Changes to healthcare in 2013

While the bulk of changes will occur in 2014, some phases of the Patient Protection and Affordable Health Care Act will be implemented throughout 2013.

The Affordable Care Act, also known as “Obamacare” became law in March 2010. According to the website healthcare.gov, the law puts in place comprehensive health insurance reforms across a four-year period. It seeks to provide all Americans with access to affordable insurance options.

Health care exchanges will be set up throughout 2013. The exchanges are sort of an online menu for health insurance. The website lets consumers choose from different companies based on their needs. The new law requires states to set one up, or the federal government will set one up for them.

Missouri, and 28 other states, decided to give the federal government the chance to go ahead and take care of that. Proposition E was passed by Missouri voters in November. That proposition, unique in the entire nation, actually prohibited the governor or any state agency from setting up an exchange without the legislature’s blessing. The proposition does not prohibit the legislature from setting up a healthcare exchange in the future.

States have until Feb. 15 to submit proposals for a state-federal partnership. The exchanges are projected to open for business on Oct. 1, 2013.

Medicare taxes will increase in 2013. According to the Internal Revenue Service, an increase of .9 percent will be added to those who file jointly and make more than $250,000 a year and single filers who make more than $200,000 a year. This increase is from the current 2.9 percent to 3.8 percent. A complete description of the increase and stipulations are available at the website www.irs.gov.

Insurance companies will be required to send consumers a basic, “plain English” summary of benefits and coverage in 2013. This summary was also required for companies who held an open enrollment after Sept. 2012.

According to the U.S. Department of Health and Human Services (DHSS) Affordable Health Care timeline, preventive health coverage will be improved this year. The law will provide new funding to state Medicaid programs that cover preventive services at little or no cost.

“Bundling” has been a marketing favorite of telephone and cable TV companies, now healthcare providers can jump on the bandwagon too. According to the DHSS, under payment bundling, providers are paid a flat rate for an episode of care rather than having each service billed separately. This will take effect Jan. 1.

Medicaid payments for primary care doctors will increase effective Jan.1. The new law requires states to pay primary care physicians no less than 100 percent of Medicare payment rates in 2013 and 2014 for primary care services.

One of the reasons for that increase, according to the Obama Administration, is to inspire medical students to specialize in preventive care due to a projected shortfall of physicians in that arena. The availability of $250 million provided by the Affordable Care act will support the training, development and placement of 16,000 new primary care providers over the next five years.

The Children’s Health Insurance Program (CHIP) will receive two more years of funding effective Oct. 1. That program provides coverage for children in families who earn too much to qualify for Medicaid, but can’t afford private insurance.

Since its implementation the law has sought to add new consumer protections, lower healthcare costs and increase access to care. One of the most important aspects of Obamacare went into place in 2010 when the federal law prohibited denying coverage for children based on pre-existing conditions. In 2014 the law will prohibit denying coverage based on pre-existing conditions for all.

Also in 2014, Americans will see the most debated part of the act take effect. Effective Jan 14, according to healthcare.gov, Americans must be enrolled in a health insurance plan that meets basic minimum standards. If not, they may be required to pay an assessment. Low income households will not have to pay. A waiver may also be granted for religious beliefs or other reasons.

Obamacare is a wide, sweeping law aimed at healthcare reform. The 974-page law contains dozens of actions related to healthcare. More of the act is scheduled to be implemented in 2014. For a complete description of the act and a timeline visit the website www.healthcare.gov.

Pat Pratt is a reporter for the Daily Journal and can be reached at 573-431-2010 ext. 172 or ppratt@dailyjournalonline.com