Since the Supreme Court has ruled that the Affordable Care Act is legal, health care changes are underway—or, rather, continuing on their way to full implementation. How will they impact your school? How will the changes affect your employees?
One of the most common questions is, “will health care costs be reduced?” The Affordable Care Act is intended to insure those who are not covered, not to reduce costs. It’s unlikely that you’ll see a reduction in health care costs over the coming year; in fact, a study by PricewaterhouseCoopers suggests that there will be a 7.5% average increase. (Of course, how your school’s rates are affected depends on claims and participation percentages unique to your group.)
“Will anything change in my current insurance?” Some changes can already be seen. Under previous provisions, children up to 26 years of age can be covered under their parents’ plans, the lifetime cap on coverage was eliminated, and women can receive free preventive care and birth control. The impacts of these changes are already being calculated. A report by the Department of Health and Human Services said 3.1 million young adults were able to access health insurance because of the new provisions, and the proportion of insured adults 19-25 climbed to nearly 75%.
What changes can you expect for the coming year? 2013 can be considered a preparation year for the provisions set to go in effect January 1, 2014. Here is a breakdown of what changes you can expect for 2013. (Read the complete article here.)
2013: Health Care Reform
- 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.
- Expanding Authority to Bundle Payments. The law establishes a national pilot program called “Payment Bundling” to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care. 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% 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.
- Providing Additional Funding for the Children’s Health Insurance Program. Under the new law, states will receive two more years of funding to continue coverage for children not eligible for Medicaid. Effective October 1, 2013.
2014: Health Care Reform
- 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.
- 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.
- 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. Effective January 1, 2014.
- 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. 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 in an Exchange—a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Effective January 1, 2014.
- Increasing the Small Business Tax Credit. The law implements the second phase of the small business tax credit for qualified small businesses and small nonprofit organizations. In this phase, the credit is up to 50% of the employer’s contribution to provide health insurance for employees. Effective January 1, 2014.
- 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. Effective January 1, 2014.
- Promoting Individual Responsibility. Under the new 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. Effective January 1, 2014.
- 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.
Additional ISM resources of interest
ISM Monthly Update for Business Managers Vol. 10 No. 8 Rises in U.S. Health Care
Private School News Vol. 9 No. 3 What You Need to Do to Comply With the New Health Care Reform Bill Right Now
Additional resources for ISM Gold Consortium members
I&P Vol. 35 No. 7 Health Care Reform: What Schools Need to Know Now
