The Affordable Care Act, informally known as Obamacare, is a hot political topic in 2017. Republicans want to repeal and replace the legislation, while millions of Americans of all political affiliations are worried about losing some of the protections the law provides. With that in mind, here are 10 facts about Obamacare that you may not be aware of that can help to illustrate the positive and negative aspects of our current healthcare law.
1. Obamacare made some big changes to health insurance plans
There's a lot more to the Affordable Care Act than mandatory health insurance, subsidies for lower-income households, and the expansion of Medicaid. Thanks to the act, health plans can no longer exclude people with pre-existing conditions, companies can no longer drop people from their plan simply because they get sick, and parents can keep their kids on their health plans up to age 26. In addition, all plans must provide 10 essential health benefits, which include preventative and wellness visits, maternity and newborn care, and lab tests. Finally, lifetime and annual limits are now a thing of the past.
2. Have you noticed those calorie counts on restaurant menus?
One provision of Obamacare that many people aren't aware of required certain types of restaurants (chains with 20 or more locations) and vending machines to give people more information about the food they're eating. The idea was that by giving people more information, they would be more likely to make healthier choices. To be fair, however, studies have found that it has made little difference.
3. The majority of Obamacare subsidies go to the middle class
Despite the popular misperception that Obamacare just helps the poor, the facts say otherwise. Between 2015 and 2024, it is estimated that Obamacare subsidies to purchase health insurance on the exchanges will cost just over $1 trillion. These subsidies go to families earning $47,000 to $94,000 per year, the heart of the middle class. This is 30% more than projected Medicaid and CHIP spending, which are programs that help lower-income Americans.
4. Obamacare does not give health insurance to illegal immigrants
Illegal immigrants are not eligible to receive subsidies to buy health insurance on the exchanges. However, the act does allow illegal immigrants to be served by community health clinics. The reason? To keep uninsured illegal immigrants out of emergency rooms, which would drive up healthcare costs.
5. To avoid an Obamacare penalty, you must have health insurance for at least nine months this year
For 2017, the penalty for not having health insurance can be as much as $2,085, or 2.5% of your income, whichever is higher. This breaks down to $695 per adult and $347.50 per child under 18, capped at that maximum. If you were covered for part of the year, your penalty is assessed at 1/12 of your calculated penalty per month. So, if you were insured for six months out of the year, you could face a penalty equal to half of your full-year total, unless you qualify for one of several exemptions.
6. Less than 10% of the population gets insurance on the Obamacare exchanges
The vast majority of insured Americans get their health coverage from a non-Obamacare source. Over 60% of Americans get health insurance through an employer's plan, and another 16% get Medicare or Medicaid. Less than 10% of people buy their own insurance on the health insurance exchanges.
7. Obamacare premiums have been rising -- and the worst may be yet to come
One of the major negative aspects of Obamacare is that premiums have been rising -- and fast. Average premiums for Obamacare health plans offered through insurance brokerage platform eHealth have risen by 39% since 2014. However, it's important to point out that the premiums paid by the 83% of Obamacare exchange customers who qualify for a subsidy haven't changed recently -- rather, the increases have been felt by the roughly 2 million people who don't qualify for a subsidized premium.
2018 may be a particularly rough year for Obamacare customers, in terms of premiums. Assuming the ACA isn't repealed or significantly modified, a recent survey shows that premiums could spike by as much as 40% next year, as my colleague Sean Williams wrote.
8. Many people may not be able to use Obamacare in 2018
Several insurers have stopped participating in the health insurance exchanges, and others are planning to do so. For example, Humana announced that it will exit the ACA exchanges by the start of 2018, while Aetna and UnitedHealth have made similar announcements.
Although the average state has 10 issuers in the HeathCare.gov marketplace, and there are 50 different health insurance plans available in the average county, that isn't the case everywhere. For 2017, about one-third of counties have just one insurer participating, and because of insurers exiting the market, we could see dead zones in the marketplace for the first time in 2018. For example, unless something changes, 25 counties in Missouri will have no ACA insurance carrier in 2018, and there are other areas in similar situations.
9. Most Obamacare users choose a "silver" health plan
About seven in 10 people who buy health insurance on the HealthCare.gov marketplace choose a "silver" plan, which essentially is a mid-range option with moderate premiums and out-of-pocket costs. According to HealthCare.gov, with silver plans, the insurance company typically pays 70% of costs and you pay the other 30%.
10. The majority of the population approves of Obamacare
According to a Pew Research Center poll conducted in February 2017, 54% of Americans approve of the Affordable Care Act and just 43% say they disapprove. It probably isn't surprising that very few Republicans approve of the legislation, but 85% of Democrats and 53% of independents approve of the law.