A lot is changing in health care. We can help you meet the new requirements.

In March of 2010, President Obama signed the Affordable Care Act into law. This extensive set of new guidelines (commonly known as “health care reform”) establishes comprehensive health insurance reforms that will be implemented over the course of several years.

Most changes to health insurance and medical care will be in place by 2014, although a few requirements will be implemented later. Since the Affordable Care Act became law, many changes have already taken place that affect both individuals and employers — changes that you can benefit from today.

In particular, you should be aware of changes that affect how you receive health care services (see “Patient’s Bill of Rights” below) and how the changes in the law now allow for small-business tax credits.

The new law helps small businesses and small tax-exempt organizations afford the cost of providing health-care coverage to their employees. If your company has less than 25 employees and you provide health insurance, you may qualify for a small-business tax credit of up to 35% (up to 25% for nonprofits) to offset insurance costs. In 2014, this credit will increase to 50% (35% for nonprofits). Through these tax credits, the cost of providing insurance to employees will be much lower.

Throughout this ongoing process of health care reform, DCA Insurance can be your trusted guide in navigating important changes. Our staff understands the scope of implementation and can provide you with the information and resources you need to make informed insurance decisions.

Although many features of the new law are already in place, the following timeline serves as a guide for changes yet to come:

Remaining in 2011

• Introducing New Innovations to Bring Down Costs.The Independent Payment Advisory Board will begin operations to develop and submit proposals to Congress and the President aimed at extending the life of the Medicare Trust Fund. The Board is expected to focus on ways to target waste in the system, and recommend ways to reduce costs, improve health outcomes for patients, and expand access to high-quality care.
• Increasing Access to Services at Home and in the Community.The Community First Choice Option allows states to offer home and community based services to disabled individuals through Medicaid rather than institutional care in nursing homes.

2012

• Linking Payment to Quality Outcomes. The law establishes a hospital Value-Based Purchasing program (VBP) in Traditional Medicare. This program offers financial incentives to hospitals to improve the quality of care. Hospital performance is required to be publicly reported, beginning with measures relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients’ perception of care.
• Encouraging Integrated Health Systems.The new law provides incentives for physicians to join together to form “Accountable Care Organizations.” These groups allow doctors to better coordinate patient care and improve the quality, help prevent disease and illness and reduce unnecessary hospital admissions. If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save.
• Reducing Paperwork and Administrative Costs.Health care remains one of the few industries that relies on paper records. The new law will institute a series of changes to standardize billing and requires health plans to begin adopting and implementing rules for the secure, confidential, electronic exchange of health information. Using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and most importantly, improve the quality of care.
• Understanding and Fighting Health Disparities. To help understand and reduce persistent health disparities, the law requires any ongoing or new Federal health program to collect and report racial, ethnic and language data. The Secretary of Health and Human Services will use this data to help identify and reduce disparities.
• Providing New, Voluntary Options for Long-Term Care Insurance.The law creates a voluntary long-term care insurance program – called CLASS – to provide cash benefits to adults who become disabled.

2013

• Improving Preventive Health Coverage.To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost.
• Expanding Authority to Bundle Payments. The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care. Under payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare.
• Increasing Medicaid Payments for Primary Care Doctors. As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government.
• Providing Additional Funding for the Children’s Health Insurance Program.Under the law, states will receive two more years of funding to continue coverage for children not eligible for Medicaid.

2014

• Prohibiting Discrimination Due to Pre-Existing Conditions or Gender. The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, the law eliminates the ability of insurance companies to charge higher rates due to gender or health status.
• Eliminating Annual Limits on Insurance Coverage.The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive.
• Ensuring Coverage for Individuals Participating in Clinical Trials. Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial.
• Making Care More Affordable. Tax credits to make it easier for the middle class to afford insurance will become available for people with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. (In 2010, 400% of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four.) The tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time. It’s also refundable, so even moderate-income families can receive the full benefit of the credit. These individuals may also qualify for reduced cost-sharing (copayments, co-insurance, and deductibles).
• Establishing Affordable Insurance Exchanges. Starting in 2014 if your employer doesn’t offer insurance, you will be able to buy it directly in an Affordable Insurance Exchange. An Exchange is a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance through Exchanges, and you will be able buy your insurance through Exchanges too.
• Increasing the Small Business Tax Credit.The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations. In this phase, the credit is up to 50% of the employer’s contribution to provide health insurance for employees. There is also up to a 35% credit for small non-profit organizations.
• Increasing Access to Medicaid.Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years.
• Promoting Individual Responsibility. Under the law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans. If affordable coverage is not available to an individual, he or she will be eligible for an exemption.
• Ensuring Free Choice. Workers meeting certain requirements who cannot afford the coverage provided by their employer may take whatever funds their employer might have contributed to their insurance and use these resources to help purchase a more affordable plan in the new health insurance Exchanges.

2015

• Paying Physicians Based on Value, Not Volume.A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care.

(A more detailed version of this timeline can be found at the official Affordable Care Act government Web site.)

LDCA Insurance can help you understand and benefit from the changes in health care reform. Let us be your trusted partner in preparing for a healthy future.

DCA Insurance looks forward to providing you with the professional, personalized service you deserve. Call (954) 349-7103 or e-mail us for a FREE, no-obligation quote today.