No surprise, everyone’s talking about the Affordable Care Act…ups
and downs, facts and politics, questions and answers…ahhh, answers! Will the
Federal Marketplace (aka Exchange) be ready? What about the 17 States
developing their own Exchanges? What’s
the impact of the delay in large employer requirements? Can 90% ofthe U.S.
population who don’t understand ACA be educated in time for October’s open
enrollment?
Large Employers
The ACA “employer mandate” requirement affects very few employers. Let’s remember, we’re talking about large employers, and almost all of them already offer coverage, so the number of these employers adding coverage under ACA wasn’t going to be big anyway. According to Kaiser Family Foundation, 98% of employers with over 200 employees already offer coverage. Zeke Emanuel, one of the President’s top health reform advisors discusses the announcement to postpone the employer mandate until 2015 in a recent editorial in the New York Times entitled “Obama’s Insurance Delay Won’t Affect Many”.
Marketplaces & Exchanges
For those in need of a primer on Health Insurance Marketplaces (HIMs), the Healthcare Information and Management Systems Society (HIMSS) released an excellent overview entitled ACA Requirement: Health Insurance Marketplace Overview- Part 1. It reviews the history and evolution of HIMs, anticipated adoption rate, and the difference among types of HIMs under development.
From an HHS–CMS perspective the word of the day seems to be: we’ll be ready, bring it on. Here’s a snapshot of their plan– On Target For Opening The Health Insurance Marketplace. And, for the next few months it’s well-worthwhile to keep watching Healthcare.gov as the site continues to develop and enhance its Welcome to the Marketplace efforts.
Industry Watch
Of course AHIP, the trade association for health insurers, has been actively tracking and reacting to ACA developments, from essential health benefits to age rating bands to ACOs. A summary can be found at AHIP Affordable Care Act. One of AHIP’s hot-button issues is the upcoming tax on health plans which can only add to the cost of policies. ACA’s new sales tax on health insurance starts at $8 billion in 2014, increases to $14.3 billion in 2018, and increases every year thereafter. It’s estimated this health insurance tax will exceed $100 billion over the next ten years…more than the new medical device tax and prescription drug tax combined. AHIP is backing legislation to repeal the health insurance tax, which now has 218 co-sponsors in the House.
More To Come
The buzz will intensify as the political noise continues (i.e., 37 attempts to repeal ACA, most recently masked in a Republican call for “permanent delay”). At the same time, reality is that the Administration intends on keeping its promise to provide access to health insurance to the uninsured and uninsurable. Critical stakeholders need to forward in preparing for ACA’s implementation:
Payers Over the next 8-years
it’s estimated that $1 trillion in ACA revenue will be in-play for insurers,
with $23 billion in subsidies expected to flow through Exchanges in 2014. Of the 30 million newly-insured
Americans under the ACA, 32% are expected to get coverage from Medicaid, 45%
from individual exchanges (and private insurers), and 23% from their employers
according to PricewaterhouseCoopers Health
Research Institute.
Providers The onslaught of 30 million patients ready to use shiny new insurance cards with pent-up demand from chronically uninsured who have been forgoing needed medical care and devoid of preventive services means a huge stress-test for the U.S. primary care system; one already stretched to its limits with 60 million Americans lacking adequate access to primary care due to a shortage of physicians in their communities. For more background see Kaiser Family Foundation’s repost Primary Care Shortage.
Consumers Explaining the inner working of a Health Insurance Marketplace or describing new rules around premium calculation and “limited networks” won’t be easy. Consumers need to know how ACA affects them and what to do. They need help making the right choice. One recent example is the partnership formed between the national Blues Association and Walgreens (two organizations with big stakes in the ACA game!). The centerpiece of their campaign is to promote the health care law and encourage people to use marketplaces to shop for health coverage. It includes in-store advertisements and informational brochures to direct consumers to a new website, learnaboutreform.com.
Finally, if you haven’t had an opportunity, review my recent piece entitled ”Shift Happens: Healthcare's Ecosystem In Turmoil”.