If we have learned anything in the 10 days since the Supreme Court ruled on the constitutionality of the Affordable Care Act, it's that the most basic facts concerning this most controversial law seem to be some of the most often abused in the fervid commentary. Some will blame the law's leviathan size and its as-yet unwritten regulations. But much is known already and has been since it was signed by President Obama in March 2010.
The Kaiser Family Foundation, a nonpartisan source of health policy information, recently put together a simple 10-question quiz to test people's knowledge of the law. With the foundation's permission we offer the quiz in its entirety below and we give the answers inside. Take the quiz and then compare your knowledge of the law to the rest of the country, as represented by the findings of the Kaiser Foundation's monthly Health Tracking Poll.
If being misinformed is your pre-existing condition, we've got you covered.
Will the health reform law require nearly all Americans to have health insurance starting in 2014 or else pay a fine?
Yes. Starting in 2014, most people will be required to have health insurance or pay a penalty if they don't. Coverage may include employer-provided insurance, coverage someone buys on his own, or Medicaid.
Several groups are exempt from the requirement to obtain coverage or pay the penalty, including people who would have to pay more than 8 percent of their income for health insurance, people with incomes below the threshold required for filing taxes (in 2009, $9,350 for a single person and $26,000 for a married couple with two children), those who qualify for religious exemptions, undocumented immigrants, people who are incarcerated, and members of Indian tribes.
The penalty for people who forgo insurance is the greatest of two amounts: a specified percentage of income or a specified dollar amount. The percentages of income are phased in over time at 1 percent in 2014, 2 percent in 2015, and 2.5 percent starting in 2016. The dollar amounts are also phased in at $95 in 2014, $325 in 2015, and $695 beginning in 2016 (with annual increases after that). The Congressional Budget Office projects that 3.9 million people will pay the penalty in 2016. The total penalty for the taxable year will not exceed the national average of the annual premiums of a bronze level health insurance plan offered through the health insurance exchanges.
Health insurance plans will provide documents to people they insure that will be used to prove that they have the minimum coverage required by law.
Percent who answered correctly: 64%
Will the health reform law allow a government panel to make decisions about end-of-life care for people on Medicare?
No. No such panels exist. While early versions of the law did contain provisions that would allow Medicare to reimburse physicians for voluntary discussions with patients about end- of-life planning, these provisions were dropped from the final legislation.
Percent who answered correctly: 45%
Will the health reform law cut benefits that were previously provided to all people on Medicare?
No. The 2010 health reform law reduces payments to Medicare Advantage plans, gradually bringing them closer to the average costs of traditional Medicare. Beginning in 2011, the law freezes the maximum county-level payments to plans (called "benchmarks") and in 2012, begins to reduce payments, based on the Medicare costs in the county relative to other parts of the country. In addition, the law reduces the amount plans are permitted to keep when bids come in below the benchmark (known as "rebates"), which achieves savings for Medicare but also reduces the amount available to plans to provide extra benefits. Some Medicare Advantage plans will begin to receive bonuses in 2012 based on quality ratings.
The law also includes new consumer protections. Plans will be subject to new rules that limit cost-sharing that can be imposed on enrollees for certain services. Medicare Advantage plans will also be required to maintain a medical loss ratio of at least 85 percent, restricting the share of premiums that Medicare Advantage companies can use for administrative expenses, including profits.
The effect of these payment reductions is expected to vary across counties and by firm. Companies offering Medicare Advantage plans may respond to these payment changes in several different ways, depending on the circumstances of the company, the location of their plans and their historical commitment to the Medicare market. Plans will continue to be required to provide all benefits that are covered by traditional Medicare, but may charge higher premiums, increase cost-sharing, reduce their network of providers, or reduce "extra benefits" such as dental care or eyeglasses.
Percent who answered correctly: 40%
Will the health reform law expand the existing Medicaid program to cover low-income, uninsured adults regardless of whether they have children?
Yes. Beginning in 2014, state Medicaid programs — which provide health coverage to low-income Americans will be expanded to cover all individuals under age 65 with incomes up to 133 percent of the federal poverty level ($14,400 for an individual or $29,300 for a family of four in 2010).
The new law creates a uniform Medicaid eligibility level and income definition across all states and eliminates a prohibition that prevented states from providing Medicaid coverage to adults without dependent children except under a waiver of federal rules.
Undocumented immigrants are not eligible for Medicaid regardless of their income, and legal immigrants who have resided in the U.S. for less than five years are also not eligible, though states have the option of extending Medicaid coverage to legal immigrant children and pregnant women who are in the five-year waiting period. The Congressional Budget Office has estimated that 16 million people will gain coverage through the Medicaid expansion by 2019.
Percent who answered correctly: 62%
Will the health reform law provide financial help to low and moderate income Americans who don't get insurance through their jobs to help them purchase coverage?
Yes. Beginning in 2014, tax credits will be available to U.S. citizens and legal immigrants who purchase coverage in the new health insurance exchanges and who have income up to 400 percent of the federal poverty level ($43,320 for an individual or $88,200 for a family of four in 2009).
To be eligible for the premium tax credits, individuals must not be eligible for public coverage — including Medicaid, the Children's Health Insurance Program, Medicare or military coverage — and must not have access to health insurance through an employer. (There is an exception in cases when the employer plan does not cover at least 60 percent of covered benefits on average or the employee share of the premium exceeds 9.5 percent of the employee's income.)
The premium tax credits will be advanceable and refundable, meaning they will be available when an individual purchases coverage and will be available whether or not an individual owes any taxes. The premium tax credits will vary with income and are structured so that the premium an individual or family will have to pay will not exceed a specified percentage of income, ranging from 2 percent for those with incomes up to 133 percent of the poverty level (about $14,400 for an individual) to 9.5 percent for those with incomes between 300 and 400 percent of the poverty level ($32,490 to $43,320 for an individual).
Percent who answered correctly: 72%
Will the health reform law prohibit insurance companies from denying coverage because of a person's medical history or health condition?
Yes. Starting in 2014, all health insurers will have to sell coverage to everyone who applies, regardless of their medical history or health status. At that time, insurers will not be allowed to charge more to individuals with pre-existing conditions; nor will they be able exclude coverage of those conditions from the insurance plans they sell.
The law provides new protections for children with pre-existing conditions that will take effect on Sept. 23, 2010. Insurers will not be permitted to deny coverage to children due to their health status, or exclude coverage for pre-existing conditions.
While adults will not have the same protections as children in the years prior to 2014, some adults may be eligible for a temporary national high-risk pool open to all U.S. citizens and legal residents who have had trouble buying insurance due to a pre-existing condition and have been uninsured for at least six months.
This federally subsidized coverage, officially known as the Pre-existing Condition Insurance Plan, will provide temporary coverage until the broader coverage provisions take effect in January 2014. States can operate their own high-risk pool or have the federal government carry out the program. The federal government began accepting applications for enrollment in their high-risk pool on July 1, 2010, with coverage beginning on Aug. 1, 2010.
Premiums for this coverage will be based standard premiums for the general population, and therefore will not be higher due to the health problems faced by the high-risk pool beneficiaries. In addition, the amount that premiums can vary based on age will be limited. The high-risk pool insurance must cover 65 percent of medical costs and the maximum cost sharing is set at the Health Savings Account limits ($5,950 for an individual and $11,900 for a family of four).
Percent who answered correctly: 67%
Will the health reform law require all businesses, even the smallest ones, to provide health insurance for their employees?
No. The health reform law does not require employers to provide health benefits. However, it does impose penalties in some cases on larger employers (those with 50 or more workers) that do not provide insurance to their workers or that provide coverage that is unaffordable.
Larger employers that do not provide coverage will be assessed a penalty beginning in 2014 if any one of their workers receives a tax credit when buying insurance on their own in a health insurance Exchange. Workers with income up to 400 percent of the poverty level are eligible for tax credits. The employer penalty is equal to $2,000 multiplied by the number of workers in the business in excess of 30 workers (with the penalty amount increasing over time).
In some instances, larger employers that offer coverage could be subject to penalties as well. If the coverage does not have an actuarial value of at least 60 percent — meaning that on average it covers at least 60 percent of the cost of covered services for a typical population — or the premium for the coverage would exceed 9.5 percent of a worker's income, then the worker can obtain coverage in an Exchange and be eligible for a tax credit. For each worker receiving a tax credit, the employer will pay a penalty of $3,000 up to a maximum of $2,000 times the number of workers in excess of 30 workers.
Percent who answered correctly: 25%
Will the health reform law provide tax credits to small businesses that offer coverage to their employees?
Yes. Beginning in 2010, business with fewer than 25 full time equivalent employees and average annual wages of less than $50,000 that pay at least half of the cost of health insurance for their employees are eligible for a tax credit.
The health reform law includes a number of provisions that reform the insurance market and encourage small businesses to offer health insurance. Coverage offered in the small group market and in the exchanges established for small business to purchase insurance must meet minimum benefit standards; allow premiums to vary only by age, tobacco use, and geographic location; be subject to reviews of premium increases; and comply with other consumer protections.
The provisions to encourage small firms to offer coverage apply only to firms under a certain size.
Fewer than 25 employees:
Beginning in 2010, business with fewer than 25 full time equivalents and average annual wages of less than $50,000 that pay at least half of the cost of health insurance for their employees are eligible for a tax credit. The full credit is available to employers with 10 or fewer employees and average annual wages of less than $25,000. The credit phases out as firm size and average wage increases. The credit is capped based on the average health insurance premium in the area where the small business is located.
The tax credit will be introduced in two phases. For tax years 2010 to 2013, eligible employers may receive a tax credit of up to 35 percent of the employer's contribution toward the employee's health insurance premium. For tax years 2014 and later, eligible small businesses that purchase coverage through the state Exchange may receive a tax credit of up to 50 percent of the employer's contribution toward the employee's health insurance premium. Employers are eligible to take the tax credit for two years. Tax-exempt small businesses meeting these requirements are eligible for tax credits of up to 25 percent of the employer's contribution toward the employee's health insurance premium for tax years 2010 to 2013, and up to 35 percent for tax years 2014 and later.
Fewer than 50 employees:
Businesses with fewer than 50 employees are exempt from penalties faced by larger employers that do not offer coverage. The penalties for larger employers (50 or more employees) do not go into effect until 2014.
Fewer than 100 employees:
Small businesses with fewer than 100 employees will be able to purchase coverage through Small Business Health Options Program Exchanges beginning in 2014. These state-based exchanges are intended to allow employers to shop for qualified coverage and more easily compare prices and benefits. In 2017, states will have the option to allow businesses with more than 100 employees to purchase coverage through the SHOP Exchanges.
Percent who answered correctly: 65%
Will the health reform law create a new government run insurance plan to be offered along with private plans?
No. The law does not create a new government-run health insurance plan. The existing Medicaid program will be expanded to cover more low-income people, government regulation of the health insurance industry will be increased, and tax credits will be provided to make private health insurance more affordable for people.
Percent who answered correctly: 27%
Will the health reform law allow undocumented immigrants to receive financial help from the government to buy health insurance?
No. Undocumented immigrants are not eligible to receive financial help from the government to buy health insurance, nor are they eligible for Medicaid or to purchase insurance with their own money in the new Exchanges.
Percent who answered correctly: 42%
Source: The Henry J. Kaiser Family Foundation