This is the second in this series of overviews of the Affordable Care Act (ACA) or Obamacare. The previous column dealt with a general overview of the legislation and its passage—critical information for those who seek to understand where we have been and where we are going. This column will address the implementation deadlines for this calendar year and what changes you will see. The next column will be a scenario to illustrate how life might change as a result.
The implementation deadlines for this year will affect not only existing entitlement programs like Medicare and Medicaid, but how health care providers, insurance companies and state legislatures come into compliance with the emerging regulations from the ACA. Let’s take a brief look at each of them, most based on the timeline available on www.healthcare.gov. Dates in parentheses are final compliance deadlines.
*Linking payment to quality outcomes: This provision offers financial incentives to hospitals striving to improve the quality of care. All hospitals will be required to report their progress publicly, particularly with heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients’ perception of care. (10/1/2012)
*Accountable Care Organizations: Physician incentives to unite into “Accountable Care Organizations” begin. These are designed to coordinate care, improve quality, prevent disease and illness, and to reduce hospital readmissions. If these organizations are effective in reducing costs, they can keep some of what has been saved. (1/1/2012)
*Reducing paperwork and administrative costs: Standardized billing and requiring health plans to use electronic exchanges of health information. Electronic records are expected to reduce cost, paperwork, errors and improve quality of care. (10/1/2012)
*Reducing health disparities: The law requires federal health programs to collect and report racial, ethnic and language data. This data will be used by the Secretary of the Health and Human Services department to identify and reduce disparities. (3/1/2012)
*State legislatures: They must decide and/or establish high risk insurance pools, commercial insurance regulations, Medicaid eligibility, create health insurance exchanges, and define essential health benefits packages. All of this is to be completed by January 1, 2013 deadline.
The Supreme Court ruling on the constitutionality of the individual mandate provision of the ACA is expected in June, 2012. Many state legislatures and other leaders are waiting for this ruling before initiating mandated implementation requirements. It is expected that the 2012 Presidential election will determine whether the ACA implementation will stand. A GOP victory promises to bring challenges to the ACA and eventual repeal. If President Obama wins, the implementation is expected to continue.
There is, of course, much more to it than the explanation here, but regardless, patients will see changes sooner rather than later. State legislatures will be under pressure to create the mandated changes in their states or cede control to the federal government. The “wait and see” approach adopted by many states, will result in either more expenditures for compliance with the ACA because they have missed the June 29, 2012, deadline for applying for federal grant money, or loss of local control of their health care dollars. Medical care providers and insurance companies are in the midst of the process and are struggling to meet the compliance deadlines. Changes are coming, ready or not.