Stakeholder implications of the Supreme Court decision on the Accountable Care Act

The upholding of President Barack Obama's healthcare reform bill has translated into important implications for various stakeholders. In this brief article, we will examine what these are and some strategies to deal with the impending changes.

Key Implications

Patients:

·        Must enroll by 2014 for health insurance coverage or face penalties on income tax by 2015 (doesn’t apply to individuals who aren’t required to pay taxes)

·        Ability to get insurance at affordable rates by having options offered by insurance exchanges

·        Children up to age 26 will be able to stay on parent’s plan. This can serve as a trial period giving youngsters time to find their own insurance.

Insurers:

·        Prohibit community rating for setting premiums

·        Can’t discriminate children based on pre-existing conditions

Employers:

·        Must subscribe to health insurance exchanges

·        Small business less than 100 employees can face penalties for not providing insurance to employees

·        Small businesses receive subsidies to help all employees get medical coverage

States:

·      Decide whether to participate in providing Medicaid expansion to their citizens which may imply that after 2014 must impose heavy taxation to keep it sustainable

·        Those that do decide to participate in the expansion must have a way of tracking individuals who do and do not enroll

·        States will still receive current Medicaid funding from feds even if opt not to participate in expansion program

·        Must set up health insurance exchanges by 2014




(reference- www.newsday.com - NY HIE article)

Strategies to prepare

Patients- Start inquiring and understanding about various plans offered, discuss with your employer benefit changes they may make, enroll children in plans

Insurers – re-structure plans and offerings; understand the impact that health insurance exchanges may have on their business model/financial strategy

Employers- make sure all employees are being enrolled, understand which plans to accept in benefit offerings, and comply with requirements for receiving subsidies (small businesses only)

States- work fast on setting up health insurance exchanges, re-examine risk/benefits in offering Medicaid expansion coverage, and develop adequate IT systems/process for tracking who in the population is in enrolled in Medicaid.

The full after-effects of the Accountable Care Act (ACA) law will only become
apparent in the next several years as various stakeholders take actions to
either comply or react to the coverage, access and quality of care initiatives
set in motion by Obama care. If you ask, Dr. Chawla this a trial period in which the country
will see whether we can fix our healthcare system.

In future articles, we will look more by in-depth by identifying which strategic options and tactics need to employed by organizations to remain compliant with ACA mandates.