As a consumer, shopping around to determine the cost of a particular medical procedure or surgery has not been a simple task – until now.  In early January, Blue Cross Blue Shield of NC introduced a new public search tool – The Treatment Cost Estimator. This new search tool allows consumers to compare the cost of more than 1,200 medical procedures by simply typing the name of the procedure into a search box. BCBSNC has taken the data they have accumulated from paying thousands of health care claims each day and made that data available to the general public allowing consumers to become more informed and make more educated decisions about their medical care.

Now consumers can easily search to determine how much a surgery or procedure might cost them. They will also have the ability to compare the costs among medical facilities and doctors in their area. The search tool is not only available to members of BCBSNC, but to the general public as well. Anyone can access the search tool on the BCBSNC website.   It also enables consumers to compare the cost of common health care procedures at hospitals and other health care providers based on BCBSNC’s broad-network Blue Advantage plan and its narrow-network Blue Value plan. The Treatment Cost Estimator is so innovative it even caught the attention of Forbes Magazine. Forbes’ contributor Dan Munro writes, “Blue Cross and Blue Shield of North Carolina is among the first (if not the first – certainly as a major) to offer these closely guarded, negotiated rates to the general public.”

The Treatment Cost Estimator is another example of Blue Cross Blue Shield of North Carolina’s strong presence in the health care industry and their commitment to providing consumers with the tools necessary to make informed decisions about their medical care and coverage. Unexpected medical costs can create a huge burden on a person or family and having the ability to shop prices among facilities and doctors can help consumers lessen that burden.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage, the Marketplace and healthcare gov  to apply for your subsidy, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care

*Information provided by BCBS of North Carolina and BCBSNC Blog post dated January 7, 2015

The health effects of smoking are the circumstances, mechanisms, and factors of tobacco consumption on human health. Epidemiological research has been focused primarily on cigarette tobacco smoking, which has been studied more extensively than any other form of consumption, but all forms of tobacco use are dangerous.  Research has proven overwhelmingly that the regular use of tobacco can damage every part of the body.

Tobacco is the single greatest cause of preventable death globally. Tobacco use leads most commonly to diseases affecting the heart, liver and lungs, with smoking being a major risk factor for heart attacks, strokes, chronic obstructive pulmonary disease (COPD) (including emphysema and chronic bronchitis), and cancer (particularly lung cancer, cancers of the larynx and mouth, and pancreatic cancer). It also causes peripheral vascular disease and hypertension. The effects depend on the number of years that a person smokes and on how frequently the person smokes. Starting to smoke earlier in life and smoking cigarettes higher in tar increases the risk of these diseases. Cigarettes sold in underdeveloped countries tend to have higher tar content, and are less likely to be filtered, potentially increasing vulnerability to tobacco-related disease in these regions.

Also, environmental tobacco smoke, or secondhand smoke, has been shown to cause adverse health effects in people of all ages.

The World Health Organization (WHO) estimates that tobacco caused 5.4 million deaths in 2004 and 100 million deaths over the course of the 20th century. Similarly, the United States Centers for Disease Control and Prevention describes tobacco use as “the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide.”

Quitting smoking may be difficult, especially for those individuals who have developed the habit of regular tobacco use.  Blue Cross Blue Shield of North Carolina wants to encourage you to make the change.  A healthy lifestyle is the number one form of preventive care and one of the best things you can do for your body.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage, the Marketplace and healthcare gov  to apply for your subsidy, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.

Blue Cross Blue Shield of North Carolina understands that insurance can be complicated and one of the biggest questions consumers have is:  What is the Difference Between an HMO and a PPO?  It’s a good question and the answer can have significant impact on your health care coverage.

A Health Maintenance Organization (HMO) is a type of health insurance that contracts with health care professionals and facilities to create a “provider network.”  In our opinion, HMO insurance is among the least flexible types of health insurance plans and when you sign up for one of these plans, you must choose a primary care provider (PCP). If your current physician is not in the plan, you will have to find another doctor, or pay to see your current physician.  With the exception of emergency care, which is always covered following Affordable Care Act reform, HMOs only cover visits to in-network providers, facilities, and pharmacies. This means that an HMO subscriber who visits an out-of-network provider will have to pay for any and all health care services out of pocket, as if he or she were completely uninsured. Usually HMOs manage care by assigning patients to a particular primary care physician who then further refers them to other specialists within the HMO, as needed.

Typically, HMOs will not pay for non-emergency care if it is performed by an out-of-network physician or facility, meaning if you go out of network you could be without coverage.  You will also need a referral from your Primary Care Physician to see a specialist.  Before you choose an HMO, you should understand your options for seeing providers outside the HMO’s preferred network and investigate the benefits and networks offered through these plans prior to purchase.

PPOs, on the other hand, are less restrictive than HMOs and will cover visits to both in-network and out-of-network providers, though they prefer for subscribers to receive their care from within the network. A preferred provider organization (PPO) also enters into contractual agreements with health care providers and creates a “provider network,” but unlike HMOs, PPO health insurance will cover out of network cost of care administered by out-of-network providers though you may pay more out of pocket. Care received from out-of-network providers is likely to be covered less than care received from in-network healthcare providers and copays and coinsurance costs are likely to be higher.  Nonetheless, PPOs will offer some assistance even if you do happen to go out of network and some coverage is always better than none.  Also, Preferred Provider Organization (PPO) plans also do not require a referral for you to see a specialist; you always have a network to visit.

Blue Cross Blue Shield of North Carolina offers coverage both in and out of network and a referral is not necessary.  In fact, BCBSNC has reciprocal agreements with every state in the United States, meaning that when you travel out of state you will still have provider networks available to you.  If you travel out of the country, you have the confidence of knowing that Blue Cross Blue Shield of NC has provider networks in over 200 countries outside of the United States.

In the U.S., health insurers tend to have networks of healthcare providers with whom they have special contracts. Insurers agree to encourage subscribers to see certain providers in return for a discount. The negotiated rates between insurers and healthcare providers are significantly lower than the list price that providers bill to uninsured patients. If a patient visits a doctor or hospital that her health plan has made a deal with, she is visiting a provider who is “in-network.” If a patient visits a provider who is not recognized by her health plan, she is “out-of-network.” In most cases, visiting an in-network provider will be easier and cheaper than visiting one who is out of the network.

Today, one of the biggest differences between HMOS and PPOs lies in how much patients are deterred from visiting out-of-network providers, but this difference can significantly affect not only your healthcare, but also your wallet. When choosing a health plan either on or off the federal Marketplace, make sure you know what you are purchasing and what kind of in-network and out-of-network coverage you will be offered.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage, the Marketplace and healthcare gov  to apply for your subsidy, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.

With all the talk surrounding the Affordable Care Act and government subsidies, it’s easy to think that a subsidized health plan through the federal Marketplace is the only kind available to you; however, that is not the case.  ACA approved unsubsidized health plans are still available to all consumers and there is no need to visit the Marketplace to apply.  In fact, every Blue Cross Blue Shield of North Carolina health plan is ACA compliant, meaning they cover the 10 essential benefits required under the Affordable Care Act and you are able to purchase the plans either with or without a federal subsidy.  Federal subsidies are based entirely on income, and though many Americans do qualify for a tax credit to offset the costs of their monthly health insurance premiums, many other Americans do not.  Initially this may seem like bad news, but it is not entirely without benefit.

If you currently do not qualify for a federal tax credit based on your income, although your monthly premiums may be higher, the application process itself will be much simpler.  In fact, you can get an unsubsidized ACA approved BCBSNC health plan in only a few short minutes.  With the exception of tobacco use, you will not have to answer any questions about your health and no income or tax information will be required.  Furthermore, your health coverage will in no way impact your federal income tax, other than the fact that maintaining a health insurance policy will save you from incurring a tax penalty.  Fluctuations in income will not need to be reported to the federal government because your health insurance premium is not being subsidized.

Another important fact to remember is that being eligible for a subsidy and being eligible for coverage are two different things.  Just because you may not qualify for a subsidy does not mean you are ineligible for insurance.  For example, your child might qualify for Medicaid and thus be unable to receive a federal subsidy; however, you can still purchase an ACA approved unsubsidized BCBSNC health plan for that child.

The main thing to keep in mind is that insurance plans and federal subsidies are two separate things and sometimes bypassing the Marketplace altogether is the smarter choice depending on your circumstance.  Either way, Blue Cross Blue Shield of North Carolina can offer you coverage unlike any other.  With the largest and most extensive network in North Carolina, BCBSNC is the best choice for you and your family – either on or off the Marketplace.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage, the Marketplace and healthcare gov  to apply for your subsidy, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.

9 Mason Jar Salad Recipes for Healthy Lunch Ideas – That New Year’s resolution to eat healthier probably includes lots of salads, but by the end of January, lettuce, cucumbers and tomatoes can get old. With layers of fruit, veggies, grains and proteins, salad-in-a-jar recipes are the perfect option for quick and easy packed lunches.  All you need is a jar, some basic knife skills and a few creative salad dressings for a clever and sophisticated salad you can actually look forward to.

Check out the Asian Noodle Salad, which is just one of 8 of these fun recipes.  For a tasty change from the plain old chopped lettuce salad, this recipe draws its inspiration from Asian cuisine. Soba noodles, also known as buckwheat noodles, are a great gluten-free option (though make sure to use gluten-free soy sauce and skip the crunchy rice noodle topping if gluten is a no-no in your diet). The homemade dressing uses peanut butter as an emulsifier, which allows the oil and vinegar to come together more harmoniously. That also means you won’t need to shake or mix it.

Promoting healthy eating, fitness and a healthy lifestyle is a main focus at Blue Cross Blue Shield of North Carolina. Enjoy!  Before starting any weight loss program, always consult your doctor first and get his/her clearance for physical activity and find out if there are any issues that would affect you participating in a new nutrition and fitness program.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage, the Marketplace and healthcare gov  to apply for your subsidy, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.

Almost every year, listed among the top 10 New Year’s resolutions are a desire to lose weight, a desire to stay fit and healthy, and a desire to quit smoking.  Not surprisingly, 2015 is no different.  Of course, as we all know there is a big difference between a desire to do something and a determination to make something happen and most of that difference hinges on the word resolve.  Webster’s Dictionary defines resolve as “a definite and serious decision to do something” and it defines the word resolution as “the act of determining or solving a conflict or problem.”  This year, Blue Cross Blue Shield of North Carolina encourages you to make some healthy resolutions and to make a BCBSNC health plan part of your healthier new year.

Perhaps your goal is to shed some extra pounds or make lifestyle changes that will help you be more fit.  Becoming a Blue Cross Blue Shield of North Carolina member gives you immediate access to Blue Connect, a new personalized way to manage not only your health care needs, but also your fitness goals.  Blue Connect partners with every BCBSNC member in preventive care maintenance by allowing you to track your daily fitness, weight loss goals and nutrition plans as well as helping you link the fitness apps you already use as part of your daily wellness regimen.  This will help you manage your fitness or weight loss resolutions and put you on the road to a healthier 2015.  Also, don’t forget that every Blue Cross Blue Shield health plan covers preventive care at 100%, giving you the peace of mind of knowing you can stay well.

As always, before starting any weight loss or fitness program, consult your doctor first and get his/her clearance for physical activity and find out if there are any issues that would affect your participating in a new nutrition and fitness program.

If quitting smoking is your 2015 New Year’s Resolution, then Blue Cross Blue Shield of North Carolina offers a substantial incentive toward that goal as well.  Did you know you can save 20% on your health insurance policy simply by becoming a non-smoker?  If you are currently paying a premium rate based on being a smoker, resolving to quit smoking in 2015 and sticking with it for twelve months will offer you the opportunity to appeal for a rate change based on a new non-smoker status.  Being a smoke free member of BCBSNC will not only increase your overall wellness, it can actually put money back in your wallet.

We all know resolutions are easy to make and hard to keep.  In fact, studies show that typically only 8% of New Year’s Resolutions are actually carried out, but percentages don’t write stories.  People do!  2015 is a New Year and you get to write your own story.  Becoming a Blue Cross Blue Shield of NC member could be one of the best resolutions you ever make toward a happier, healthier year.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage, the Marketplace and healthcare gov  to apply for your subsidy, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.

Now that the holidays are over and the New Year has begun, you may find yourself wondering if you missed your chance to acquire health coverage for 2015.  Good news!  There is still plenty of time to apply.  Although December 15th was the application deadline for coverage beginning January 1st, Open Enrollment is still ongoing and will be until mid-February.

If you are applying for a government subsidy through the healthcare Marketplace, you can still get coverage beginning February 1st as long as you complete your application by the 15th of January.  Also, if you are NOT applying for a federal subsidy, you can be in a Blue Cross Blue Shield individual health plan as early as January 15th, provided you complete your application by midnight January 8th.

Don’t forget:  Under the Affordable Care Act, you are required to carry health insurance or incur a tax penalty and the penalty is increasing.  For 2015, the penalty is 2% of your yearly household income or $325 per person and $162.50 for each child.  In order to avoid paying a tax penalty, the federal government has mandated you cannot go more than a three month period without health insurance and that’s where Blue Cross Blue Shield of North Carolina can help.  Not only will a BCBSNC health plan save you from incurring this tax penalty in 2015, it will also give you the peace of mind that comes from knowing you and your family are covered in times of sickness and health.

Whether you are applying for a federal subsidy or not, Blue Cross Blue Shield of NC has a health plan that will fit not only your family’s health care needs, but also your budget.  Don’t miss your opportunity to apply.  The New Year has begun, but there is still time to complete an application for health insurance before Open Enrollment 2015 comes to a close.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage, the Marketplace and healthcare gov  to apply for your subsidy, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.

Blue Cross Blue Shield of North Carolina announced that it will begin providing many of its ACA (Affordable Care Act) members the opportunity to receive an in-home visit offering a comprehensive medical exam.  During this at-home visit, members can review medications and discuss health care conditions and concerns with a licensed medical professional.  BCBSNC is offering this program in an effort to better assess the health conditions of its members and to help encourage members to practice preventive health care maintenance.

Because Blue Cross Blue Shield NC recognizes that many of its members are new to the health care system, they are making strides to try and engage new ACA enrollees in a health maintenance program.  These visits not only offer members a chance to discuss their health history with a professional from the comfort of their own home, the home assessment also helps identify any urgent health care problems.  During the visit, members can ask questions and get advice on issues they may need to discuss further with their primary care doctor.  Once the at-home visit has taken place, the health professional will share the results from the assessment with the member’s primary care doctor to ensure that the PCP has knowledge of the member’s overall health status and to help manage any health concerns.

BCBSNC sent letters to many ACA members and has also made phone calls offering these in-home health assessments.  Members may have been contacted for various reasons, including being high-risk, having no prior history with a Primary Care Physician or having a medical condition that would benefit from such an assessment.  These home assessments come at no charge to members and are performed by certified registered nurse practitioners, physicians and physician’s assistants.  Although not required, Blue Cross Blue Shield NC encourages its members to take advantage of the at-home assessment.

Typically, the at-home visit take about an hour and there is no lab work or blood work done during the assessment.  At the conclusion of the visit, the health provider will provide the member with information based on the outcome of the assessment and will discuss the importance of maintaining a relationship with a health care professional.  Members are being encouraged to follow-up with their PCP to discuss the outcomes of the assessment.

BCBSNC is committed to the health and well-being of its members.  Offering in-home health assessments is just one more way Blue Cross Blue Shield of North Carolina is striving to insure the health of North Carolina residents.  For more information on Blue Cross Blue Shield of North Carolina insurance coverage, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.

Blue Cross Blue Shield of North Carolina is bringing in the New Year with a whole new look, but it isn’t simply cosmetic.  Blue Connect will replace My Member Services starting January 1st, 2015 and although the changes are big, they were made with you and your family in mind.  We live in a fast paced, media-driven world and BCBSNC is setting the standard for keeping you and your health care needs connected in an innovative and user friendly way.  In fact, when you become a member of Blue Cross Blue Shield of North Carolina, you don’t just get an insurance policy.  You get a partner in healthy living.  Blue Cross Blue Shield’s Blue Connect allows you the opportunity to see not only your policy and premium, but how your money is being spent, where you can save an extra dollar and how much of your deductible has been exhausted.  With a personalized webpage that graphs how your family is using your health care dollars, you can make sure you are getting the most out of your insurance policy.

In addition, Blue Connect wants to partner with you in preventive care maintenance by allowing you to track your daily fitness, weight loss goals and nutrition plans as well as helping you link the fitness apps you already use as part of your daily wellness regimen.  Blue Cross Blue Shield of North Carolina knows that preventive care is the most important part of living a healthy lifestyle and Blue Link provides you with a place to integrate and manage all of your wellness goals and data.  If a healthier lifestyle is part of your New Year’s resolution, then this is the place to start.

In fact, finding a doctor or hospital in your area has never been easier with Blue Connect’s updated and improved Health Navigator.  Find Primary Care Physicians, Specialists and Mental Health Care Providers in your area, plus read reviews on these health care providers from other Blue Cross Blue Shield members.  You can research which plans certain providers accept and Blue NAV will tell you which tier those doctors and hospitals fall into.  With Blue Connect, there is never a reason you can’t stay in network with a doctor or hospital you have researched and reviewed.

Allowing you to manage everything from mail order prescriptions to finding the best pediatrician in your local area, Blue Connect is a friendly personal assistant for all your family’s health care needs.  It’s a new year and with all the changes in insurance due to the Affordable Care Act and subsidy eligibility, you may have more questions than ever.  With pertinent news and information on both your insurance policy as well as steps you can take toward preventive care, Blue Connect is your family’s new healthcare hub for 2015.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage, the Marketplace and healthcare gov if you qualify for a subsidy, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.

Blue Local with Carolinas HealthCare System

Are you a resident of the Charlotte or Gaston area? If you live in the Charlotte or Gaston region you might be eligible to enroll in Blue Cross Blue Shield of NC’s new product, Blue Local with Carolinas HealthCare System, during the 2015 Open Enrollment. This new product will be available both on and off the NC Health Insurance Marketplace to individual health care consumers under the age of 65 in the following counties: Anson, Cabarrus, Cleveland, Gaston, Lincoln, Mecklenburg, Rowan, Stanly, and Union County. If you are not a resident of one of these counties you will not be eligible to enroll in a Blue Local plan. Blue Local coverage can begin as early as January 1, 2015.

So, what are the benefits of enrolling in a Blue Local plan? Eligible health insurance consumers can potentially pay a lower premium by enrolling in this new point-of-service product with a limited, system-centric network. BCBSNC hopes this product will appeal to consumers in the Charlotte and Gaston regions who are comfortable receiving their care within the Carolinas HealthCare System and its affiliated providers. Members of Blue Local will benefit from this product by receiving high-quality, integrated health care and care coordination within the Carolina HealthCare System and its affiliated providers.

The Blue Local network will be comprised mainly of physicians and facilities that are already affiliated with the Carolinas HealthCare system. However, other in-network providers have been added to ensure accessibility to all types of providers and specialty care.  As with any plan, it is important for consumers to be aware of which hospitals and providers are in network with the Blue Local product.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage, the Marketplace and healthcare gov if you qualify for a subsidy, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.

There are many people out there who simply can’t afford Obama care. If you are one of those people and you are in need of health insurance coverage, you may want to consider Short term health insurance.  Short term health insurance is a fast, affordable, and easy solution for people who are currently without coverage.

The premiums for the ACA/Obama Care health insurance plans do not necessarily fit in everyone’s budget, especially if you don’t qualify for a subsidy. However, it is never a favorable option to be uninsured. Many people will consider short term coverage to bridge the gap between starting a new job and qualifying for their company’s group coverage or if they are between jobs, but it is also important to consider a short term option if you simply can’t afford a health insurance plan otherwise.

Short term health insurance coverage can protect you and your family from the high cost of unexpected health conditions. Short term plans do not cover preexisting conditions or preventive care, but are instead designed to protect you in the event of an accident or unexpected sickness. The premium you will pay is a small price to pay for peace of mind and can be considerably lower than other health insurance options.  A short term plan provides valuable benefits and pays for covered medical expenses once your deductible and coinsurance requirements have been met. Coverage can begin as early as 12:01 am the day after your submit your application and policies are available for 1 to 6 months.

Because short term health insurance plans do not meet the minimum essential requirements of the Affordable Care Act, short term coverage will not exclude you from a possible tax penalty, but you can have coverage up to 2 million dollars.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage, the Marketplace and healthcare gov if you qualify for a subsidy, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.

Blue Cross Blue Shield of North Carolina understands that emergencies happen and when they do, the last thing you need is added pressure.  That’s why BCBSNC, does NOT require prior review and certification in cases of emergency.  Oftentimes, health insurance companies do require prior review for emergency situations and this can add unnecessary frustration to an already stressful circumstance.

Prior review, sometimes referred to as prior plan approval, prior authorization , prospective review, or precertification, is the process by which BCBSNC reviews the provision of certain medical services and medications prior to the services being provided and based on supporting health care management guidelines. In non-emergency situations, prior review may be required based on your plan’s summary of benefits and coverages, but when the unexpected happens you need the confidence and comfort of having a health insurance company that provides emergency coverage without prior review.

As a BCBSNC customer, you have the freedom to take care of your emergency needs without worrying about whether or not you will be covered.  In fact Blue Cross Blue Shield of North Carolina does not require notification of an urgent or emergency admission until the second business day of the admission, giving you and your family time to take care of each other first and foremost.  Whether your plan is Blue Advantage, Blue Select or Blue Value, BCBSNC makes emergency health care simple and stress free.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.