Health insurance marketplace

In the United States, health insurance marketplaces,[1] also called health exchanges, are organizations set up to facilitate the purchase of health insurance in each state in accordance with the Patient Protection and Affordable Care Act (ACA, known colloquially as "Obamacare"). Marketplaces provide a set of government-regulated and standardized health care plans from which individuals may purchase health insurance policies eligible for federal subsidies.

All ACA health exchanges were to be fully certified and operational by January 1, 2014, under federal law.[2] Enrollment in the marketplaces started on October 1, 2013, and continued for six months. As of April 19, 2014, 8.02 million people had signed up through the health insurance marketplaces. An additional 4.8 million joined Medicaid.[3] Enrollment for 2015 began November 15, 2014 and ended December 15, 2014.[4]

Private non-ACA health care exchanges also exist in many states, responsible for enrolling 3 million people.[5] These exchanges predate the Affordable Care Act and facilitate insurance plans for employees of small and medium size businesses.

Background

Health insurance exchanges in the United States are intended to help insurers comply with consumer protection laws, compete in cost-efficient ways, and expand insurance coverage to more people. Exchanges are not themselves insurers, so they do not bear risk themselves, but they do determine the insurance companies that are allowed to participate. An ideal exchange promotes insurance transparency and accountability, facilitates increased enrollment and delivery of subsidies, and helps spread risk to ensure that the costs associated with expensive medical treatments are shared more broadly across large groups of people, rather than spread across just a few beneficiaries. The Health Insurance Exchanges will use EDI (Electronic Data Interchange) to transmit required information between the Exchanges and Carriers (trading partners), in particular the 834 transaction for enrollment information and the 820 for premium payment[6]

History

Health insurance exchanges by state.[7][8]
  Creating state-operated exchanges
  Establishing state-federal partnership exchanges
  Defaulting to federal exchange

Health exchanges first emerged in the private sector in the early 1980s, and they used computer networking to integrate claims management, eligibility verification, and inter-carrier payments. These became popular in some regions as a way for small and medium-sized businesses to pool their purchasing power into larger groups, reducing cost. An additional advantage was the ability of small businesses to offer a range of plans to employees, allowing them to compete with larger corporations. The largest such exchange prior to the ACA is CaliforniaChoice, established in 1996. By 2000, CaliforniaChoice's membership included 140,000 individuals from 9000 business groups.

President Barack Obama promoted the concept of a health insurance exchange as a key component of his health care reform initiative. Obama stated that it should be "a market where Americans can one-stop shop for a health care plan, compare benefits and prices, and choose the plan that's best for them, in the same way that Members of Congress and their families can. None of these plans should deny coverage on the basis of a preexisting condition, and all of these plans should include an affordable basic benefit package that includes prevention, and protection against catastrophic costs. I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest."[9] Although the House of Representatives had sought a single national exchange as well as a public option, the Patient Protection and Affordable Care Act (ACA) as passed used state-based exchanges, and the public option was ultimately dropped from the bill after it did not win filibuster-proof support in the Senate.[10] States may choose to join together to run multi-state exchanges, or they may opt out of running their own exchange, in which case the federal government will step in to create an exchange for use by their citizens.[10]

The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010. The law required that health insurance exchanges commence operation in every state on October 1, 2013.[11][12] In the first year of operation, open enrollment on the exchanges ran from October 1, 2013, to March 31, 2014, and insurance plans purchased by December 15, 2013, began coverage on January 1, 2014.[13][14][15][16] For 2015 open enrollment will begin November 15, 2014 and end on February 15, 2015.[17][18][19]

Implementation of the individual exchanges changed the practice of insuring individuals. The expansion of this market is a major focus of President Obama's Patient Protection and Affordable Care Act.[20]

Over 1.3 million Americans have already selected plans for 2015 Marketplace coverage in the first three weeks the this year's Open Enrollment period, including people who have renewed their coverage and new customs.[21]

As of January 3, 2014, only 2 million people had selected a health plan through the health insurance marketplaces.,[22] but by April 19, 2014, 8.02 million people had signed up through the health insurance marketplaces and an additional 4.8 million joined Medicaid.[3]

As of February, 2015, about 11.4 million of Americans who have already made getting health care a priority and signed up for or been automatically renewed for 2015 Marketplace coverage.[23]

Today, more than 1400 local outreach events have been conducted in Federally Facilitated Marketplace states across the country.[21]

Patient Protection and Affordable Care Act regulations

United States Department of Health and Human Services (HHS) federal poverty level in 2013[36]
Persons in
Family Unit 		48 Contiguous States
and D.C. 		Alaska Hawaii
1 $11,490 $14,350 $13,230
2 $15,510 $19,380 $17,850
3 $19,530 $24,410 $22,470
4 $23,550 $29,440 $27,090
5 $27,570 $34,470 $31,710
6 $31,590 $39,500 $36,330
7 $35,610 $44,530 $40,950
8 $39,630 $49,560 $45,570
Each additional
person adds 		$4,020 $5,030 $4,620

Subsidies

The subsidies for insurance premiums are given to individuals who buy a plan from an exchange and have a household income between 133% and 400% of the poverty line.[37][43][44][45] Section 1401(36B) of PPACA explains that each subsidy will be provided as an advanceable, refundable tax credit[46] and gives a formula for its calculation:[47]

Except as provided in clause (ii), the applicable percentage with respect to any taxpayer for any taxable year is equal to 2.8 percent, increased by the number of percentage points (not greater than 7) which bears the same ratio to 7 percentage points as the taxpayer's household income for the taxable year in excess of 100 percent of the poverty line for a family of the size involved, bears to an amount equal to 200 percent of the poverty line for a family of the size involved. *(ii) SPECIAL RULE FOR TAXPAYERS UNDER 133 PERCENT OF POVERTY LINE- If a taxpayer's household income for the taxable year is in excess of 100 percent, but not more than 133 percent, of the poverty line for a family of the size involved, the taxpayer's applicable percentage shall be 2 percent.
-- Patient Protection and Affordable Care Act: Title I: Subtitle E: Part I: Subpart A: Premium Calculation[47]

A refundable tax credit is a way to provide government benefits to individuals who may have no tax liability[48] (such as the earned income tax credit). The formula was changed in the amendments (HR 4872) passed March 23, 2010, in section 1001. To qualify for the subsidy, the beneficiaries cannot be eligible for other acceptable coverage. The U.S. Department of Health and Human Services (HHS) and Internal Revenue Service (IRS) on May 23, 2012, issued joint final rules regarding implementation of the new state-based health insurance exchanges to cover how the exchanges will determine eligibility for uninsured individuals and employees of small businesses seeking to buy insurance on the exchanges, as well as how the exchanges will handle eligibility determinations for low-income individuals applying for newly expanded Medicaid benefits.[49][50] Premium caps have been delayed for a year on group plans, to give employers time to arrange new accounting systems, but the caps are still planned to take effect on schedule for insurance plans on the exchanges;[51][52][53][54] the HHS and the Congressional Research Service calculated what the income-based premium caps for a "silver" healthcare plan for a family of four would be in 2014:

Health Insurance Premiums and Cost Sharing under PPACA for Average Family of 4[50][55][56][57][58]
Income % of federal poverty level Premium Cap as a Share of Income Income $ (family of 4)a Max Annual Out-of-Pocket Premium Premium Savingsb Additional Cost-Sharing Subsidy
133% 3% of income $31,900 $992 $10,345 $5,040
150% 4% of income $33,075 $1,323 $9,918 $5,040
200% 6.3% of income $44,100 $2,778 $8,366 $4,000
250% 8.05% of income $55,125 $4,438 $6,597 $1,930
300% 9.5% of income $66,150 $6,284 $4,628 $1,480
350% 9.5% of income $77,175 $7,332 $3,512 $1,480
400% 9.5% of income $88,200 $8,379 $2,395 $1,480

a.^ Note: In 2014, the FPL is projected to equal about $11,800 for a single person and about $24,000 for a family of four.[59][60] See Subsidy Calculator for specific dollar amount.[61] b.^ DHHS and CBO estimate the average annual premium cost in 2014 would be $11,328 for a family of 4 without the reform.[56]

Maximum Out-of-Pocket Premium Payments
PPACA Premium CRS
Maximum Out-of-Pocket Premium Payments Under PPACA by Family Size and federal poverty level.[55] (Source: CRS)
PPACA Premium Chart
Maximum Out-of-Pocket Premium as Percentage of Family Income and federal poverty level[55] (Source: CRS)

Guaranteed issue

State and district exchanges
Arkansas Health Connector
Covered California
Connect for Health Colorado
Access Health CT (Connecticut)
DC Health Link (District of Columbia)
Hawaiʻi Health Connector
Get Covered Idaho
Get Covered Illinois
Kynect (Kentucky)
Maryland Health Connection
Massachusetts Health Connector
MNsure (Minnesota)
Nevada Health Link
BeWellNM (New Mexico)
NY State of Health (New York)
Cover Oregon
HealthSource RI (Rhode Island)
Vermont Health Connect
Washington Healthplanfinder

In the individual market, sometimes thought of as the "residual market" of insurance, insurers have generally used a process called underwriting to ensure that each individual paid for his or her actuarial value or to deny coverage altogether.[62] The House Committee on Energy and Commerce found that, between 2007 and 2009, the four largest for-profit insurance companies refused insurance to 651,000 people for previous medical conditions, a number that increased significantly each year,[63] with a 49% increase in that time period.[64] The same memorandum said that 212,800 claims had been refused payment due to pre-existing conditions and that insurance firms had business plans to limit money paid based on these pre-existing conditions. These persons who might not have received insurance under previous industry practices are guaranteed insurance coverage under the ACA. Hence, the insurance exchanges will shift a greater amount of financial risk to the insurers, but will help to share the cost of that risk among a larger pool of insured individuals. The ACA's prohibition on denying coverage for pre-existing conditions began on January 1, 2014. Previously, several state and federal programs, including most recently the ACA, provided funds for state-run high-risk pools for those with previously existing conditions.[65][66] Several states have continued their high-risk pools even after the first marketplace enrollment period.[66]

Limit to price variation

Pricing Factors Allowed in the exchange under the ACA:[67]
  • Age: 3:1
  • Smoking status: 1.5:1

Pricing variation will be allowed by area (within a state) and family composition ("tier") as well.

Comparable tiers of plans

Within the exchanges, insurance plans are offered in four tiers designated from lowest premium to highest premium: bronze, silver, gold, and platinum. The plans cover ranges from 60% to 90% of bills in increments of 10% for each plan. For those under 30 (and those with a hardship exemption), a fifth "catastrophic" tier is also available, with very high deductibles.[68]

Insurance companies select the doctors and hospitals that are "in-network".[69]

Proponents of health care reform believe that allowing comparable plans to compete for consumer business in one convenient location will drive prices down. Having a centralized location increases consumer knowledge of the market and allows for greater conformation to perfect competition. Each of these plans will also cap liabilities for consumers with out-of-pocket expenses at $6,350 for individuals and $12,700 for families.[42]

2015

A study by Avalere Health says that healthcare insurance premiums of popular plans available under Obamacare for 2015 rose by 3-4% .[70]

According to the US Department of Health & Human Service, as enrollment for the Health Insurance Marketplace began on November 15, about 11.4 million people have explored their options, learned about the financial assistance available, and signed up for or renewed a health plan that meets their needs and fits their budget. As of February, 2015, $268 was the average monthly tax credit for people who qualify for financial assistance in 37 states using HealthcCare.gov through January 30.[71]

Economics of health insurance exchanges: the individual mandate

The health insurance advocacy group America's Health Insurance Plans was willing to accept these constraints on pricing, capping, and enrollment because of the individual mandate: The individual mandate requires that all individuals purchase health insurance.[72][73] This requirement of the ACA allows insurers to spread the financial risk of newly insured people with pre-existing conditions among a larger pool of individuals.

Additionally, a study done by Pauly and Herring estimates that individuals with pre-existing conditions in the 99th percentile of financial risk represented 3.95 times the average risk (mean).[62] Figures from the House Committee on Energy and Commerce would indicate that approximately 1 million high-risk individuals will pursue insurance in the health benefits exchanges.[63] Congress has estimated that 22 million people will be newly insured in the health benefits exchanges.[74] Thus the high-risk individuals do not number in high enough quantities to increase the net risk per person from previous practice. It is thus theoretically profitable to accept the individual mandate in exchange for the requirements presented in the ACA.

Acronym

HIX (Health Insurance Exchange) is emerging as the de facto acronym across state and federal government stakeholders, and the private sector technology and service providers that are helping states build their exchanges. The acronym HIX differentiates this topic from health information exchange, or HIE.[75]

The de facto acronym of HIX will be replaced in the soon (March 2013) to be released 3rd Edition of the HIMSS Dictionary of Healthcare Information Technology Terms, Acronyms and Organizations with HIEx. See more information on the HIMSS Dictionary at 2nd Edition of the HIMSS Dictionary of Healthcare Information Technology Terms, Acronyms and Organizations.

Criticism and controversy

First week of operation

The message, "Please try again later", greeted many people who tried to view information on marketplace websites across the United States during the first week of operation. Websites were reported to have either crashed or to offer very sluggish response times. A statement by Todd Park, U.S. Chief Technology Officer, resolved the initial disagreement about whether the culprit was the high volume of views or deeper technical issues : he asserted that glitches were caused by unexpected high volume at the federal health exchange (HealthCare.gov), when the site drew 250 thousand visitors instead of the 50-60 thousand expected, and claimed that the site would have worked with fewer visitors. More than 8.1 million people visited the site from October 1–4, 2013.[76]

On the date the Patient Protection and Affordable Care Act of 2010 was enacted, only a few health insurance exchanges across the country were up and running. Among them were the Massachusetts Health Connector, the New York HealthPass - a non-profit exchange, and the Utah Health Exchange.[77] Advocates claim these exchanges make these "markets" more efficient, providing oversight and structure, arguing that previous health insurance markets in the United States are poorly-organized and deal with wide variations in coverages and requirements among different companies, employers, and policies.[78]

It was unknown how many people in total successfully enrolled in the first week. The federal marketplace website was scheduled for maintenance on the weekend.[79][80] Some reporters nicknamed the program "Slowbamacare".[81]

CGI Group came under media scrutiny as a developer behind several marketplace websites,[82] after numerous issues[83] surfaced with the federal health insurance marketplace, HealthCare.gov.

On October 1, 2013, the state-run marketplaces also opened to the public, and some of them reported first statistics. During the first week of enrollment:

Postponement of tax penalty

On October 23, 2013, The Washington Post reported that Americans with no health insurance would have an additional six weeks before they would be penalized.[85] That deadline was extended to March 31, and those who do not enroll by then may still avoid incurring penalties and getting locked out of the healthcare enrollment system this year. Exemptions and extensions apply to:[86][87]

Primary concerns

Medicaid expansion by state.[90][91]
  Expanding Medicaid
  Not expanding Medicaid
  Still debating Medicaid expansion

Congressional reaction

On October 29, 2013, Rep. Lee Terry (R, NE-2) introduced the Exchange Information Disclosure Act (H.R. 3362; 113th Congress).[103] The bill would require the United States Department of Health and Human Services to submit weekly reports to Congress reviewing the number of people using HealthCare.gov and signing up for health insurance.[104] These reports would be due every Monday until March 31, 2015, and would be available to the public.[105] The bill would "require weekly updates on the number of unique website visitors, new accounts, and new enrollments in a qualified health plan, as well as the level of coverage," separating the data by state.[104] The bill would also require reports on efforts to fix the broken portions of the website.[104] The House was scheduled to vote on it on January 10, 2014.[106]

On January 16, 2014, the bill was passed. 226 Republicans and 33 Democrats have voted yes to the bill.[107]

Private health insurance exchanges

A private health insurance exchange is an exchange run by a private sector company or nonprofit. Health plans and insurance carriers in a private exchange must meet certain criteria defined by the exchange management. Private exchanges combine technology and human advocacy, and include online eligibility verification and mechanisms for allowing employers who connect their employees or retirees with exchanges to offer subsidies. They are designed to help consumers find plans personalized to their specific health conditions, preferred doctor/hospital networks, and budget. These exchanges are sometimes called marketplaces or intermediaries, and work directly with insurance carriers, effectively acting as extensions of the carrier. The largest and most successful private health care exchange is CaliforniaChoice, established in 1994.

Private health exchanges predate the Affordable Care Act. One example of an early health care exchange is International Medical Exchange (IMX), a company venture financed in Louisville, Kentucky, by Standard Telephones and Cables, a large British technology company (now Nortel), to develop the exchange concept in the U.S. using on-line technology. The product was created in the mid-1980s. IMX developed an eligibility verification system, a claims management system, and a bank-based payments administration system that would manage payments between the patient, the employer, and the insurance carrier. Like proposed exchanges today, it focused on standards of care, utilization review by a third party, private insurer participation, and cost reduction for the health care system through product simplification. The focus was on creating local or regional exchanges that offered a series of standardized health care plans that reduced the complexity and cost of acquiring or understanding health care insurance, while simplifying claims administration. The system was modeled after the standardized stock exchange and banking industry back office processes. The major difference was that IMX health care exchanges would provide their products through a national network of existing commercial banks rather than setting up a duplicate payment and administration systems network as proposed today. The IMX product rights were acquired by Anthem (then Blue Cross and Blue Shield of Kentucky). The exchange product became the basis for inter-carrier claims settlement between commercial insurance carriers and Blue Cross organizations. The founders of IMX were from top management at Humana, and top management of First Tennessee National Corp (now First Horizon).

In overlapping markets, the co-existence of public and private exchange plans can lead to confusion when speaking of an "exchange plan." In California, Anthem Blue Cross offers HMO plans through both the state-run Covered California exchange and the private CaliforniaChoice exchange, but doctor networks are not identical. Physicians advertising acceptance of Anthem Blue Cross Exchange HMOs may misinform individuals enrolled in Anthem Blue Cross Exchange HMOs through the private exchange.

See also

References

  1. ↑ "What is the Health Insurance Marketplace?". Healthcare.gov.
  2. ↑ Lewis, Nicole (July 12, 2011). "HHS Proposes Health Insurance Exchange Rules". InformationWeek.
  3. 1 2 Mangan, Dan (May 1, 2014). "Latest score: Obamacare enrolls 8.02 million by April 19". CNBC.
  4. ↑ http://markets.cbsnews.com/Higher-bar-for-health-law-in-2nd-sign-up-season/0541af3455712d82/
  5. ↑ Carrns, Ann. "Private Health Care Exchanges enroll more than Predicted". Retrieved 16 July 2014.
  6. ↑ Take advantage of the emerging market place of the Health Benefit Exchanges of October 16 2014 - hipaasuite
  7. ↑ "State Decisions For Creating Health Insurance Exchanges, as of May 28, 2013 - Table". Kaiser Family Foundation. May 28, 2013.
  8. ↑ "State Decisions For Creating Health Insurance Exchanges, as of May 28, 2013 - Map". Kaiser Family Foundation. May 28, 2013.
  9. ↑ Hass, Christopher (June 3, 2009). "President Obama Reiterates Support for Public Option and Health Insurance Exchange". Obama for America. Archived from the original on August 20, 2012. Retrieved February 7, 2014.
  10. 1 2 Grier, Peter (March 10, 2010). "Health care reform bill 101: What's a health 'exchange'?". Christian Science Monitor.
  11. ↑ "Welcome to the Marketplace". Healthcare.gov.
  12. ↑ "What is the Health Insurance Marketplace?". Healthcare.gov.
  13. ↑ Luhby, Tami (April 23, 2013). "Millions eligible for Obamacare subsidies, but most don't know it". CNN.
  14. ↑ "Establishing Health Insurance Marketplaces: An Overview of State Efforts". Kaiser Family Foundation. May 2, 2013.
  15. ↑ "How can I get ready to enroll in the Marketplace?". Healthcare.gov. Archived from the original on June 26, 2013.
  16. ↑ Morgan, David; Begley, Sharon (September 30, 2013). "Obamacare push accelerates as government shutdown nears". Reuters. Retrieved October 1, 2013. Sebelius said on Monday that 'the key date really is the 15th of December,' the deadline for buying coverage that starts on January 1.
  17. ↑ "Glossary: Open Enrollment Period". Healthcare.gov. Retrieved October 4, 2013.
  18. ↑ Young, Jeffrey (September 25, 2013). "Obamacare Benefits Enrollment Will Start Slowly, White House Predicts". The Huffington Post. Retrieved October 2, 2013.
  19. ↑ Cohn, Jonathan (August 5, 2013). "Burn Your Obamacare Card, Burn Yourself". The New Republic.
  20. ↑ Goldstein, Amy (2010). "Priority One: Expanding Coverage". In The Staff of the Washington Post. Landmark: The Inside Story of America's New Health-Care Law and What It Means for Us All. New York: Public Affairs. pp. 73–83. ISBN 9781410428998.
  21. 1 2 http://www.hhs.gov/healthcare/facts/factsheets/2014/12/open-enrollment-outreach-education.html
  22. ↑ Acosta, Jim; Cohen, Tom (December 31, 2013). "More than 2 million enrolled under Obamacare". CNN.
  23. ↑ content
  24. ↑ "I have been denied coverage because I have a pre-existing condition. What will this law do for me?" (PDF). Health Care Reform Frequently Asked Questions. New Hampshire Insurance Department. p. 2. Retrieved June 28, 2012.
  25. ↑ Binckes, Jeremy; Wing, Nick (March 22, 2010). "The Top 18 Immediate Effects Of The Health Care Bill". The Huffington Post. Retrieved March 22, 2010.
  26. ↑ "What does Marketplace health insurance cover?". Healthcare.gov.
  27. ↑ "Minimum Coverage Provision". American Public Health Association.
  28. 1 2 "Technical Explanation of The Revenue Provisions of the Reconciliation Act of 2010, as Amended, in Combination With the Patient Protection And Affordable Care Act". Joint Committee on Taxation. March 21, 2010. Generally, in 2010, the filing threshold is $9,350 for a single person or a married person filing separately and is $18,700 for married filing jointly.
  29. ↑ Doyle, Brion B. (March 5, 2013). "Understanding the Impacts of the Patient Protection and Affordable Care Act". The National Law Review. Retrieved 17 April 2013.
  30. 1 2 Galewitz, Phil (March 26, 2010). "Consumers Guide To Health Reform". Kaiser Health News.
  31. ↑ Downey, Jamie (March 24, 2010). "Tax implications of health care reform legislation". The Boston Globe. Retrieved March 25, 2010.
  32. ↑ Luhby, Tami (August 13, 2013). "Uninsured next year? Here's your Obamacare penalty". CNN.
  33. ↑ Kliff, Sarah; Klein, Ezra (March 27, 2012). "Individual mandate 101: What it is, why it matters". Wonkblog at the Washington Post. Retrieved July 2, 2012.
  34. ↑ "Requirement to maintain minimum essential coverage". Cornell University Law School Legal Information Institute. September 18, 2013. Described in 26 USC § 5000A(f)(4)(A)
  35. ↑ Sahadi, Jeanne (June 29, 2012). "How health insurance mandate will work". CNN. Retrieved July 12, 2013.
  36. ↑ "2013 Poverty Guidelines". United States Department of Health and Human Services.
  37. 1 2 Rice, Sabriya (March 25, 2010). "5 key things to remember about health care reform". CNN. Retrieved May 21, 2010.
  38. 1 2 "Medicaid Expansion: 5. Is Medicaid eligibility expanding to 133 or 138 percent FPL, and what is MAGI?". American Public Health Association.
  39. ↑ Luhby, Tami (July 1, 2013). "States forgo billions by opting out of Medicaid expansion". CNN.
  40. ↑ "Is Medicaid Expansion Good for the States?". U.S. News & World Report.
  41. ↑ Kliff, Sarah (April 25, 2013). "The outlook for Medicaid expansion looks bleak". Washingtonpost.com. Retrieved July 17, 2013.
  42. 1 2 MacGillis, Alec (2010). "The Insurers: More Customers, More Restrictions". In The Staff of the Washington Post. Landmark: The Inside Story of America's New Health-Care Law and What It Means for Us All. New York: Public Affairs. pp. 93–98. ISBN 9781410428998.
  43. ↑ Peterson, Chris L.; Gabe, Thomas (April 6, 2010). "Health Insurance Premium Credits Under PPACA (P.L. 111-148)" (PDF). Congressional Research Service.
  44. ↑ Galewitz, Phil (March 22, 2010). "Health reform and you: A new guide". msnbc.com. Retrieved March 23, 2010.
  45. ↑ Grier, Peter (March 20, 2010). "Health care reform bill 101: Who gets subsidized insurance?". The Christian Science Monitor.
  46. ↑ wikisource:Patient Protection and Affordable Care Act/Title I/Subtitle E/Part I/Subpart A
  47. 1 2 Patient Protection and Affordable Care Act: Title I: Subtitle E: Part I: Subpart A: Premium Calculation
  48. ↑ "Refundable Tax Credits". Bread for the World Institute. Archived from the original on March 5, 2012.
  49. ↑ "Health Insurance Premium Tax Credit" (PDF). Federal Register (Washington, D.C.: Government Printing Office) 77 (100): 30377–30400. May 23, 2012.
  50. 1 2 "Treasury Lays the Foundation to Deliver Tax Credits to Help Make Health Insurance Affordable for Middle-Class Americans" (PDF) (Press release). United States Department of the Treasury. August 12, 2011.
  51. ↑ Pear, Robert (August 12, 2013). "A Limit on Consumer Costs Is Delayed in Health Care Law". The New York Times.
  52. ↑ Cohn, Jonathan (August 13, 2013). "The Latest Right-Wing Freakout Over Obamacare". The New Republic.
  53. ↑ Goddard, Teagan (August 13, 2013). "Just Another Obamacare Delay". Roll Call.
  54. ↑ Chait, Jonathan (August 15, 2013). "George Will: Now Obama Is Worse Than Nixon". New York.
  55. 1 2 3 "Private Health Insurance Provisions in PPACA (P.L. 111-148)" (PDF). Congressional Research Service. April 15, 2010.
  56. 1 2 "Health Insurance Premiums: Past High Costs Will Become the Present and Future Without Health Reform" (PDF). HealthCare.gov. January 28, 2011. Archived from the original (PDF) on January 15, 2013.
  57. ↑ "Financing Center of Excellence | SAMHSA | Health Insurance Premiums: Past High Costs Will Become the Present and Future Without Health Reform". Substance Abuse and Mental Health Services Administration. March 14, 2011. Retrieved June 29, 2012.
  58. ↑ "Health Insurance Premium Credits Under PPACA" (PDF). Congressional Research Service. April 28, 2010. Archived from the original (PDF) on October 27, 2012.
  59. ↑ "An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act". Congressional Budget Office. November 30, 2009.
  60. ↑ "Policies to Improve Affordability and Accountability". whiteHouse.gov.
  61. ↑ "Subsidy Calculator: Premium Assistance for Coverage in Exchanges". Kaiser Family Foundation.
  62. 1 2 Pauly, Mark V.; Herring, Bradley (May 2007). "Risk Pooling and Regulation: Policy and Reality in Today's Individual Health Insurance Market". Health Affairs 26 (3): 770–779. doi:10.1377/hlthaff.26.3.770.
  63. 1 2 Waxman, Henry A.; Stupak, Bart (October 12, 2012). "Re: Coverage Denials for Pre-Existing Conditions in the Individual Health Insurance Market [Memorandum]" (PDF). United States House Committee on Energy and Commerce. Retrieved December 15, 2012.
  64. ↑ Hall, Jean P. (October 19, 2010). "Affordable Care Act Options for People with Preexisting Conditions". The Commonwealth Fund.
  65. ↑ Vesely, Rebecca (February 28, 2011). "States try it again". Modern Healthcare 41 (9): 17.
  66. 1 2 Haeder, Simon (2013). "Making the Affordable Care Act Work: High-Risk Pools and Health Insurance Marketplaces". The Forum 11 (3). doi:10.1515/for-2013-0056.
  67. ↑ "Compilation of Patient Protection and Affordable Care Act" (PDF). Office of the Legislative Counsel. June 9, 2010.
  68. ↑ "How do I choose Marketplace insurance?". HealthCare.gov. Retrieved October 28, 2013. There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.
  69. ↑ Somashekhar, Sandhya; Kliff, Sarah (September 24, 2013). "Premiums unveiled show wide range for health overhaul plans". The Seattle Times.
  70. ↑ http://www.marketwatch.com/story/obamacare-premiums-for-2015-include-some-big-changes-2014-11-18
  71. ↑ http://www.hhs.gov/healthcare/facts/factsheets/2015/02/open-enrollment-by-the-numbers.html
  72. ↑ Japsen, Bruce (June 17, 2012). "Mandate To Buy Coverage: Health Insurance Industry's Idea, Not Obama's". Forbes. Retrieved February 7, 2014.
  73. ↑ "Individual Responsibility - Glossary". HealthCare.gov. Archived from the original on June 19, 2013. Retrieved 3 June 2013.
  74. ↑ Board, Editorial (February 7, 2014). "The CBO report does not show the new health-care law is failing". The Washington Post.
  75. ↑ Dimick, Chris (June 1, 2010). "Accrediting HIEs". Journal of AHIMA.
  76. ↑ Mullaney, Tim (October 6, 2013). "Obama adviser: Demand overwhelmed HealthCare.gov". USA Today.
  77. ↑ "State Health Insurance Exchanges".
  78. ↑ Blumberg, Linda J.; Pollitz, Karen (April 1, 2009). "Health Insurance Exchanges: Organizing Health Insurance Marketplaces to Promote Health Reform Goals". Urban Institute.
  79. ↑ Lohr, Kathy (October 5, 2013). "Glitches Slow Health Exchange Sign-ups". NPR.
  80. ↑ Goldstein, Amy; Sun, Lena H.; Somashekhar, Sandhya (October 1, 2013). "Rush of interest continues on insurance Web sites". The Washington Post.
  81. 1 2 3 4 5 Westneat, Danny (October 8, 2013). "Obamacare is here, GOP, ready or not". The Seattle Times.
  82. ↑ Auerbach, David (October 8, 2013). "What really went wrong with healthcare.gov?". Slate. Retrieved February 7, 2014.
  83. ↑ Periroth, Nicole (October 2, 2013). "Problems at Health Care Web Site Not From Online Attack, Experts Say". New York Times.
  84. ↑ Landa, Amy Snow (October 21, 2013). "Washington Healthplanfinder: more than 35,000 have enrolled in 3 weeks". The Seattle Times.
  85. ↑ Somashekhar, Sandhya; Goldstein, Amy; Eilperin, Juliet (October 23, 2013). "Americans will have an extra six weeks to buy health coverage before facing penalty". The Washington Post.
  86. 1 2 3 SARA MORRISON (March 25, 2014). "Obamacare: Enrollees Get Post-Deadline 'Special Enrollment Period' Extension".
  87. 1 2 3 "Obama Administration Announces Health Care Extension". Fox News. March 25, 2014.
  88. ↑ DAN RITTER (March 25, 2014). "I'll Take the Tax: 10 Obamacare Exemptions You Don't Want". Wall Street Cheat Sheet.
  89. ↑ "How do I qualify for an exemption from the fee for not having health coverage?". HealthCare.gov. Retrieved March 26, 2014.
  90. ↑ "Status of State Action on the Medicaid Expansion Decision, as of July 1, 2013 - Table". Kaiser Family Foundation. June 20, 2013.
  91. ↑ "Status of State Action on the Medicaid Expansion Decision, as of July 1, 2013 - Map". Kaiser Family Foundation. June 20, 2013.
  92. ↑ Allen, Greg (October 1, 2013). "In Florida, Insurer And Nonprofits Work On Enrollment". NPR.
  93. ↑ "Subsidy Calculator". Kaiser Family Foundation.
  94. ↑ Bastasch, Michael (October 3, 2013). "Study: Obamacare spikes young people’s health insurance costs". The Daily Caller.
  95. ↑ Condon, Stephanie (October 2, 2013). "Obamacare marketplaces raise data security concerns". CBS.
  96. ↑ Ydstie, John (October 4, 2013). "Part-Time Workers Search New Exchanges For Health Insurance". NPR.
  97. ↑ Thompson, Connie (September 30, 2013). "Scammers newest ruse: Health care reform". KLEW-TV.
  98. ↑ Tarpley, Tiffany (October 1, 2013). "Protecting yourself from healthcare law scams". WDJT-TV.
  99. ↑ Landa, Amy Snow (October 4, 2013). "Left off many networks, Seattle Children’s sues". The Seattle Times.
  100. ↑ McGarr, Cappy (October 5, 2009). "A Texas-Sized Health Care Failure". The New York Times. Retrieved October 6, 2009.
  101. ↑ "The Affordable Care Act: The Individual Mandate" (PDF). University of Missouri. Retrieved February 23, 2014.
  102. ↑ Haeder, Simon; Weimer, David; Mukamel, Dana (2015). "California Hospital Networks Are Narrower In Marketplace Than In Commercial Plans, But Access And Quality Are Similar". Health Affairs 34 (5): 741–748. doi:10.1377/hlthaff.2014.1406.
  103. ↑ "H.R. 3362 - All Actions". United States Congress. Retrieved January 7, 2014.
  104. 1 2 3 Kasperowicz, Pete (January 4, 2014). "House GOP to demand O-Care updates". The Hill. Retrieved January 7, 2014.
  105. ↑ "Text of H.R. 3362". GovTrack. Retrieved January 7, 2014.
  106. ↑ "Leader's Weekly Schedule Week of January 6, 2014" (PDF). House Majority Leader's Office. Retrieved January 7, 2014.
  107. ↑ https://www.govtrack.us/congress/votes/113-2014/h23

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