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U.S. Affordable Care Act (ACA) of 2010 Rewrites the Rules and Increases Coverage, But May Not Restrain Costs, Business and Industry Trends Analysis

Provisions that took effect within the first six months of signing included coverage for adult children up to age 26 on their parents’ policies; making it unlawful for insurers to place lifetime caps on payouts or deny coverage should a policy holder become ill; and new policies being required to pay the full cost of selected preventive care and exempt that care from deductibles.  Small businesses with fewer than 25 employees and average annual wages of less than $50,000 became eligible for tax credits to cover up to 35% of staff insurance premiums.
A 3.8% income tax on investment income was levied on individuals earning more than $200,000 per year and families earning more than $250,000 per year to fund the programs in the act.  Also, the government began fining citizens who choose not to carry health insurance.  (This penalty was eliminated by the Trump administration.) Employers with more than 50 employees that do not offer health benefits began paying a fine per full time staff member if any of the workers receives a tax credit to buy coverage.  Businesses with more than 200 employees are required to enroll all staff automatically in health insurance plans.  Self-insurance is an option for large companies and is a common practice.  Under self-insurance, employers typically hire large outside health insurance firms to manage their plans.
The act is more than 1,000 pages in length and has far too many provisions to cover succinctly; however, there are a number of additional provisions that are little known.  These include allowing insurers to charge smokers as much as 50% more for coverage in new polices; and a 30% break for employees who participate in company wellness programs or meet high health standards.  Meanwhile, online health care insurance “exchanges” began enabling consumers to shop for health coverage on a state-by-state basis.  
Washington and Colorado passed public health insurance legislation, offering residents state-sponsored health plans to compete with private insurance.  Delaware, Massachusetts and New Mexico have adopted similar plans.  In Colorado, the plan focuses on the 7% of the population who buy insurance directly rather than rely on employer or government programs such as Medicare or Medicaid.  Premiums for these plans are typically 11% to 17% lower than private plans, and coverage began in 2022.  The state of Nevada recently adopted a law that requires private insurers to begin bidding on insurance plans with premiums priced 5% less than public plans (meaning those that comply with ACA mandates) by 2026.

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