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Main article: "Patient Protection and Affordable Care Act Health Insurance Rate Review Program

Effective January 1, 2012[edit]

Effective August 1, 2012[edit]

Effective October 1, 2012[edit]

Effective January 1, 2013[edit]

Effective August 1, 2013[edit]

Effective October 1, 2013[edit]

Effective January 1, 2014[edit]

"United States Department of Health and Human Services (HHS) federal poverty level in 2014[85]
Persons in
Family Unit
48 Contiguous States
and D.C.
Alaska Hawaii
1 $11,670 $14,580 $13,420
2 $15,730 $19,660 $18,090
3 $19,790 $24,740 $22,760
4 $23,850 $29,820 $27,430
5 $27,910 $34,900 $32,100
6 $31,970 $39,980 $36,770
7 $36,030 $45,060 $41,440
8 $40,090 $50,140 $46,110
Each additional
person adds
$4,060 $5,080 $4,670
""
""
Medicaid expansion by state.[86]
  Expanding Medicaid
  Not expanding Medicaid
  Ongoing debate over Medicaid expansion
Health Insurance Premiums and Cost Sharing under PPACA for Average Family of 4[98][103][104][105][106]
Income % of "federal poverty level Premium Cap as a Percentage of Income Income $ (family of 4)a Max Annual Out-of-Pocket Premium Premium Savingsb Additional Cost-Sharing Subsidy
100%
2%
$23,850
$477
$10,851
$5,040
133%
3%
$31,721
$952
$10,376
$5,040
150%
4%
$35,775
$1,431
$9,897
$5,040
200%
6.3%
$47,700
$3,005
$8,323
$4,000
250%
8.05%
$59,625
$4,800
$6,528
$1,930
300%
9.5%
$71,550
$6,797
$4,531
$1,480
350%
9.5%
$83,475
$7,930
$3,398
$1,480
400%
9.5%
$95,400
$9,063
$2,265
$1,480

a.^ Note: The 2014 "FPL is $11,670 for a single person and about $23,850 for family of four.[85] See Subsidy Calculator for specific dollar amount.[107] b.^ "DHHS and "CBO estimate the average annual premium cost in 2014 will be $11,328 for a family of 4 without the reform.[104]

Maximum Out-of-Pocket Premium Payments
""PPACA Premium CRS
Maximum Out-of-Pocket Premium Payments Under PPACA by "Family Size and "federal poverty level.[103] (Source: "CRS)
""PPACA Premium Chart
Maximum Out-of-Pocket Premium as Percentage of Family Income and "federal poverty level[103] (Source: "CRS)

Effective October 1, 2014[edit]

Effective January 1, 2015[edit]

Effective October 1, 2015[edit]

Effective January 1, 2016[edit]

Effective January 1, 2017[edit]

Effective January 1, 2018[edit]

Effective January 1, 2019[edit]

Effective January 1, 2020[edit]

Temporary waivers during implementation, 2010-2011[edit]

During the implementation of the law, there were interim regulations put in place for a specific type of employer-funded insurance, the so-called "mini-med" or limited-benefit plans, which are low-cost to employers who buy them for their employees, but cap coverage at a very low level. The waivers allowed employers to temporarily avoid the regulations ending annual and lifetime limits on coverage, and were put in place to encourage employers and insurers offering mini-med plans not to withdraw medical coverage before those regulations come into force, by which time small employers and individuals will be able to buy non-capped coverage through the exchanges. Employers were only granted a waiver if they could show that complying with the limit would mean a significant decrease in employees' benefits coverage or a significant increase in employees' premiums.[150]

By January 26, 2011, HHS said it had granted a total of 733 waivers for 2011, covering 2.1 million people, or about 1% of the privately insured population.[151] In June 2011, the Obama Administration announced that all applications for new waivers and renewals of existing ones had to be filed by September 22 of that year, and no new waivers would be approved after this date.[152]

The limited-benefit plans were sometimes offered to low-paid and part-time workers, for example in fast food restaurants or purchased direct from an insurer. Most company-provided health insurance policies starting on or after September 23, 2010, and before September 23, 2011, may not set an annual coverage cap lower than $750,000,[150] a lower limit that is raised in stages until 2014, by which time no insurance caps are allowed at all. By 2014, no health insurance, whether sold in the individual or group market, will be allowed to place an annual cap on coverage.

Among those receiving waivers were employers, large insurers, such as "Aetna and "Cigna, and union plans covering about one million employees. "McDonald's, one of the employers that received a waiver, has 30,000 hourly employees whose plans have annual caps of $10,000. The waivers are issued for one year and can be reapplied for.[153][154] Referring to the adjustments as "a balancing act", "Nancy-Ann DeParle, director of the Office of Health Reform at the White House, said, "The president wants to have a smooth glide path to 2014."[153]

Delays[edit]

On July 2, 2013, the "Obama Administration announced on the "Treasury Department’s website that it would delay the employer mandate for one year, under Proposed Regulations REG-138006-12 until 2015.[115][116][155][156] In the statement, the Administration said that they were delaying implementation in order to meet two goals: “First, it will allow us to consider ways to simplify the new reporting requirements consistent with the law. Second, it will provide time to adapt health coverage and reporting systems while employers are moving toward making health coverage affordable and accessible for their employees."[156]

The announcement was met with strong criticism by some who claimed that the authority to delay the implementation of the law lay with Congress.[157][158][159] Senate Minority Leader "Mitch McConnell argued that President Obama’s authorization to delay the provision exceeded the limits of his executive power.[159] House Republicans brought two bills to a vote to draw attention to the issue: The "Authority for Mandate Delay Act; and the "Fairness for American Families Act, which would apply the same delay to the individual mandate, arguing that the individual mandate should be treated the same way – an action which the Obama Administration opposes.[157]

Constitutional scholar Simon Lazarus countered critics, saying that the delay was a lawful discretion of Executive power: "In effect, the Administration explains the delay as a sensible adjustment to phase-in enforcement, not a refusal to enforce… To be sure, the federal "Administrative Procedure Act authorizes federal courts to compel agencies to initiate statutorily required actions that have been ‘unreasonably delayed.’ But courts have found delays to be unreasonable only in rare cases where, unlike this one, inaction had lasted for several years, and the recalcitrant agency could offer neither a persuasive excuse nor a credible end to its dithering."[160][161] Critics of the House Republicans’ comparison of the employer and individual mandate also pointed out that the two provisions are qualitatively different.[162][163][164]

In August, another provision was delayed for a year: the premium caps on group plans. This was to give employers time to arrange new accounting systems for the premium caps, but the caps are still planned to take effect on schedule for insurance plans on the exchanges.[99][100][101][102]

On 10 February 2014, the "Treasury Department issued Treasury Decision 9655, which are final regulation, that it would delay the employer mandate until 2016 for employers with 50 to 99 workers.[127] The Treasury Decision 9655 modifies Proposed Regulations REG-138006-12.[127]

See also[edit]

References[edit]

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