ACA Out-Of-Pocket Caps Waived Until 2015

The Affordable Care Act (ACA) hit another speed-bump before numerous mandates rollout October 1, 2014. Caps on out-of-pocket insurance costs such as co-pays and deductibles will be delayed until 2015. According to Forbes, the limits on out-of-pocket costs for 2014 were supposed to be $2,000 for individual policies and $4,000 for family policies. As a result of the delay, consumers may end up paying more out-of-pocket expenses for doctors’ services, hospital care and prescription medications.

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Breaking Down ObamaCare Employer Mandate

Employers with 50+ full time employees who chose to opt out of providing Minimum Essential Coverage (MEC) face multiple tax penalties under the ACA employer mandate.  If the employer offers MEC plans, they avoid a yearly $2,000 tax per employee and the employee who enrolls satisfies the individual mandate.  Consequently, if the plan offered by the employer does not have Minimum Value (MV) the employer can still be subject to a tax of $3,000 for employees who decline the employers’ plan and shop at a state or federal exchange.  Minimum value plans must cover at least 60% of the costs of services covered under the plan and cost no more than 9.5% of the employees W-2 earnings.  If an employer wishes to avoid all potential penalties under ObamaCare, it may be in their best interest to offer both a MV plan and a MEC plan.

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HMS Blog Series: Impact Of Federal Health Reform

HMS Healthcare Management Solutions will be issuing a series on the impact of federal health reform.  We’ll break down consumer rights and protections, insurance options and provide an overview of some of the programs already in place in Connecticut.

Look for Part I of our special series on the HMS blog later today and continue to check in for more as we continue to sift through the results of the decision.

Health Reform Series Part X: The Law

HMS Healthcare Management SolutionsThere are four legal issues are at stake in today’s pivotal decision on the Patient Protection & Affordable Care Act (PPACA).  Below is a brief synopsis of the legalities facing health care reform from NBC News.

1. Can challenges to the law can be resolved now or must they wait until 2015 when the federal government begins collecting penalties from people who refuse to buy insurance as required by the PPACA.

2.  Is the PPACA’s individual mandate unconstitutional? The Constitution gives Congress the power to regulate interstate commerce, but not the power to force a non-buyer to become a buyer.

3.  Can part of the PPACA be removed while leaving the remainder intact?  Or does the entire law have to be struck down because each of its parts were designed to work together?

4.  Is the PPACA’s Medicaid provision, which adds nearly 30 million more people to the insurance program for low-income Americans, unconstitutionally coercive because it forces states to go along with the expansion?

The nation holds its collective breath as it awaits the verdict sometime today.

Health Reform Series Part IX: Hospitals

The value of for-profit hospital stocks rests in the hands of the U.S. Supreme Court.

Hospital stocks could take a big hit if the high court throws out the entire Patient Protection and Affordable Care Act (PPACA), driving down shares by as much as 10%.  Conversely, stocks would likely jump 10% should the high court uphold the legislation.

A report earlier this month from Moody’s Investors Service warned a full or partial repeal of the health reform law would hurt for-profit hospitals as they will face increased exposure to bad-debt and reduced reimbursements.

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Health Reform Series Part VIII: National Debt

HMS Healthcare Management SolutionsThough the health reform debate has covered many topics, one of the big questions has always surrounded its potential impact on deficits. The nonpartisan Congressional Budget Office (CBO) has estimated health reform could modestly reduce deficits in the first 10 years and much more in the years to follow, but those estimates could change after the Supreme Court rules on health reform tomorrow.

Below are some of the possible fiscal ramifications:

Law Upheld: Even if the Affordable Care Act is upheld, there are likely to be changes in assessing the law’s costs and savings, such as new forecasts about health care costs and employment. The CLASS Act, a long-term care insurance program that would have helped seniors in need of assistance with daily tasks, has already been eliminated – the deficit-reduction potential of health reform by roughly $80 billion in the first decade.

Law Overturned: In February 2011, the CBO estimated that a bill to repeal the law would have increased deficits by $210 billion. In addition, an estimated 30 million who would have been insured under the law would remain uninsured.

Law Repealed: A repeal of the mandate could reduce deficits by $282 billion over 10 years. Fewer people would buy insurance, and therefore the federal government would spend less on the new insurance subsidies intended to help eligible individuals and families pay for their policies.

Medicaid Expansion Overturned: The law calls for an expansion of eligibility for Medicaid, and it provides additional federal money to states to cover it. States that choose to participate in Medicaid must accommodate the expansion or potentially risk losing other federal matching funds for the program.

Healthcare Reform Series Part VII: Physicians

The Patient Protection and Affordable Care Act (PPACA) will implement numerous changes impacting physician providers.  Several of these provisions affect primary care physicians and specialists separately, while other provisions will impact all physician providers with an increased focus on the coordination of patient care.

Below is an overview of some of the impacts of health reform may have on physicians.

  • Medicare bonus payments to primary care physicians in rural areas in an effort to increase access to care
  • Implementation of a relative value based modifier to enable physician payments based on quality metrics
  • Various expanded regulatory compliance and disclosure requirements
  • The expansion of fraud and abuse compliance
  • The launch of the Physician Compare website which has information about Medicare-enrolled Physicians and Healthcare Professionals
  • Various demonstration projects and new delivery models, including ACOs, to test the effectiveness of various reform initiatives
  • Expanded funding for scholarships and loan repayments for primary care providers

Changes to the U.S. healthcare delivery system under the PPACA are intended to improve the quality of care delivered to patients, as well as to reign in healthcare costs and increase patient access.  A ruling by the Supreme Court on healthcare reform is slated for this Thursday, June 28.