Health Care Reform

Health Care Reform, also known as the Affordable Care Act, was signed into law on March 23, 2010. The health insurance reforms are being rolled out over a four year period, and beyond, with most changes taking place by 2014.

The official government website for Health Care Reform is Healthcare.gov. Here, you can find a timeline of Health Care Reform changes and other helpful information such as the Small Employer Tax Credits.

Provisions of the Affordable Care Act, By Year, for Health Plans

(Information provided by BlueCross BlueShield of Georgia.)

2012

January 1, 2012

Health insurers, self-funded plan sponsors and plan administrators are required to follow uniform standards when providing group and individual plan applicants, enrollees and policy/certificate holders with a summary of benefits and coverage. Also requires uniform glossary of common health care and insurance terms be provided.
Part of the Summary of Benefits and Coverage provision, pre-enrollment materials must be provided to Individual applicants shopping for coverage on the benefits and exclusions of various plan offerings.
Plan sponsors or issuers are required to provide 60 days advance notice to enrollees when making material modifications to the plan outside of the regular renewal process.

2013

January 1, 2013

Employers will need to start telling employees about exchanges, premium subsidies and free choice vouchers.
Employee contributions for FSAs will be capped at $2,500 annually, with the cap adjusted annually to the Consumer Price Index.
Employers with self-funded health care plans will start paying a fee to fund a comparative effectiveness research agency. If the health care plan is fully insured, the health insurer will be assessed this fee. This charge will be $1 times the average number of covered lives. In 2014, it will be $2 times the average number of covered lives. The fee ends on September 30, 2019. This is based on Fiscal Year 2013, which starts in 2012.

Provisions of the Affordable Care Act, By Year

(Information provided by http://www.healthcare.gov/law/timeline/full.html)

2012

IMPROVING QUALITY AND LOWERING COSTS

Linking Payment to Quality Outcomes. The law establishes a hospital Value-Based Purchasing program (VBP) in Traditional Medicare. This program offers financial incentives to hospitals to improve the quality of care. Hospital performance is required to be publicly reported, beginning with measures relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients’ perception of care. Effective for payments for discharges occurring on or after October 1, 2012.
Encouraging Integrated Health Systems. The new law provides incentives for physicians to join together to form “Accountable Care Organizations.” These groups allow doctors to better coordinate patient care and improve the quality, help prevent disease and illness and reduce unnecessary hospital admissions. If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save. Effective January 1, 2012. Fact Sheet: Improving Care Coordination for People with Medicare. Watch a video to learn more about Accountable Care Organizations.
Reducing Paperwork and Administrative Costs. Health care remains one of the few industries that relies on paper records. The new law will institute a series of changes to standardize billing and requires health plans to begin adopting and implementing rules for the secure, confidential, electronic exchange of health information. Using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and most importantly, improve the quality of care. First regulation effective October 1, 2012. Learn how the law improves the health care system for providers, professionals, and patients.
Understanding and Fighting Health Disparities. To help understand and reduce persistent health disparities, the law requires any ongoing or new Federal health program to collect and report racial, ethnic and language data. The Secretary of Health and Human Services will use this data to help identify and reduce disparities. Effective March 2012.

INCREASING ACCESS TO AFFORDABLE CARE

Providing New, Voluntary Options for Long-Term Care Insurance. The law creates a voluntary long-term care insurance program – called CLASS — to provide cash benefits to adults who become disabled. Note: On October 14, 2011, Secretary Sebelius transmitted a report and letter to Congress stating that the Department does not see a viable path forward for CLASS implementation at this time. View a copy of the CLASS report. Read about the original CLASS proposal.

2013

IMPROVING QUALITY AND LOWERING COSTS

Improving Preventive Health Coverage. To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost. Effective January 1, 2013. Learn more about the law and preventive care.
Expanding Authority to Bundle Payments. The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care. Under payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare. For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care. It aligns the incentives of those delivering care, and savings are shared between providers and the Medicare program. Effective no later than January 1, 2013.

INCREASING ACCESS TO AFFORDABLE CARE

Increasing Medicaid Payments for Primary Care Doctors. As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government. Effective January 1, 2013. Learn how the law supports and strengthens primary care providers.
Providing Additional Funding for the Children’s Health Insurance Program. Under the law, states will receive two more years of funding to continue coverage for children not eligible for Medicaid. Effective October 1, 2013. Learn more about CHIP.

2014

NEW CONSUMER PROTECTIONS

Prohibiting Discrimination Due to Pre-Existing Conditions or Gender. The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, the law eliminates the ability of insurance companies to charge higher rates due to gender or health status. Effective January 1, 2014. Learn more about protecting Americans with pre-existing conditions.
Eliminating Annual Limits on Insurance Coverage. The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive. Effective January 1, 2014. Learn how the law will phase out annual limits by 2014.
Ensuring Coverage for Individuals Participating in Clinical Trials. Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial. Applies to all clinical trials that treat cancer or other life-threatening diseases. Effective January 1, 2014.

IMPROVING QUALITY AND LOWERING COSTS

Making Care More Affordable. Tax credits to make it easier for the middle class to afford insurance will become available for people with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. (In 2010, 400% of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four.) The tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time. It’s also refundable, so even moderate-income families can receive the full benefit of the credit. These individuals may also qualify for reduced cost-sharing (copayments, co-insurance, and deductibles). Effective January 1, 2014. Learn how the law will make care more affordable in 2014.
Establishing Affordable Insurance Exchanges. Starting in 2014 if your employer doesn’t offer insurance, you will be able to buy it directly in an Affordable Insurance Exchange. An Exchange is a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance through Exchanges, and you will be able buy your insurance through Exchanges too. Effective January 1, 2014. Learn more about Exchanges.
Increasing the Small Business Tax Credit. The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations. In this phase, the credit is up to 50% of the employer’s contribution to provide health insurance for employees. There is also up to a 35% credit for small non-profit organizations. Effective January 1, 2014. Learn more about the small business tax credit.

INCREASING ACCESS TO AFFORDABLE CARE

Increasing Access to Medicaid. Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years. Effective January 1, 2014. Learn more about Medicaid.
Promoting Individual Responsibility. Under the law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans. If affordable coverage is not available to an individual, he or she will be eligible for an exemption. Effective January 1, 2014. Learn more about individual responsibility and the law.
Ensuring Free Choice. Workers meeting certain requirements who cannot afford the coverage provided by their employer may take whatever funds their employer might have contributed to their insurance and use these resources to help purchase a more affordable plan in the new health insurance Exchanges. Effective January 1, 2014. Learn more about coming improvements for small businesses.

2015

IMPROVING QUALITY AND LOWERING COSTS

Paying Physicians Based on Value Not Volume. A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care. Effective January 1, 2015.