President Barack Obama signed health care reform legislation into law on March 23, 2010, after a drawn-out fight in the U.S. House of Representatives and Senate. The bill, dubbed "Obamacare" by critics, has since been the subject of much Republican opposition, with 2012 presidential candidate Mitt Romney even vowing to "repeal and replace" the law if elected.
We sort out the six need-to-know provisions of the law, as many are scheduled to take effect this year or next.
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Perhaps the most important element of the plan is the individual mandate, which requires U.S. citizens to carry health insurance. If consumers do not have health insurance, beginning in 2014, they could face a fine.
As a primary candidate against Hillary Clinton in 2008, Obama opposed the individual mandate, while Clinton supported it.
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Young adults can now stay on their parents' health care plans until age 26; this part of the Affordable Care Act is already in effect.
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Beginning in 2014, businesses with more than 50 employees would be required to at least offer the option of health insurance coverage to their full-time workers, or pay a fine.
Some larger food service companies took exception to the ruling, with Darden Restaurants, owner of the Olive Garden and Red Lobster chains, even threatening to hire more part-time workers to avert the potential penalty, though the company later backed away from those comments.
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The Affordable Care Act requires states, starting in 2014, to set up insurance exchanges, or a Health Insurance Marketplace, so consumers, in theory, can shop around for the plan that suits their needs. The plan, though, has been rebuffed by many conservative-leaning states, with some even threatening to not set up their own exchanges. Nebraska ultimately opted to allow the federal government to set up an exchange for the state. Iowa chose a state-federal partnership.
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The law includes a substantial Medicaid expansion, which was estimated to cover 16 million more Americans who were previously uninsured, beginning in 2014. The law instructed that states that did not permit the Medicaid expansion would risk losing existing Medicaid funds.
In June, however, the Supreme Court, though upholding the bill in a close 5-4 vote, ruled that provision to be unconstitutional, leaving the states with the right to not accept the Medicaid expansion without risking the loss of existing Medicaid funds.
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The Affordable Care Act includes a list of new taxes, many taking effect in 2013, mostly aimed at the wealthy. The most notable is a 3.8 percent tax on investment income for individuals making more than $200,000 a year and married couples making more than $250,000. People at those income levels also will face a 0.9 percent Medicare payroll tax increase on wage income.
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