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Insurance & Employee Benefits

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Health Care Reform Section

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Health Care Reform Quick Terms

Affordable Care Act

Donut Hole

Essential Health Benefits

Grandfathered Health Plans

Health Care Exchange

Medical Loss Ratio (MLR)

Qualified Health Plan

Payment Bundling

Pre-Existing Condition

Preventive Services


Value-Based Purchasing




Affordable health care

No pre-existing conditions

No annual or lifetime limits

Low cost preventive care

Higher taxes

Individual mandate penalties

Less choice


Lower cost alternatives through exchanges

Tax credits available to small employers

Higher taxes

Employer plan mandate penalties

Less choice

Greater regulation


Change brings opportunities

New consulting field emerges

Reduced commissions

Reduced competition

Extra work

Less incentives


Better alternative than single payer system

Systematic change to simplify & unify administration functions

Erosion of profits

Greater regulation

Less flexibility

Less innovation


Increase efficiencies

Streamline billing & appeals

Universal payment system


Reduced fees

Greater regulation

Less autonomy

Push for consolidation

Greater regulation


Capture votes

Increase government

Increase tax base

Reduce Medicare/Medicaid burden

Tax dollars granted to states

System collapses

Provisions repealed

Loss of votes

Increase in deficit spending


Increased opportunities

Establish new industry

Greater flexibility

Greater regulation

There are roughly seven directly affected individuals or organizations including the federal and state governments.  The chart below outlines a few of the advantages and some possible concerns of each category.  Please send your comments to include what you think may be missing.

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Government Links


No Employer Mandate for Small Business


Consumer Operated and Oriented Plans (CO-OPs)

Department of Health & Human Services

Grandfathered Plans

Internal Revenue Service

AFA Nondiscrimination Provisions Applicable to Insured Group Health Plans

The Center for Consumer Information and Insurance Oversight

Regulations & Guidence

Fact Sheets

Tools from the Carriers

Oxford Health Plans - UHC

Health Care Lane

The Road to Reform Oxford

Navigating Health Care Reform  2-99

Navigating Health Care Reform  100+

Health Reform Next Steps  2-99

Health Reform Checklist  2-99

Meeting Presentation

PPACA Presentation Opening

PPACA Timeline at a Glance

PPACA Timeline at a Glance

Coverage & Admin Provions at a Glance

Preventive Care at a Glance

Essential Health Benefits at a Glance

Health Care Exchanges at a Glance

Medical Loss Ratio at a Glance

Small Employer Tax Credits at a Glance

Employer Requirements at a Glance

Grandfathered Plans at a Glance

Summary of Benefits and Coverage at a Glance

Advantages & Concerns at a Glance

Empire Blue Cross Changes Page 1

Empire Blue Cross Changes Page 2

Empire Blue Cross Changes Page 3

Disclaimer- Please note that the information in this site does not constitute legal, financial, or accounting advise by Group Coverage, Inc., it’s affiliates, or by William F. Schaake.  In addition it should be noted that Group Coverage, Inc., it’s affiliates, and William F. Schaake, assume no liability for the content contained herein as it is provided for informational purposes only.  We recommend to seek the advise of a qualified attorney, financial planner or tax advisor.  

Timeline Past Present & Future Health Care Exchange Medical Loss Ratio (MLR) Business Tax Credit Essential Health Benefits Coverage & Admin Employer Mandates Grandfathered Plan

Health Care Reform Tools

Preventive Care Summary of Benefits