What's New in Healthcare

OVERVIEW OF THE AFFORDABLE CARE ACT AND HEALTH INSURANCE EXCHANGES

Whats New in Healthcare

The Patient Protection and Affordability Care Act of 2010, more commonly known as “Obamacare” or the “ACA,” was intended to provide quality, affordable health care for all Americans, expand the Medicaid program, and improve the quality and efficiency of medical care services. It also sought to prevent chronic disease and improve public health, increase the number of trained health care workers, combat fraud through transparency and integrity, improve access to innovative medical therapies, and revise the way health care is funded.

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To effect some of these changes, this healthcare reform package sought to modify insurance policies by eliminating pre-existing condition exclusions, denials of coverage or the raising of premiums on select groups of people based on gender, health status, medical condition, claims experience, genetic information, or other health-related factors, all while making insurance more affordable to consumers. Insurance policies must also include various Essential Health Benefits (“EHBs”) in their plans, making some plans considerably more comprehensive (and, in some cases, more expensive) than many existing plans. These EHBs include, among other things, ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, habilitative and rehabilitative services, laboratory services, preventive and wellness services, chronic disease management, and pediatric services including dental and vision care.

The Affordable Care Act also requires states to provide these new insurance policies through health insurance exchanges, or “marketplaces,” where private and non-profit insurers offer individuals the ability to purchase these new health insurance policies online. States were given the option to create and run their own insurance marketplaces or partner with the federal government to do so. Only 16 states chose to develop and operate their own insurance exchanges. For the 34 states opting out of this process, the U.S. Department of Health and Human Services, through its federal website, HealthCare.gov, is providing state-specific insurance policies and enrollment information for those states’ insurance residents online. As is well documented in current news headlines, various “glitches” in the federal website have created a myriad of online enrollment problems which have greatly limited the number of successful insurance enrollees to date. However, current projections anticipate that HealthCare.gov is scheduled to operate more smoothly by the end of November – just in time to finish enrolling people before the current December 15, 2013 deadline for insurance coverage to begin effective as of January 1, 2014.

What does this mean for you? If you currently have insurance for 2014 through your employer or privately, you have met the law’s requirement to be insured beginning in 2014. If you need to shop for health insurance, https://www.healthcare.gov/what-is-the-marketplace-in-my-state/ helps you determine if your state runs its own insurance exchange or if you should use the federal website. All public exchanges also provide information about available subsidies to help cover the cost of insurance premiums. For U.S. citizens whose incomes fall below 138% of the Federal Poverty Level, insurance options through Medicaid may be available to you. For more information about low-income eligibility for Medicaid, visit Medicaid.gov.

-Julie Lopez-Rickman, MBA

HVHC Compliance Specialist


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