PUBH 3135W Lecture Notes - Lecture 14: Essential Health Benefits, Community Rating, Adverse Selection
Document Summary
2010 health reform law: obamacare: patient protection and affordable care act (aca) Cause: adverse selection, denied of pre existing conditions, unaffordable prices, experience rating, low bargaining power. Cost shifting: when someone pays less of bill, and provider shifts costs to others. Can"t deny coverage for preexisting conditions (community rating) Only allowed to vary premiums based on age, geographic area, tobacco use, number of family members. Young adults can stay on parents" plan up to 26. Waiting period for coverage limited to 90 days. So people don"t wait til they"re sick to sign up for insurance. Individual between 133% and 400% federal poverty limit (fpl) Only if employer doesn"t offer or employee"s share for coverage exceeds 9. 5% of income. Essential health benefits (individual and small group markets) Mental health and substance use disorder services. Preventive and wellness services and chronic disease management. People uninsured for less than 3 months. Not to exceed bronze plan premium in state exchange.
