Obamacare Simplified: Your Go-To Guide for Understanding Obamacare

Copyright © 2014 Hamisu Salihu, MD, PhD.

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the publisher except in the case of brief quotations embodied in critical articles and reviews.

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ISBN: 978-1-4908-5768-8 (sc)

ISBN: 978-1-4908-5770-1 (hc)

ISBN: 978-1-4908-5769-5 (e)

Library of Congress Control Number: 2014919138

WestBow Press rev. date: 10/24/2014

CONTENTS

Preface

Chapter 1 What Is ObamaCare?

Chapter 2 ObamaCare Health Exchange Basics

Chapter 3 Pregnant Women, Illegal Immigrants, Medicaid and Medicare under ObamaCare

Chapter 4 Dental and Eye Care under ObamaCare: Part 1

Chapter 5 Dental and Eye Care under ObamaCare: Part 2

Chapter 6 ObamaCare: Opposing Viewpoints

Chapter 7 ObamaCare and the Business Environment

Chapter 8 How the Health Exchange Works

Chapter 9 How Does ObamaCare Affect Me?

Chapter 10 ObamaCare as It Unfolds

Chapter 11 ObamaCare Literacy in Medical Technology

PREFACE

The Patient Protection and Affordable Care Act of 2010—ObamaCare—has sparked great relief among those who previously had limited options for health care coverage while creating apprehension among those who resent a law requiring insurance for all. Intense debate continues regarding the impact this law will have on Americans and this great nation. The long-term outcome of ObamaCare remains to be seen, but all of us need to understand this law and how it may affect our lives. This book does not weigh in on the ObamaCare debate; instead, it provides a user-friendly approach to understanding the basic tenets of the law, with questions and responses concerning coverage and scenarios to aid comprehension.

ObamaCare Simplified also deals with issues that are not often discussed but should be. Chapter 6, for instance, addresses common misconceptions about the law and provides factual information that will allow readers to draw their own conclusions. This book will allow readers to contribute to the ObamaCare dialogue regardless of their position on the issue.

As a board-certified physician and a public health professional, I am adamant about offering my patients health care information they can understand and use. I encourage them to ask questions, and I try my best to give them honest and unbiased answers. This book follows the same principle, building on fundamental knowledge to empower the consumer whether an individual, a small business, or a large corporation. The material will enable readers to take advantage of ObamaCare’s benefits, such as subsidies and tax credits, and to avoid its pitfalls.

Topics extend from the general, including ObamaCare basics, to the specific, such as vision and dental coverage and health insurance for special populations. I have dedicated the final chapter to literacy in medical technology, an area poorly understood by most of us because we are intimidated by the topic. This is mostly because we lack a basic understanding of the technology and feel overwhelmed by its complexity. Since medical technology accounts for a significant portion of health care advancement and expenditure, grasping what it is and how it will affect our lives under ObamaCare is imperative. This book will not make everyone technologically literate, but it will set the foundation for continuing study.

This book’s versatility makes it useful in a variety of settings. For example, it could be used as a textbook in medical, business, health policy, and public health courses. ObamaCare Simplified can easily be read cover to cover, and each chapter can stand alone as a topic for discussion. The book can be a valuable employee training manual in small businesses or large corporations. The straightforward dialogue makes this book an ideal addition to any coffee table, bookshelf, and personal or public library. It is a practical tool for learning the basics of ObamaCare and the impact it will have on us as individuals and as a nation.

CHAPTER 1

What Is ObamaCare?

Introduction to the chapter: ObamaCare regulates health insurance coverage. Although the law has received wide media coverage, a majority of citizens still do not understand its basic tenets. This chapter and the ones that follow will simplify the main provisions of ObamaCare in a question-and-answer format, using scenarios to reinforce understanding.

Objective of the chapter: This chapter will enable readers to understand the components of ObamaCare, including universal coverage and affordability, qualification criteria for tax credits, and essential health benefits. The regulations regarding the mandate and pre-existing conditions will be explained with easy-to-understand scenarios that clarify complex issues.

1. Sue, who is nineteen and leaving for college, receives a health insurance application from the school. She doesn’t know whether to fill it out. She is on her parents’ health plan. Can she remain on that plan and ignore the school’s application?

a. No, because ObamaCare stipulates that as soon as a child turns eighteen, he or she must be on a separate health plan.

b. Yes, because ObamaCare stipulates that a child may stay on his or her parents’ health plan until age twenty-one.

c. Yes, because ObamaCare allows a child to remain on his or her parents’ health plan until age twenty-six.

d. All of the above are irrelevant because she is now in college.

2. Sam, the owner of a small business, does not have health insurance. He weighs the pros and cons of purchasing insurance and decides that, since he is healthy, he is not going to worry about it. Which of the following could happen under the law?

a. He will be fined 5 percent of his monthly income until he purchases a health insurance policy.

b. He will be ordered by a court to purchase health insurance.

c. The federal government will provide him with Medicaid coverage until he makes a decision.

d. He will be charged a penalty and will have to pay for all of his health care.

3. Sam is considering purchasing a health insurance policy after being diagnosed with gastro- esophageal reflux disease. Which of the following could happen under the law?

a. He will be charged a higher premium for having a pre-existing health condition.

b. The insurance company may refuse him coverage.

c. He will not be charged a higher premium, but he will receive less coverage than someone without a pre-existing health condition.

d. He will be able to purchase a health plan without any of the complications listed above.

4. ObamaCare stipulates which of the following?

I. Universal health coverage

II. Children can be on their parents’ policy until twenty-one years of age.

III. Health insurance carriers cannot deny coverage.

IV. Carriers cannot charge more for pre-existing conditions.

a. I, III, IV

b. I, II, III

c. I, II, IV

d. All of the choices above

5. What is ObamaCare’s official name?

a. Patient Protection and Affordable Care Act

b. Healthcare and Education Reconciliation Act

c. Health Aid and Patient Responsibility Act

d. America’s Affordable Health Choices Act

6. Health care involves both mental and physical health. Given this fact, if a patient with health insurance walks into a clinic and her primary concern is anxiety due to stress, which of the following scenarios is unlikely?

a. The staff will ask the patient to sign in and will check her coverage.

b. The staff will not provide assistance because stress is not considered a legitimate health concern.

c. The doctor will prescribe medication if appropriate.

d. The patient will be referred to a psychiatric office for further diagnosis if needed.

7. Which of the following best describes the operation of the Small Business Health Options Program (SHOP)?

a. As of 2014, until December 2015, only businesses with fewer than fifty full-time equivalent employees are eligible.

b. If a business is determined to be eligible, the owner and spouse can also sign up for SHOP.

c. As of 2014, under ObamaCare a small business is one with fifty or fewer full-time employees.

d. All of the above

8. Which of the following are the goals of ObamaCare?

I. Universal health coverage

II. Creating a source of revenue for the government

III. Making health care more affordable for those who cannot otherwise afford it

IV. Balancing pay among health care professionals

a. I, II, III

b. I, II, IV

c. I, III, IV

d. None of the above

9. The launch of ObamaCare heralds a new era in health insurance, with many more changes to be made until 2022. One of the most important stipulations is that individuals must be covered under what kinds of health plans?

a. Private, state, or federally assisted providers

b. Private or state providers because the federal government will no longer be providing assistance.

c. Only federally assisted providers

d. Only private providers

10. President Obama aims to redirect money in a way that helps the common man. ObamaCare is one of the means through which he plans on accomplishing this. Right now, many Americans are without health insurance. As of July 2013, how many Americans were without health coverage?

a. Twelve million

b. Forty-four million

c. Seventy-six million

d. Ninety-eight million

ObamaCare: Affordability and Essential Health Benefits Forty-Eight Contiguous States and Washington, D.C.

Note: The 100 percent column shows the federal poverty level for each family size, and the percentage columns that follow represent income levels commonly used as guidelines for health programs.

http://aspe.hhs.gov/poverty/13poverty.cfm

11. Sara is a mother of three, and her husband is terminally ill. He is indefinitely hospitalized, and she makes $70,000 a year as a dental hygienist. Where do her household size and total income put her on the chart for poverty level?

a. 150%

b. 200%

c. 250%

d. 300%

12. Peter is a mechanic and has a health plan through his