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Explaining Health Care Reform: Questions About Health Insurance Subsidies

Issue Brief
  1. Center for Health System Change – Living on the Edge: Health Care Expenses Strain Family Budgets: http://www.hschange.org/CONTENT/1034/?topic=topic05

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  2. Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured – Approaches to Covering the Uninsured: A Guide at
    http://kff.org/health-reform/issue-brief/approaches-to-covering-the-uninsured-a-guide/

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  3. For more information about the silver plan and other plans available in the exchange, please see “Explaining Health Care Reform: Questions About Health Insurance Exchanges,” available at www.kff.org/healthreform/7908.cfm.

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  4. Essential benefits must include at least the following general services: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health benefits and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease managements, and pediatric services including oral and vision care. 

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  5.  Poverty projected based on projected change in consumer price index, available at http://www.cbo.gov/budget/econproj.shtml

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  6. See 26 U.S.C. §22 3(g).

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  7. PPACA provides that the Secretary can adjust the maximum out-of-pocket limits if they would result in plans exceeding the specified actuarial values. This could happen if an out-of-pocket limit is too low to allow a deductible and other cost sharing that is consistent with the specified actuarial value.

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  8. Congression Budget Office, “H.R. 4872, Reconciliation Act of 2010 (Final Health Care Legislation),” March 20, 2010, available at http://www.cbo.gov/ftpdocs/113xx/doc11379/Manager%27sAmendmenttoReconciliationProposal.pdf. While CBO is required to project the costs over a ten-year time period, the subsidies will not be available until 2014.

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