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Affordable Care Act (ACA) Highlights

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Ban on Rescissions

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Prohibits insurers from canceling coverage once an individual gets sick, as long as the customer does not commit fraud. Provides more security to the insured.

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Closing the Medicare Part D 'Donut Hole'

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Provides discounts to seniors on prescription drugs when they fall into the coverage gap in Medicare Part D. Aims to make medication more affordable for the elderly.

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Dependent Coverage

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Allows children to stay on their parents' health insurance until age 26. Designed to provide coverage to young adults during transition periods.

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Pre-existing Conditions

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Insurers cannot deny coverage or charge higher premiums based on pre-existing conditions. Ensures more equitable access to health insurance.

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Center for Medicare & Medicaid Innovation

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Established to test innovative payment and service delivery models to reduce costs while preserving or enhancing quality of care. Intended to improve the effectiveness of Medicare and Medicaid.

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Preventive Services

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Requires coverage of preventive care without cost-sharing such as copayments or deductibles. Aims to promote health maintenance and early detection of disease.

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National Health Workforce Commission

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Creates a commission to review healthcare workforce and projected workforce needs. The goal is better alignment of workforce resources with healthcare demands.

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Premium Tax Credits

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Subsidies provided on a sliding scale to individuals and families to help pay for health insurance premiums. Intended to make coverage through health insurance exchanges more affordable.

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Nutrition Labeling of Standard Menu Items

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Requires calorie information to be displayed on menus and menu boards of chain restaurants. A public health strategy aimed at combating obesity by informing consumer choices.

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Employer Mandate

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Requires employers with 50 or more full-time employees to provide health insurance or pay penalties. Intended to extend health security to more workers.

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Medicaid Expansion

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Expands Medicaid to cover all adults with income up to 138% of the federal poverty level. Designed to increase health care access for low-income individuals and families.

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Community Health Center Funding

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Increases funding for community health centers to provide care for millions of Americans. Aims to improve access to primary care services in underserved areas.

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Health Insurance Exchanges

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Marketplaces established for individuals and small businesses to compare and purchase health insurance plans. Aimed to provide greater choice and transparency in the health insurance market.

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Essential Health Benefits

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A set of 10 categories of services health insurance plans must cover under the ACA. It ensures comprehensive coverage, including preventive services and mental health.

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Summary of Benefits and Coverage

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Requires health plans to provide a standardized summary document to help consumers understand and compare health insurance options. Ensures transparency and informed decisions.

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Tanning Services Tax

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Imposes a 10% excise tax on indoor tanning services. Implemented as a public health measure against skin cancer and to offset some of the costs of the ACA.

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Medical Loss Ratio

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Insurers must spend at least 80% of premium dollars on medical care rather than administrative costs. This is to ensure value for the premium dollars paid by consumers.

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Non-Discrimination in Health Care

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Prohibits discrimination based on race, color, national origin, sex, age, or disability in certain health programs or activities. Aims to ensure fair and equal treatment in healthcare.

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Flexible Spending Account Changes

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Implements new regulations on flexible spending accounts, including limiting annual contributions and restrictions on qualified medical expenses. Aims for better management of reimbursable expenses.

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Individual Mandate

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A requirement that most Americans obtain health insurance or pay a penalty. This was intended to ensure that people don't only purchase insurance when they're sick.

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Annual and Lifetime Limits

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Prohibits annual and lifetime dollar limits on essential health benefits. Guarantees that patients' coverage won't run out when they need it most.

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Patient-Centered Outcomes Research Institute

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Funded by ACA to conduct comparative effectiveness research. The objective is to guide patients, practitioners, and policy-makers in making informed health decisions.

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Rate Review

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Requires health plans to justify rate increases of 10% or more before they can be implemented. Promotes accountability and moderates health care pricing.

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Breastfeeding Support

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Requires new private health plans to cover breastfeeding support, supplies, and counseling. Promotes maternal and child health by removing cost as a barrier to breastfeeding.

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Small Business Tax Credits

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Provides tax credits to small businesses offering health insurance to their employees. Intended to ease the financial burden on small businesses for providing health benefits.

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