12 Days of Obamacare

12 days of ObamacareSummary: Keeping with the theme of the season, we thought it only fitting to create an article on the 12 days of Obamacare.

The Affordable Care Act a.k.a Obamacare was enacted in 2010 with provisions becoming effective through 2015 and beyond. The goals of this legislation are to provide care which is affordable, accessible, accountable, coordinated, and of high quality while reducing healthcare spending. Following are the 12 days of Obamacare:

On the 1st day of Obamacare, Obama gave to me…

an individual mandate

The individual mandate requires all Americans (with few exceptions) to carry health insurance coverage or face a penalty. This particular provision was highly disputed as to whether it or not it was considered a “tax”. Final ruling deems it to be a “mandate”.

On the 2nd day of Obamacare, Obama gave to me…

healthcare exchanges

and an individual mandate12 Days of Obamacare

Healthcare exchanges become effective January 1, 2014 with an open enrollment period of October 1, 2013 through December 23, 2013. The exchanges are marketplaces in which consumers can shop different plans and different companies in one place, generally on-line, however, other enrollment opportunities exist such as via phone or kiosks.

On the 3rd day of Obamacare, Obama gave to me…

preventive care

healthcare exchanges

and an individual mandate

Preventive care is available for most Americans covered under insurance plans for procedures such as mammograms and colonoscopies. The ACA began with the Medicare population and has expanded through to the Medicaid population.

On the 4th day of Obamacare, Obama gave to me…

no preexisting

preventive care

12 days of Obamacarehealthcare exchanges

and an individual mandate

Pre-existing conditions are a thing of the past in terms of being denied for coverage solely for this reason or from being charged higher premiums.

On the 5th day of Obamacare, Obama gave to me…

affordable healthcare

no preexisting

preventive care

healthcare exchanges

 and an individual mandate

This provision is still up for debate in ter12 days of Obamacarems of “affordability”. Many individuals will pay substantially higher premiums in 2014 than they did in 2013. One reason is trying to level the playing field. Leveling the playing field in essence requires a large number of young healthy individuals to enroll to balance out the healthcare costs associated with the older population. At this point, many in the young healthy group are opting to take the penalty rather than insurance coverage. This could definitely upset the applecart.

On the 6th day of Obamacare, Obama gave to me…

increased age for children

affordable healthcare

no preexisting

preventive care

healthcare exchanges

and an individual mandate

In 2010, the ACA expanded coverage permitting children to be covered under their parent’s policies until the age of 26.

On the 7th day of Obamacare, Obama gave to me…

Medicaid expansion

increased age for children

affordable healthcare

no preexisting

preventive care

healthcare exchanges

and an individual mandate

12 days of ObamacareMedicaid expansion was designed originally for each state to expand coverage up to 138% of the poverty level. There were many issues surrounding the passing of this particular provision and whether or not it was constitutional. In the end, it was left up to each individual state as to whether or not to expand. This individual state decision also affects who is eligible for the health insurance exchanges by state.

On the 8th day of Obamacare, Obama gave to me…

Accountable Care Organizations

Medicaid expansion

increased age for children

affordable healthcare

no preexisting

preventive care

healthcare exchanges

and an individual mandate

Accountable Care Organizations are the new buzz word. The term refers to a neighborhood of medical homes or a group of organizations, hospitals, and physician practices who form an alliance with the purpose of reducing healthcare costs and increasing the quality of care – 2 important goals of the ACA.

On the 9th day of Obamacare, Obama gave to me…

health insurance subsidies

Accountable Care Organizations

Medicaid expansion

increased age for children

affordable healthcare

no preexisting, preventive care

healthcare exchanges

and an individual mandate12 days of Obamacare

Health insurance subsidies are exclusive to the public health insurance exchanges. They are designed to assist those in income brackets from 100% to 400% of the poverty level. To qualify, financial information must be supplied at the time of enrollment to determine if a subsidy is applicable, and if so, how much.

On the 10th day of Obamacare, Obama gave to me…

bundled payments

health insurance subsidies

Accountable Care Organizations

Medicaid expansion

increased age for children

affordable healthcare

no preexisting, preventive care

healthcare exchanges

and an individual mandate

Bundled payments refer to a single12 days of Obamacare payment paid for a procedure across multiple providers rewarding for the coordination of care rather than each provider billing separately for their part of the service rendered. The intent is to focus upon coordination and quality of care.

On the 11th  day of Obamacare, Obama gave to me…

employer mandates

bundled payments

health insurance subsidies

Accountable Care Organizations

Medicaid expansion

increased age for children

affordable healthcare

no preexisting

preventive care

healthcare exchanges

and an individual mandate

Employer mandates are 12 days of Obamacaresimilar to the individual mandates except they are assessed to the employer for not providing health insurance coverage options to their full time employees. This provision has also received quite a bit of controversy. According to the ACA, a full time employee is deemed to work at least 30 hours per week. There are 2 groups of employers, those with 50 or less employees and those with greater than 50 employees. These groups are treated separately in terms of when they have to comply. Both have been pushed out beyond 2014.

On the 12th day of Obamacare, Obama gave to me…

value based purchasing

employer mandates

bundled payments

health insurance subsidies

Accountable Care Organizations

Medicaid expansion

increased age for children

affordable healthcare

no preexisting

preventive care

healthcare exchanges

and an individual mandate

Value-based purchasing is also becoming a new buzz word. The traditional payment system based upon volume is being replaced with payments 12 days of Obamacarebased upon value or a shift from quantity to quality. Consumers are beginning to do cost/benefit analysis on their services. Price is not the only factor. Consumers are weighing what they receive with what they have to give up. Cost are not only tangible but can have an intangible component as well. This provision is also tied in with the goal of increasing the quality of care.

These are the 12 days of Obamacare. There are many other provisions, of course, but this highlights some of the major ones. The ACA is concerned with affordability, accessibility, accountability, coordination of care, and quality while balancing reducing healthcare spending.

BHM Healthcare Solutions – www.bhmpc.com 

If you need assistance sorting out and complying with the Affordable Care Act, please contact us at 1-888-831-1171 or results@bhmpc.com.

Our main service lines include:

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Also to assist you with provisions of the ACA, we have a white paper entitled “The ACA in a Nutshell”. Please click on the icon below to download a copy.

The Affordable Care Act in a Nutshell

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Posted in Care Coordination, Health Care Reform, Health Insurance, Health Insurance Exchange, Healthcare Prevention, Learning Series, Medicare and Medicaid, Services

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