Summary: January 1, 2014 is rapidly approaching and this date is the effective date for many major provisions of the ACA. What is the status of these issues? Where do we stand as a country?

The Patient Protection Affordable Care Act (PPACA) has some of the most significant provisions becoming effective in 2014. The PPACA was designed with one of the goals to provide health insurance for more Americans.

In order to accomplish this goal, the following have been slated:

• Expansion of Medicaid to more Americans. While this is good in theory, it isn’t being implemented consistently across the US. Individual states have the opportunity to either expand Medicaid coverage or not. So, if you are one of the lower income Americans, it depends upon which state you reside as to whether you will be eligible for Medicaid.
• Employer mandate. The employer mandate requires most employers to provide insurance to their full time employees. Full time in this respect is 30 or more hours per week and slated to apply to those companies who have more than 50 employees. In order to comply (or not have to comply), companies have begun reducing employee hours to under 30 which takes them out of the total on which the mandate is based and doesn’t require them to be covered under health insurance plans. The employer mandate has been postponed until 2015 which should give companies more time to figure out how to comply. With that being said, employees who thought they would be offered coverage through their employers and who currently don’t have insurance coverage, will be forced to seek insurance through the exchanges. This one is certainly a political issue. With the delay, it causes Republicans to once again question the validity of the PPACA.
• Individual mandate. The individual mandate requires most Americans to have health insurance coverage or face a penalty. As of today, this provision is still slated to take effect as of January 1, 2014, with open enrollment beginning October 1, 2013.
• Healthcare exchanges/marketplaces. As of January 1, 2014, the health exchanges are required to be up and running. Right now, that is a very tight window and there is a possibility of delay, however, HHS is confident that no delay will be necessary. Some of the issues surrounding the exchanges include: the subsidy portion in which consumers are required to provide proof of income to see what if any federal subsidies they might be entitled, the technological issues to setup a portal that will be able to communicate insured information across federal and state as well as with insurance companies, and the privacy protection of this protected health information. These are all major hurdles and things seem to be going according to plan as long as no additional changes are recommended.  The administration’s limited staff and financial resources are also of concern and could add to the probability of delay. In order to somewhat fast-track the creation of the exchanges, the requirement that exchanges verify the health insurance and income status of applicants has been delayed along with the star quality ratings for insurance companies.

These are significant initiatives which are either slated for 2014 or have been delayed until 2015. Healthcare Reform has been deemed one of the most significant healthcare enactments since the creation of Medicaid and Medicare in 1965. Time is growing short to have everything in place to be able to remain on schedule. Any little glitch in terms of technology or any additional proposed changes could certainly impact the effective date. It will be important to stay abreast of these changes and learn how they may affect you.

About BHM Healthcare Solutions – www.bhmpc.com

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development.

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