Obamacare from A to Z: 26 things to know about the health care overhaul – The Star-Ledger – NJ.com

ABORTIONS – The Affordable Care Act does not require any insurance company to cover abortions, nor does it prevent them either. States that run their own exchange may ban insurance companies that cover abortions. Every state must have at least one health insurance plan in their exchange that doesn’t cover abortion. States don’t have to offer any health insurance plans in their exchange that cover abortion. If a state decides it does want to have health plans that cover abortion services on its exchange, and if a woman chooses one of those plans, then she has to pay a separate fee of at least $1 to a separate account for that coverage in order to make sure no federal dollars are used to support abortion services.

BROKERS – There are licenses brokers to help you purchase insurance on the exchanges. To avoid scams, make sure they are licensed by the state of New Jersey.

CONTRACEPTION – The Affordable Care Act counts contraception as preventative care for women and mandates its coverage without any copayment. The Obama administration exempted churches, other houses of worship and similar organizations from covering contraception on the basis of their religious objections.

DEFUND – Several Republicans are trying to persuade their Congressional colleagues to pass a budget that does not provide any funding for Obamacare. It is important to remember that this would not end the law, or eliminate its least popular provisions like the individual mandate. It would, however, make it harder to administer the law.

Wheelchairs line the main entrance area at the Princeton Radiology center in Monroe Township, Middlesex County.Patti Sapone/The Star-Ledger

END OF LIFE CARE – The President had wanted doctors to be allowed to bill for conversations around end of life care, hoping that would help cut expensive procedures from the elderly or terminally ill. This led to accusations of the government creating “death panels,” and the administration backed away from its plan. The law does allow Medicare to pay for “voluntary advanced care planning” to be included in wellness appointments.

FLEXIBLE SPENDING ACCOUNT – The law caps the amount an individual may put into a flexible spending account at $2,500. Anything more than that will be taxed as ordinary income. That is expected to raise $13 billion between 2013 and 2019, according to the Joint Committee on Taxation.

GOVERNMENT RUN HEALTH CARE – There are pages and pages of new regulations and standards that doctors and hospitals must comply with because of the ACA. But the federal government is actually providing large subsidies to private health insurance companies. Medicare and Medicaid remain the only large government run health insurance options.

HERITAGE FOUNDATION – The Heritage Foundation, a conservative think tank, did support the idea of an individual mandate in the early 90s. But their proposal was far different that what became law under Obama. In an amicus brief to the U.S. Supreme Court, the Heritage Foundation noted that it had reversed its policy and that its version of the mandate was only for “catastrophic coverage.” Further, their proposal did not threaten to impose fees.

Dr.Ashwin Jadhav, a maternal fetal medicine specialist, performs an ultrasound on Maria Holiguin, 32, at Somerset Medical Center in Somerville. Holiguin who is five months pregnant, is expecting her fifth child.Patti Sapone/The Star-Ledger

INDIVIDUAL MANDATE – one of the law’s most controversial provision. It means every American is required to purchase insurance or pay a fee. The fee in 2014 is $95, though Republicans have repeatedly called on the White House to waive the penalty for one year as the President did for businesses.

JOB-BASED CARE – Employers drooping coverage. The CBO estimates that 7 million people will lose their employer based coverage over the next decade as companies choose to pay the penalty rather than insurance for their employees. Those employees will be forced to buy health insurance on their own or pay a fee assessed by the IRS

K-12 – New Jersey’s school districts are considered “large employers” because nearly all have more than 50 employees. That means they are responsible for providing health insurance, or paying a penalty, for each employee that works more than 30 hours per week. That could lead some districts to consider privatizing paraprofessionals and teachers’ aides, which was discussed but ultimately rejected in Parsippany.

LONG-TERM CARE – The Community Living Assistance Services and Supports (CLASS) Act was supposed to be a self-funded voluntary long-term care insurance option run by the federal government. But the Obama Administration deemed it unworkable and the law was repealed in January. Therefore, long term care insurance is not part of the ACA, according to the director of the American Association for Long Term Care Insurance.

MEDICAID – New Jersey has about 1.2 million people enrolled in Medicaid. According to the Urban Institute, another 307,000 will be eligible because of the laws expansion of the Medicaid program.

Yinzhu Shen, 30, of Newark is checked by a medical student at Rutgers New Jersey Medical School’s Student Family Health Care Center in Newark.Patti Sapone/The Star-Ledger

NAVIGATOR – An individual or organization that’s trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms. These individuals and organizations are required to be unbiased. Their services are free to consumers.

ORAL CARE – Only children are required to be covered for dental care under the Affordable Care Act.

PARITY – Parity laws are meant to provide adequate coverage for substance abuse and other mental disorders. The Affordable Care Act builds on the Mental Health Parity and Addiction Equity Act of 2008, according to the Department of Health and Human Services, by requiring coverage of mental health and substance use disorder benefits as one o0f the 10 essential benefits the law requires all insurers to offer. It is not clear, however, on the quality of such coverage.

QUALIFYING LIFE EVENTS – That’s a fancy way of saying certain changes in your life – like moving to a new state, changes to your income or family size, allow you to qualify for a special enrollment period.

RESIDENCY – If you work in New York but live in NJ, or work in Pennsylvania and live in New Jersey, you must buy insurance in New Jersey even if you might have gotten a better price in another state.

SMALL BUSINESS HEALTH OPTIONS – The Small Business Health Options Program, known as SHOP, is open to employers with 50 or fewer full-time employees. If you’re self-employed with no employees, you are not eligible.

TRICARE – If you’re enrolled in Tricare, the veterans health care program, you’re considered covered under. You don’t need to make any changes.

URGENT CARE CENTER – Urgent care centers are primarily meant to treat patients who do not have or can’t get an appointment with a primary care physician. They have extended hours and can treat emergencies, though are usually not capable of handling major traumatic events. Some suggest there will be a growth in this business because so many more people will have insurance, specifically Medicaid, but won’t choose to, or be able to, find a primary care physician.

X-ray technicians are expected to be in high demand when Obamacare kicks in. Pictured is a worker at the Princeton Radiology center in Monroe Township.Patti Sapone/The Star-Ledger

VISION – Only children are required to be covered for vision care under the Affordable Care Act.

WELL-BABY AND WELL-CHILD VISITS – Routine doctor visits for comprehensive preventive health services that occur when a baby is young and annual visits until a child reaches age 21. Services include physical exam and measurements, vision and hearing screening, and oral health risk assessments.

X-RAYS – X-ray technicians are expected to be in high demand because of the increased access to services like mammograms.

YEARLY CAPS – Annual limits on co-payments and deductibles were set at $2,000 per year for individual plans, and $4,000 per year for family plans. They were supposed to take effect in January but the President delayed this rule for one year.

ZERO – There is zero cost for preventative measures like colonoscopies and mammograms on all insurance plans, whether you purchase insurance on the exchange or receive it though your employer. Grandfathered plans are exempt.

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