Talking Points on Patient Protection and Affordable Care Act (H.R.3590)

The Patient Protection and Affordable Care Act is a positive step forward on the path to reform.

  • The bill will insure 31 million Americans, or 94% of the under-65 population.
  • The bill also includes necessary insurance reforms, including prohibiting coverage denials due to pre-existing condition or health status and ending lifetime caps on benefits.
  • Middle class families will get assistance, so premiums are no more than 10% of income and out-of-pocket expenses are capped.
  • Health plans will cover recommended preventive services and other essential benefits, as defined by the Secretary.
  • Families eligible for the Exchange will have a choice of private plans or a national public plan, called the Community Health Insurance Option, unless a State enacts a law to opt out of it.

The bill needs additional improvements before it can be passed.

  • Improved affordability for lower-income families: The bill must do better for families with modest incomes, whose premiums under this bill are higher than in the Senate HELP or House-passed bills. Recommendation: Lower the percentage of income lower-income families must pay toward premiums.
  • Higher value of benefits: Benefit packages in the Exchange could leave families vulnerable to high out-of-pocket costs. Recommendation: Raise the value of the benefit packages so that deductibles and out-of-pocket-costs are affordable.
  • Fair financing: The tax on high-cost plans will reduce benefits and shift costs to middle class workers, particularly those in dangerous occupations, who are older, or who live in costlier states. Recommendation: Replace the excise tax on the middle class with a small tax on the wealthiest Americans.
  • True shared responsibility: In the bill, large employers are not required to offer coverage, but they are fined if they do not. Gaps in the plan create incentives for employers to offer high-deductible health plans with fewer benefits and eliminate the positions of full-time workers and replace them with part-time workers. Recommendation: Require employers to offer good coverage or pay some amount for both full-time and part-time workers.
  • Immigrants: Adult legal immigrants will still be prohibited from Medicaid eligibility during their first 5 years in the country. Undocumented immigrants will be barred from the purchase of unsubsidized coverage in the Exchange. Recommendation: Lift the 5-year bar on legal immigrants and allow undocumented immigrants to purchase unsubsidized coverage.

You can download this fact sheet as a Word document or a PDF.