide when I apply for Marketplace coverage?, U.S. Department of Health and Human Services, www.healthcare.gov, https://www.healthcare.gov/what-income-and-household-information-do-i-provide-when-i-apply-for-marketplace-coverage/ (Last visited January 31, 2014). 30 Supra note 29.
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Matthew Herper, Obamacare Raises Health Insurance Premiums, Especially for the Young, Forbes, December 5, 2013, available at http://www.forbes.com/sites/matthewherper/2013/12/05/obamacare-raises-health-insurance-costs-especially-for-the-young/ (Last visited February 5, 2014). 34 Supra note 33.

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What if my state is not expanding Medicaid?, U.S. Department of Health and Human Services, www.healthcare.gov,https://www.healthcare.gov/what-if-mystate-is-not-expanding-medicaid/ (Last visited January 31, 2014). 36 Supra note 35. 37 Supra note 10.
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Where the States Stand on Medicaid Expansion, The Advisory Board Company, January 24, 2014, http://www.advisory.com/dailybriefing/resources/primers/medicaidmap (Last visited January 31, 2014). 40 Supra note 1 at p.64.
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Governor Bentleys 2014 State of the State Address, January 14, 2014, governor.alabama.gov, http://governor.alabam a.gov/newsroom/2014/01/governorbentleys-2014-state-state-address/ (Last visited January 31, 2014). 43 Supra note 42. 44 Supra note 30. 45 State General Fund Comparison Sheet: SGF FY 2014 Enacted, Legislative Fiscal Office, available at http://www.lfo.state.al.us/pdfs/FY%202014%20Spreadsheets/SGF/SGF%20FY%202014%20Enacted.pdf, (Last visited February 6, 2014). 46 Medicaid In Alabama: A Primer, Alabama Policy Institute, February 28, 2013, available at http://www.alabamapolicy.org/wp-content/uploads/2013Medicaid-Primer.pdf (Last visited February 6, 2014). 47 Supra note 46. 48 What if someone doesnt have health coverage in 2014?, U.S. Department of Health and Human Services, www.healthcare.gov, https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in-2014/ (Last visited January 31, 2014). 49 Supra note 10. 50 Questions and Answers on the Individual Shared Responsibility Provision, Internal Revenue Service, irs.gov, http://www.irs.gov/uac/Questions-and-Answerson-the-Individual-Shared-Responsibility-Provision. (Last visited January 31, 2014). 51 Supra note 48.
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Mike Patton, Obamacare: Penalties and Exemptions, Forbes, October 28, 2013, available at http://www.forbes.com/sites/mikepatton/2013/10/28/obamacare-penalties-and-exemptions/ 62 What if I have a grandfathered health plan?, U.S. Department of Health and Human Services, www.healthcare.gov, https://www.healthcare.gov/what-if-ihave-a-grandfathered-health-plan/ (Last visited January 31, 2014). 63 Supra note 62.
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Supra note 16.

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Id. Id. 91 Id. at p. 24 92 Supra note 1 at pp.123-124. 93 Id. 94 Id. at 123.


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Keith Wagstaff, Obamacares Big Millennial Problem, The Week, November 15, 2013, available at http://theweek.com/article/index/252897/obamacaresbig-millennial-problem (Last visited January 31, 2014). 131 Supra note 127. 132 Reinsurance, Risk Corridors, and Risk Adjustment Final Rule, p.7, Centers for Medicare and Medicaid Services, March 2012, http://www.cms.gov/cciio/resources/files/downloads/3rs-final-rule.pdf (Last visited January 31, 2014). 133 Supra note 123. 134 Jake Sherman and Jennifer Haberkorn, Paul Ryan: Obamacare Could Come up in Debt Talks, Politico, January 23, 2014, available at http://www.politico.com/story/2014/01/paul-ryan-obamacare-debt-102538.html (Last visited January 31, 2014). 135 A Large New Tax on Small Business, The Wall Street Journal, December 29, 2013, available at http://online.wsj.com/news/articles/SB10001424052702304465604579220413773642016(Last visited January 31, 2014). 136 Supra note 132.
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Reed Abelson, High End Health Plans Scale Back to Avoid Cadillac Tax, The New York Times, May 28, 2013, available at http://www.nytimes.com/2013/05/28/business/cadillac-tax-health-insurance.html?pagewanted=all&_r=0 (Last visited January 31, 2014). 149 Supra note 148.

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Congressional Healthcare Caucus, New 3.8% Medicare Tax on Unearned Net Investment Income, p. 1, http://health.burgess.house.gov/uploadedfiles/one_page_on_unearned_medicare_tax.pdf (Last visited January 31, 2014). 156 Supra note 155. 157 Andrew Dugan, Majority of Americans Still Disprove of Healthcare Law, Gallup, February 4, 2014, available at http://www.gallup.com/poll/167309/majority-americans-disapprove-healthcare-law.aspx (Last visited February 5, 2014).

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