Now that “The Patient Protection and Affordable Care Act” (ACA) has taken effect how will you be affected. I have broken down by group how the implementation of ACA will effect different groups of people. As you will see most people are negatively affected by ACA but you can judge that for yourself.
Medicare Recipients
There is a little good news for those on Medicare. The “donut hole” in the Medicare prescription drug coverage will be eliminated by 2020. However the bad news is too fold. First, a reduction in coverage and second, a limit to access. In July 2012 the Congressional Budget Office projected $716 billion would be cut from Medicare. The cuts will fall into three categories: 1. the reduction in the number of plans available to seniors, 2. elimination of Medicare Advantage Plan benefits, and 3. reduction in reimbursement rates to Providers.
Although the President has promised that the quality of care seniors receive will not be affected by the reduction in funding, Well, that remains to be seen. Think about the number of Physicians, Clinics, and Hospitals that might stop servicing seniors when they are paid less. The healthcare system in America already expierences a shortage of Primary Care Physicians (PCP). What happens to seniors when PCP’s refuse to treat Medicare recipients because they no longer accept Medicare as a form of payment? What happens when PCP’s decide to retire altogether and leave the system which is already expierencing a shortage of PCP’s?
A provision of the ACA is the implementation of the Independent Payment Advisory Board (IPAB). This board is a Presidential Commission with appointments by the President. They are independent meaning it takes a super majority (3/5) for Congress to over ride any of there determinations. They will not be held accountable at the voter box. Congress and the Administration can point to IPAB as the problem with out any political fall. Further the IPAB is specifically taxed with cutting spending in Medicare. This will be harder on seniors
Employees with Employer Provided Insurance
With all the negative news for employees there is one thing the ACA provides that is positive. Insurance companies will not be able to impose annual or lifetime benefit limits to coverage. Small businesses may benefit from buying insurance in the exchange as it most likely will be cheaper than buying insurance outside the exchange.
Employers such as Dominos may not be willing to provide any insurance benefits by limiting the number of hours worked to remain part time (under 30 hours a week). Large employers may decide to no longer provide coverage to employees especially in industries that do not need to use insurance as an incentive to compete for employees. They may just decide to pay the fine of $2,000 per worker which may be significantly cheaper than providing insurance. It is estimated that up to 30% of large employers may drop insurance coverage for their employees.
Private Insurance buyers
If you buy health insurance because you are self-employed or find yourself in circumstances the you have private insurance, you may benefit from ACA. That is because the new law was designed to level the playing field. Private has always been more expensive with significant restrictions then group insurance. Under ACA you will be able to buy from the exchanges as well which will be cheaper than buying insurance outside the exchange.
Uninsured
This group in particular benefits the most from ACA. That is because they now have access to the same exchanges that are available to the insured. For those individuals and families that were outside of Medicaid because they made to much, they will now be able to enroll in health insurance through the exchange and depending upon income level will receive a government subsidy that may cover 100% of the cost of insurance.
Medicaid/CHIP
If you are enrolled in your State Medicaid program or CHIP (the Children’s Health Insurance Program) you will not be affected very much by ACA. That’s because these programs are in place for the poor, disabled, very sick, and children. Many PCP’s don’t accept Medicaid patients because of the very low reimbursement rates. The goal of ACA is to raise reimbursement rates to Medicare rates. So more PCP may begin accepting new patients.
But with the enrollment of some 15 million people into State Medicaid programs over the next ten years the system is most likely to be overwhelmed. With the shortage of PCP’s access is most likely an issue.
And if you live in State that has more generous enrollment programs you might actually lose your Medicaid benefits.
Well that’s enough for today!