Obamacare is the name people use to describe the sweeping health reform law that created new responsibilities and protections for pretty much everyone, including individuals, employers and insurance companies.
The Patient Protection and Affordable Care Act of 2010, as it’s officially called, aims to shrink the number of people without health insurance and ensure everyone has access to good coverage, among other things. Under the law, most people are required to have health insurance or pay a fine, and insurers have to take all comers, even if they’re sick. Employers with 50 or more workers have to offer plans that meet minimum standards for quality and affordability or face a penalty.
The law also expanded eligibility for Medicaid coverage to adults without children who make up to 138% of the federal poverty level (about $16,000). But following a Supreme Court decision, states get to decide whether or not to expand coverage; 32 states have done so to date.
For people without on-the-job coverage, the law created health insurance marketplaces where consumers can buy plans from private insurers or sign up for Medicaid. Small employers with up to 50 workers can generally buy coverage through the marketplaces too. Plans sold on the marketplaces have to at a minimum cover 10 services that are considered essential, including hospitalization, prescription drugs, and doctor visits, and insurers can’t charge people higher premiums because they have medical conditions that might make them more expensive to insure.
The federal government provides premium tax credits to people with incomes up to 400% of the federal poverty level (about $47,000 for one person or $97,000 for a family of four) to buy coverage on the marketplaces, and subsidies to reduce deductibles and other out-of-pocket costs for people whose income is less than 250% of poverty (about $29,000).
Employer and marketplace plans alike have to cover preventive care, including recommended cancer screenings and vaccines, without charging consumers anything. The law also eliminated annual and lifetime dollar caps on benefits, and set a dollar limit on how much people can be required to pay out of pocket in total each year for health care they get from providers that are in their insurance network.
Obamacare ni jina la sheria ya afya ya Marekani ambayo ilitoa ulinzi mpya kwa kila mtu, ikiwa ni pamoja na wafanyikazi, wafanyikazi na makampuni ya bima. Sheria ya Ulinzi wa Mgonjwa na Huduma ya Affordable ya 2010 (PPAA) inakusudia kupunguza idadi ya watu wasio na bima ya afya na kuhakikisha kila mtu ana upatikanaji wa chanjo nzuri. Chini ya sheria, watu wengi wanatakiwa kuwa na bima ya afya au kulipa faini, na wajasiriamali wanapaswa kuchukua wote wanaokuja, hata kama ni wagonjwa. Waajiri wenye wafanyikazi 50 au zaidi wanapaswa kutoa mipango inayokidhi viwango vya chini vya ubora na bei nafuu au wanakabiliwa na adhabu. Sheria hiyo pia iliongeza haki ya kupata Medicaid kwa watu wazima wasio na watoto ambao wanafikia 138% ya kiwango cha umaskini wa shirikisho (karibu $ 16,000). Kwa mujibu wa uamuzi wa Mahakama Kuu, majimbo 32 yameamua kupanua chanjo ya COVID-19 hadi sasa. Kwa wale ambao hawana bima ya kazi, sheria hiyo iliunda soko la bima ya afya ambapo watumiaji wanaweza kununua mipango kutoka kwa wajasiriamali wa kibinafsi au kujiandikisha kwa Medicaid. Waajiri wadogo wenye wafanyikazi hadi 50 wanaweza pia kununua bima kupitia soko. Mipango inayouzwa kwenye soko lazima angalau ifunikie huduma 10 zinazohesabiwa kuwa muhimu, pamoja na kulazwa hospitalini, dawa za dawa, na ziara za daktari, na wawekezaji wa bima hawawezi kuwalipa watu malipo ya juu kwa sababu wana hali za matibabu ambazo zinaweza kuwafanya kuwa ghali zaidi. Serikali ya Marekani hutoa mikopo ya kodi kwa watu wenye mapato ya chini ya asilimia 400 ya kiwango cha umaskini cha serikali (karibu $47,000 kwa mtu mmoja au $97,000 kwa familia ya watu wanne) kununua bima kwenye soko, na ruzuku ya kupunguza deductibles na gharama nyingine za nje ya mfuko kwa watu ambao mapato ni chini ya asilimia 250 ya kiwango cha umaskini (karibu $29,000). Mipango ya mfanyakazi na soko sawa lazima ifunikie huduma ya kuzuia, ikiwa ni pamoja na uchunguzi wa saratani uliopendekezwa na chanjo, bila kulipa watumiaji chochote. Sheria hiyo pia iliondoa mapungufu ya dola ya kila mwaka na ya maisha ya faida, na kuweka kikomo cha dola juu ya kiasi ambacho watu wanaweza kuhitajika kulipa kutoka mfukoni kwa jumla kila mwaka kwa huduma ya afya wanayopata kutoka kwa watoa huduma ambao wako katika mtandao wao wa bima.