Health-care law glossary

By Amy Goldstein

Here is a glossary of parts of the Patient Protection and Affordable Care Act that are being challenged in federal lawsuits around the country.

Read the latest story on an appeal court's ruling on the individual mandate

INSURANCE MANDATE

Starting in 2014, most Americans will be required to carry health insurance that meets certain standards. There will be exceptions for people uninsured for three months or less, illegal immigrants, Native Americans and veterans who are covered through other government health programs, prisoners and those who object on religious grounds. Critics' central argument is that, under the Constitution's commerce clause, the government cannot require citizens to make a private purchase.

PENALTY FOR NOT BUYING COVERAGE

People required to have insurance will be assessed a tax penalty to be phased in between 2014 and 2016. Critics say the penalty is unconstitutional for the same reason as the mandate and will deprive people objecting to insurance of money they could spend on their own care.

MEDICAID EXPANSION

Starting in 2014, the insurance program for the poor - a shared responsibility of the federal government and states that dates to the 1960s - will cover Americans with incomes up to 133 percent of the poverty level, letting in more people than qualify now in most states. The federal government will start out picking up the entire cost of newly eligible and will, over time, pay 90 percent. But states facing big budget problems say they cannot afford their fraction of the expansion.

POSSIBLE FEDERAL FUNDING OF ABORTION

Under a hard-fought compromise, the law allows health plans to be sold through the new exchanges to cover abortions, as long as they require customers to make a separate payment for the small part of their premiums devoted to that part of the coverage. Critics contend this could lead to federal money being used for abortions - not allowed before - because most customers in exchanges will get public subsidies to pay for their insurance.

HEALTH EXCHANGE

By 2014, each state must create-designate a body to create-an exchange, a new kind of insurance market to help residents buy coverage on their own or through small companies. Plaintiffs say the exchanges will burden the state government and compel state legislatures to bend to federal dictates.

EMPLOYER INSURANCE REQUIREMENTS

The law sets standards for coverage offered by employers. And once federal subsidies for buying insurance through an exchange become available in 2014, employers with 50 or more workers must offer insurance - or pay a fine if any of its employees get a subsidy through an exchange. Critics say the standards and the penalty are unfair burdens on employers.

MEDICARE ADVANTAGE PAYMENT CHANGES

One of the big budget savings in the law is a gradual reduction in reimbursements to private health plans that insure elderly Americans through Medicare Advantage, a managed-care part of Medicare. Plaintiffs are patients in such plans who argue that they will lose their coverage if the payment changes prompt plans to leave the program.

MEDICARE INDEPENDENT PAYMENT ADVISORY BOARD

A new body will be created to help hold down Medicare payment rates and propose regulations. Critics say the board will have too much power and could end up driving private health plans out of the program.

MEDICARE RULES FOR DOCTORS

Plaintiffs argue federal rules should make it easier for doctors not to participate in Medicare.

MEDICAL PRIVACY

Critics contend that the coverage mandate will require Americans to share private information about their health with insurers and, in turn, the federal government.

WOMEN'S HEALTH INITIATIVES

Plaintiff alleges that the law discriminates against men by creating offices within HHS to promote women's health but not similar initiatives for men. The government points out that such offices pre-date the new law.

RESTRICTIONS ON PHYSICIAN-OWNED HOSPITALS

In an attempt to clamp down further on doctors referring patients to hospitals in which they have a direct financial stake, the law prohibits doctors or their families to open new hospitals that treat Medicare patients, expand such existing hospitals or increase their investments in them. Critics say the rules unfairly tread on doctors' business decisions and favors other hospitals.

SOURCES: Staff reports. The Washington Post - December 13, 2010


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