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The Affordable Care Act

Quick Facts

  • Provides sliding scale tax credits to help businesses (2010-2013) purchase health insurance for their employees. In order to be eligible for tax credits, businesses must employ no more than 25 people and average annual wages must be less than $50,000. Small employers would have to contribute at least 50 percent of the cost of employees’ health insurance to receive tax credits.
  • Provides a $250 rebate to Medicare beneficiaries who hit the prescription drug “donut hole” this year and closes it completely by 2020.
  • Eliminates deductibles, copayments, and other cost-sharing for preventive care, and provides free annual wellness check-ups for Medicare beneficiaries starting in 2011.
  • Creates a new Medicare and Medicaid Center on Innovation to accelerate pilot-testing of innovative payment and delivery system reforms, including Patient-Centered Medical Homes.
  • Creates additional primary care residency slots for 500 new primary care physicians by 2015.
  • Gives 10% Medicare bonus payments to primary care physicians and general surgeons practicing in underserved areas and 5% Medicare bonus payments for mental health providers
  • Insurance plans that offer a family coverage plan must offer coverage to enrollees’ adult children until age 26 even if the young adult no longer lives with his or her parents, is not a dependent on a parent’s tax return, or is no longer a student. 
  • Insurers and plans will be prohibited from rescinding coverage – for individuals or groups of people – except in cases involving fraud or an intentional misrepresentation of material facts.
  • Creates new standardization rule for health insurance claims processing requirements allowing for easier tracking of claims which should improve revenue cycles and lower overhead costs.

 

The Challenge

In 2009, 49 million Americans were uninsured. 14,000 lost their insurance every day during the economic downturn. Those who are insured are facing rising premiums and the ever-present threat of having their care denied for pre-existing conditions. Physicians spend an average of 8 hours a week on paperwork instead of taking care of patients. Our primary care system is in crisis with only 12% of medical students choosing to go into primary care. Despite having some of the best hospitals in the world, our health care indices fall far behind that of other industrialized nations.

The Opportunity

In March 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law after a year-long national debate. While no single piece of legislation can fix our health care system, this was a significant step forward to address the challenges in our healthcare system.  The new health reform law is both comprehensive and complex. It will take time to fully digest and even longer to implement. A number of key provisions in the new law will have an immediate impact on your practice and your patients, while others will take years to implement.

The Affordable Care Act expands access to health care for all Americans, creates new incentives to change clinical practice to foster better coordination and quality, gives physicians more information to make them better clinicians, patients more information to make them more value-conscious consumers, and changes the payment system to reward value.

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