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25 terms you should know to understand the health care debate

  • Individual mandate penalty

    Under the Republican-backed Tax Cuts and Jobs Act of 2017, the individual mandate penalty of the Affordable Care Act was repealed. The mandate required all Americans to maintain health insurance coverage unless they were eligible for an exemption, and the IRS levied a penalty on those without coverage. The individual mandate remains in effect, but there is no longer a federal penalty for non-compliance. Massachusetts, New Jersey, Vermont, and the District of Columbia have imposed their own mandates and penalties.

  • Medicaid expansion

    Under the Affordable Care Act, the government’s health insurance program for low-income residents was to be expanded to cover people with incomes no higher than 138% of the federal poverty level. But the U.S. Supreme Court ruled that compliance with that part of the ACA was optional. As a result, some states have strict eligibility criteria because they did not expand Medicaid coverage, while others have implemented broader coverage. Medicaid is sometimes called a single-payer system, but it is jointly funded by the federal government and each state government. Increased Medicaid funding is up for a vote as a part of larger updates to the expanded Patient Protection and Affordable Care Act Enhancement Act bill. Members of the U.S. House were set to vote on the bill June 29.

  • Underinsured

    People who are underinsured are covered by health insurance but may have high deductibles and out-of-pocket expenses. They might be unable to pay their medical bills or delay or skip treatment because of its cost.

  • UCR

    UCR stands for Usual, Customary, and Reasonable, and it is the amount insurers will pay for a medical service in a geographic area. It is based on what providers in the area typically charge.

  • Two-tier health care

    In a two-tier health care system, the government provides basic health care, and secondary coverage is available to those who can afford more costly coverage. Two-tier systems are in place in France, Australia, Ireland, Hong Kong, Singapore, and Israel.

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