Summary: What can we expect in 2013 in terms of healthcare? Will it be more “affordable”? Will it be more “accessible”? Will there be “value” added? Just how affordable will healthcare be in 2013?

2013 is right around the corner.  So, what can we expect in terms of provisions of the Affordable Healthcare Act (ACA) which will become effective? Actually, 2013 is a relatively benign year for the ACA. 2014 is going to be the big one.

There are only 4 provisions which will become effective in 2013:

  1. Improving preventative health coverage – The purpose of the provision is to provide certain preventative services without having to pay co-payment, co-insurance, or deductible. While this seems good on the surface, these provisions may or may not be available to you based upon such issues as whether your plan is “grandfathered”, whether you are using “in-network” providers, and whether your physician includes these in the office visit fees. This provision seems to provoke more questions than provide answers. The list may include:
    1. Blood pressure, diabetes and cholesterol screening
    2. Cancer screenings, including mammograms and colonoscopies
    3. Counseling for such issues as quitting smoking, losing weight, depression and alcohol abuse
    4. Well baby and well child visits up to the age of 21
    5. Routine vaccinations such as measles, polio, flu and pneumonia
    6. Counseling, screening and vaccines to ensure a healthy pregnancy
    7. Expanding authority to bundle payments – The purpose of this provision is to create a bundling effect for how affordable will healthcare be in the decades to come? reimbursement of services. For example, if you have surgery, there would be one claim sent to Medicare rather than separate claim filing from the Anesthesiologist, the Surgeon, and the hospital. It is supposed to promote the continuity of care and provide efficiency in the reimbursement arena. This will be interesting to see how this works. It may increase the time in which reimbursement occurs which will cause dissatisfaction among providers.
    8. Increasing Medicaid payments for Primary Care Physicians – This provision is designed to help offset the reduced number of Medicaid patients seen by each physician in 2013 and 2014. It will be fully funded by the Federal government. The intent is to increase the number of physicians by dangling the carrot of increased Medicaid reimbursement. I don’t see any negatives in terms of primary care physicians but wondering how the Federal government is going to fund this when a multi trillion dollar debt exists.
    9. Providing additional funding for the Children’s Health Insurance Program– This provision extends the funding to states for an additional two years. The CHIP plan covers children whose families are unable to afford insurance but don’t qualify for Medicaid. In theory, this is a great program, but decreasing the Medicaid required income level could fix the issue without creating another federal plan.

The Affordable Care Act has a number of great provisions. I think we need to ask a few questions: How will the Federal government provide funding for these? Will it increase the accessibility and affordability to consumers? What will the impact be upon physicians and other providers? For a full list of all of the provisions of the ACA, please visit

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