In 2010 President Obama signed the nation’s most monumental health care reform bill of the 21st century into law. Many changes to the health system began to take shape: Information was made available online; health insurance was extended to adult children until the age of 26; preventive care was made available without any cost to the patient; and seniors who reached the Medicare gap in prescription drug coverage received rebate checks, among other milestones.
Here is what changed in 2012, and what will happen in 2013 and beyond.
- 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. 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 quality, help prevent disease and illness and reduce unnecessary hospital admissions. Effective January 1, 2012.
- Reducing paperwork and administrative costs. 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. First regulation effective October 1, 2012.
- Understanding and fighting health disparities. Health programs to help understand and reduce persistent health disparities, 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.
- Providing new, voluntary options for long-term care insurance. A voluntary long-term care insurance program (CLASS) will provide cash benefits to adults who become disabled. The Secretary shall designate a benefit plan no later than October 1, 2012.
- Improving preventive health coverage. To state Medicaid programs that choose to cover preventive care at little or no cost, the law provides new funding. Effective January 1, 2013.
- Expanding authority to bundle payments. Bundling payments establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient 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 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 percent 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.
- Additional funding for the Children’s Health Insurance Program. States will receive two more years of funding to continue coverage for children not eligible for Medicaid. Effective October 1, 2010.
- Discrimination due to pre-existing conditions or gender prohibited. The law will prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, insurance companies will not be able to charge higher rates in the individual and small group market, due to gender or health status. Effective January 1, 2014.
- Annual limits on insurance coverage eliminated. The law will prohibit new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive. Effective January 1, 2014.
- Coverage ensured for individuals who participate 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.
- Affordable care. For the middle class to afford insurance, tax credits will become available for people with incomes above 133 percent and below 400 percent of the poverty level who are not eligible for or offered other affordable coverage. These individuals may also qualify for reduced cost-sharing (e.g. copayments, coinsurance, and deductibles). Effective January 1, 2014.
- Establishing health insurance exchanges. Starting in 2014, if your employer doesn’t offer insurance, you will be able to buy insurance directly through a state or federal exchange – a 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. Effective January 1, 2014.
- Small business tax credit increase. In this phase of the law, implementations for qualified small businesses and small nonprofit organizations credit up to 50 percent of the employer’s contribution to provide health insurance for employees. There is also up to a 35 percent credit for small nonprofit organizations. Effective January 1, 2014.
- Increased access to Medicaid. Americans who earn less than 133 percent of the poverty level will be eligible to enroll in Medicaid. States will receive 100 percent federal funding for the first three years to support the expanded coverage, phasing to 90 percent federal funding in subsequent years. Effective January 1, 2014.
- Individual responsibility. Under the new law, 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.
- Free choice. Workers who meet certain requirements that cannot afford the coverage provided by their employer may take the 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.
Physician pay based on value not volume. A new provision will tie physician payments to the quality of care they provide. Those physicians who provide higher value care will receive higher payments than those who provide lower quality care. Effective January 1, 2015.