As 2013 approaches, the push to comply with the Affordable Care Act (ACA), or Obamacare, continues. Some Americans may not realize that the ACA has already passed and is now law, since the Supreme Court has not yet given a ruling on the Constitutionality. However, its momentum is kind of like a freight train that moves even after the engineer applies the brakes. Regardless of what happens, some parts of the ACA will continue to be implemented and you will see that reflected in your insurance, medical care and even employee benefits.
Providers, insurance companies, businesses, and state legislatures are working hard to make changes that will put them in compliance with the latest health reform regulations that define the law. The challenge they face is the scope of the law and the overwhelming details included in the 10,000 plus pages of regulations they must follow. The public will see more and more results of this effort in 2013, especially since headlines recently announced that funding from the White House was diverted to theIRSfor compliance with the individual mandate. Jobs are being created as a result of Obamacare!
Next year the ACA deadlines for health reform will focus on improving quality and lowering costs while increasing access to affordable care. The government website, www.healthcare.gov, is again the basis for this information, although other sources that give more detail are given at the end of this column. There are four main areas that will be addressed in 2013.
1. Improving Preventive Health Coverage
New funding will be provided to states that decide to cover preventive services to Medicaid patients at little or no cost. These state programs will expand the number of Americans receiving preventive care. (Effective1/1/2013)
2. Expanding Authority to Bundle Payments
A pilot program is written into the law that is available to U.S.providers who work together to coordinate and improve the quality of patient care. Details of the program include “bundling”, described as a flat rate for an episode of care, such as gall bladder surgery, rather than a billing to Medicare by each individual provider. In this system, Medicare pays one flat fee to a team of providers, that includes hospitals, doctors, labs, etc. The incentive to providers to deliver efficient and quality service comes when savings are shared between the provider team and the Medicare program. (Effective no later than 1/1/2013)
3. Increasing Medicaid Payments for Primary Care Doctors
The projected increase of Medicaid patients in 2014, due to increased coverage provided by the ACA legislation, requires states to increase payments to primary care physicians to 100% of Medicare payment rates, funded by the federal government. Both Medicaid and Medicare reimbursements would be equal. Reimbursements for medical specialists, like cardiologists, is not mentioned. (Effective1/1/2013)
4. Providing Additional Funding for the Children’s Health Insurance Program (CHIP).States will be granted funding for two more years to provide insurance coverage for children ineligible for Medicaid. (Effective10/1/2013)
Once these new provisions are in place, most Americans will be covered by some sort of insurance for medical care. Billing will be streamlined and teams of medical providers will be delivering services. Preventive care will be easier to access, while primary care physicians will be fully reimbursed for serving both Medicare and Medicaid patients and the CHIP program for children not qualifying for Medicaid, will have two more years of funding.
Most patients will not notice a big change from the waiting room, but behind the main desk, additional staff will be scurrying to keep up with new demands in the billing and records process. Patients can expect fewer pieces of mail in the billing cycle, longer waits to see primary care physicians due to the increased number of the currently uninsured who are no longer delaying medical care, and more emphasis on preventive care options.
The smoking gun for many will be the expiration of the current tax policy, commonly referred to as the “Bush Tax Cuts.” Since tax policy is passed on a ten year timetable, tax rates we are used to paying will increase dramatically should nothing be done.
Healthcare and taxes. Nobody can avoid them. Strap on your seatbelt. It will be an adventurous ride.