What Is Obamacare?

Obamacare Explained

Happy female doctor and nurse discussing with male patient in clinic
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Definition

"Obamacare" is an alternative term for the Patient Protection and Affordable Care Act (ACA) of 2010. The aim with this plan was to make health care more affordable for everyone by lowering costs for those who can't afford them.

Key Takeaways

  • "Obamacare" is an alternative term for the Patient Protection and Affordable Care Act (ACA) of 2010.
  • The plan aimed to make health care more affordable for everyone by lowering costs and increasing coverage.
  • Among its provisions, the ACA mandated that insurance companies include 10 necessary benefits and offered states the opportunity to expand Medicaid coverage.

Definition and Example of Obamacare

Obamacare is the Patient Protection and Affordable Care Act (ACA). Most people think it only affects health insurance, but it has changed the way the U.S. delivers health care overall. The term "Obamacare" was first coined by critics of the former president's efforts to reform health care, but the name stuck.

The ACA made important changes to the way many people are able to access health care. For example, before the ACA, insurance companies could exclude people with pre-existing conditions. As a result, the people with the greatest health expenses sometimes had to go without insurance or settle for a policy that did not cover their condition. Because they couldn't afford regular doctor visits, they often ended up in hospital emergency rooms, unable to contribute to the expense of their treatments.

Note

The accessibility of Obamacare allows people with pre-existing conditions to afford preventive care, thus reducing hospital visits and slowing the rise of health care costs.

How Obamacare Works

The ACA's primary goal was to slow the rising cost of health care by taking steps to make health insurance more available and more affordable to those who need it the most. The act also required everyone to carry health insurance or pay a tax penalty, but that provision ended in 2019.

The ACA also aims to make health insurance more affordable for those with the lowest incomes by subsidizing the cost. Medicaid was extended to those who earn up to 138% of the federal poverty level, but as of 2022, 12 states have elected to not expand Medicaid, limiting accessibility for their residents. Located mostly in the South, the states are:

  • Alabama
  • Florida
  • Georgia
  • Kansas
  • Mississippi
  • North Carolina
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Wisconsin
  • Wyoming

The poverty level usually increases each year to keep up with inflation. Those who earn too much for Medicaid receive tax credits if their income is less than 400% of the poverty level. The credit is applied monthly rather than as an annual tax rebate. They also pay reduced co-payments and deductibles.

Do I Need To Pay a Penalty?

To ensure that insurance companies could afford to add patients with pre-existing conditions, the ACA initially required everyone to have health insurance for at least nine months out of every 12 or be subject to a tax.

In December 2017, Congress repealed the penalty with the Tax Cuts and Jobs Act. The penalty no longer applies to tax years past 2018. Even before that happened, many groups had successfully petitioned Congress so they could be exempt from Obamacare.

By removing the mandate, Congress effectively required insurance companies to take patients with pre-existing conditions while potentially removing healthier patients, thus increasing costs for the insurance companies. Since the subsidies remain in place, Congress also made sure the government would pick up a percentage of the rising costs.

How Much Are Obamacare Taxes?

Even though the mandate no longer applies, there are still some taxes related to Obamacare:

  • If you make more than $200,000 per year: Taxes increased in 2013 for individuals making more than $200,000 per year or $250,000 for married couples, some health care providers, and other health-related businesses.
  • If you're a business owner: If you have 50 or more employees, you must provide insurance to at least 95% of full-time employees or pay a fine.

How To Get Obamacare

Even though Congress cut off one of the legs supporting the ACA, you still can take advantage of the parts that work.

Health Insurance Exchanges

The health insurance exchanges are open for enrollment from Nov. 1 to Jan. 15 each year. If you miss the window, you still can use the exchanges to buy interim private insurance or apply for Medicaid. You also can use them to compare plans for the future.

Note

Some exchanges are run by states, and some by the federal government. It is important to compare all costs, including monthly premiums, annual deductibles, percentages covered, and copayments.

What Does Obamacare Cover?

Under the ACA, insurance plans must allow parents to include their children on their plans up to age 26 and provide 10 essential services:

  1. Preventive and wellness visits, including chronic disease management
  2. Maternity and newborn care
  3. Mental and behavioral health treatment
  4. Services and devices to help people with injuries, disabilities, or chronic conditions
  5. Lab tests
  6. Pediatric care
  7. Prescription drugs
  8. Outpatient care
  9. Emergency room services
  10. Hospitalization

Frequently Asked Questions (FAQs)

Who qualifies for Obamacare?

Obamacare was a wide-ranging health care bill, so it likely impacted almost everyone in some way. For example, under Obamacare, all children under the age of 26 qualify to use their parents' health care insurance. A major aspect of Obamacare was expanding Medicaid, and if you live in a state that expanded Medicaid, then you qualify for coverage if you earn up to 138% of the federal poverty threshold.

When is Obamacare open enrollment?

Open enrollment for Marketplace coverage occurs toward the end of the calendar year. It opens on Nov. 1 and runs through Jan. 15. Those who enroll during this period will obtain coverage for the following calendar year.

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Sources
The Balance uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. U.S. Centers for Medicare & Medicaid Services. "At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans."

  2. U.S. Centers for Medicare & Medicaid Services. "Fee."

  3. Kaiser Family Foundation. "Status of State Medicaid Expansion Decisions: Interactive Map."

  4. U.S. Centers for Medicare & Medicaid Services. "Medicaid Expansion & What It Means for You."

  5. Internal Revenue Service. "Premium Tax Credit: Claiming the Credit and Reconciling Advance Credit Payments."

  6. Internal Revenue Service. "Individual Shared Responsibility Provision."

  7. Congressional Research Service. "The Individual Mandate for Health Insurance Coverage: In Brief," Pages 1-5.

  8. Internal Revenue Service. "Affordable Care Act Tax Provisions: Additional Medicare Tax," Expand "Additional Medicare Tax."

  9. Internal Revenue Service. "Employer Shared Responsibility Provisions."

  10. U.S. Centers for Medicare & Medicaid Services. "When Can I Enroll in 2023 Marketplace Insurance?"

  11. U.S. Centers for Medicare & Medicaid Services. "How to Get or Stay on a Parent’s Plan."

  12. U.S. Centers for Medicare & Medicaid Services. "What Marketplace Health Insurance Plans Cover."

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