Glossary of Key Terms in Health Care Reform
Health care reform is complex and some of the terms may be unfamiliar. Here are some frequently used terms and their definitions.
The Patient Protection and Affordable Care Act (PPACA)/Affordable Care Act (ACA)/ObamaCare – The comprehensive federal health care reform law (Public Law 111-148) signed by President Obama on March 23, 2010.
Congressional Budget Office (CBO) – A non-partisan Congressional agency established to develop budgetary and economic information to Congress. The CBO issues reports on the federal cost of legislation, as well as the impact on state and local governments and the private sector.
Cost Sharing Reduction (CSR) – The PPACA provided two ways by which individuals who qualify may receive financial assistance for purchasing insurance. The CSR is a subsidy for low-income households and is paid directly to the covered individual’s health insurance carrier by the federal government.
Department of Health and Human Services (HHS) – HHS has 11 operating divisions, including eight agencies in the U.S. Public Health Service and three human services agencies. HHS administers a wide variety of health and human services and conducts research.
Essential Health Benefits – The Patient Protection and Affordable Care Act (PPACA) required all individual and small group health insurance plans sold after 2014 to include a basic package of benefits. PPACA defined essential health benefits to “include at least the following general categories and the items and services covered within the categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.’’
Federal Poverty Level (FPL) – A measure of income issued every year by the Department of Health and Human Services (HHS). Federal poverty levels are currently used to determine eligibility for certain programs and benefits.
Health Insurance Marketplace/ Exchanges – A national or state-by-state run and regulated marketplace where consumers and small businesses can buy health insurance established by the PPACA.
Insurance Mandate for Individuals – Also known as “individual responsibility,” under the PPACA. Beginning in 2014, the PPACA required that most Americans obtain and maintain health insurance each month or pay a tax penalty.
Insurance Mandate for Employers – Under the PPACA, employers must offer health coverage to their employees beginning in 2014, or face a tax penalty. This applies to employers with 50 or more full-time employees.
Medicaid – Medicaid provides health coverage to certain low-income individuals and families who fit into an eligibility group that is set by federal and state law. The eligibility rules vary from state to state. Medicaid sends payments directly to providers for individuals and/or families who qualify. However, depending on state rules, beneficiaries may pay a copayment for some medical services.
Pre-Existing Health Condition – Any condition, illness, or injury for which medical advice or treatment was recommended or received before a person obtains health insurance.
Reconciliation – Is a term for a legislative process in the United States Senate intended to allow passage of a budget bill that is not subject to filibuster in the Senate. It only takes a simple majority, typically 51 votes, in the Senate to pass a reconciliation bill. Senate Republicans need the backing of at least 50 of the 52 Republicans in the chamber to pass the bill under reconciliation. Republicans plan to use a fast-track budget process called reconciliation to pass their revised version of the AHCA.
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