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Health Care Reform

Health care reform is a general term used for discussing major health policy creation or changes—for the most part, governmental policy that affects health care delivery in a given place.  Numerous government efforts have been made in the United States to make health care services available and affordable for everyone.  There are three major periods for health reform in recent years;  Pre-Obamacare, Obamacare, and now The American Health Care Act

American Health Care Act 

The President of the United States has said that he has ideas to improve health care in America.  If there are any changes to health care that affect you, you will be notified by the government, or your health insurance company.    


Obamacare (The Patient Protection and Affordable Care Act)

In 2010, the Congress passed a new law called the Patient Protection and Affordable Care Act.  This law includes a series of specific health insurance and health care industry provisions, and includes individual and employer responsibilities to maintain health insurance, or pay a penalty to the IRS.  The provisions begin at different times during the implementation period from 2010 through about 2020.  Many parts of the law are popular, but the average rate increase for private health insurance for 2015 through 2017 have been about 25% annually. 

2020       

2016

  • The 2016 individual health plan open enrollment has several enrollment periods and several possible start dates
  • The 2016 individual health insurance open enrollment ends on January 31, 2016
  • 8 of 10 consumers who enroll in the health insurance marketplace are receiving the advanced premium tax credit
  • Read more about the individual open enrollment periods here.

2015

       
  • The Federally facilitated marketplace healthcare.gov becomes the new health insurance marketplace, replacing the failed Cover Oregon.

2014

  • Eligibility waiting periods for group health insurance can be no more than 90 days
        
                       
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2013

  • October 1: Open enrollment in the Health Insurance Marketplace begins
  • Employers must notify employees about the Exchange Marketplaces. Notice is due October 1, 2013.  Click here to request help with this.
  • Employers must provide employees with a Summary of Benefits and Coverage with a Universal Glossary of Insurance Terms
  • The following programs are expected to terminate on December 31, 2013
    • The Oregon Medical Insurance Pool (OMIP)
    • The Federal Medical Insurance Pool (FMIP) 
    • Portability plans
    • Non-qualified medical plans
  • Some grandfathered plans may continue to be available provided they were purchased prior to 2010  


2012



Pre-Obamacare  

There was no requirement to purchase health insurance.

Health insurance companies required medical questions for applicants who wanted to purchase an individual health insurance policy.  About 30% of individual applicants were rejected for medical reasons. 

The Oregon Medical Pool was a high risk medical pool for the uninsurable.  The plans had limited coverage and premiums through 2013 of $500-$700 per month for one person.

Policyholders could have deductibles up to $10,000 and out of pocket maximums of $12,000 or more.  Many consumers purchased these low premium plans, but were unable to pay the out of pocket expenses when having major medical services.

Premiums were very low because policies were allowed to have high deductible and out of pocket options, such as $10,000 deductible and $12,000 individual annual out of pocket maximum.

Those with income below 140% of the federal poverty level received Medicaid if they were pregnant, a child, or a winner of a periodic lottery.