Health Care Reform Research Paper
Final Paper; Healthcare Reform
Ottawa Online
Nicol Britten
BUS 7303 Legal, Ethical & Political Aspects of Health Care Management
Armando Nunez
October 4th, 2012
Table of Contents
Abstract……………………………………………………………………...Page 3
Introduction………………………………………………………………….Page 4
Political Viewpoints…………………………………………………………Pages 4-5
Affordable Healthcare Act (AHA)………………………………………….Pages 5-6
Access to Care……………………………………………………………….Pages 6-7
Impact; Businesses and Employees………………………………………….Pages 8-9
Conclusion…………………………………………………………………..Pages 9-10
References…………………………………………………………………..Page 11
Abstract
Today, Citizens of the United States and American business is on the verge of one of the biggest changes in American healthcare history. Whether you on the right side (Republican), or the left side (Democratic), of the argument one thing is for certain, if you live in this great country changes in the way you seek healthcare are imminent. In addition, those working in healthcare face the additional responsibility of preparing and planning business strategies to ensure an organizations vitality and survival in during this time transition. This paper will touch on the U.S. history in healthcare as well as, …show more content…
explore the Affordable Healthcare Act (AHA) and the potential impact AHA will have to providers and employers.
Introduction
For Centuries we as a country have debated whether the government should play a role in helping people have access to and afford healthcare. Yet the argument goes beyond government’s role, the debate includes complex issues surrounding both the fundamental right of access to healthcare and who should and will pay for it. From President Roosevelt’s support of creating national health insurance in 1935 to Presidents Richard Nixon’s passion to require all employers to cover workers 1974, which was later derailed by the Watergate scandal, to President Ronald Regan’s signing of the COBRA Act in1986, requiring all employers to allow former employees to remain on company insurance for a period of 18 months at the former employees cost, healthcare and how to pay for it continues to be one of the hottest topics blazing the campaign trail.
When President Obama decided to run for office he took no exception, matter a fact, President Obama made Healthcare his primary campaign topic and so Healthcare Reform is born. In June of 2012, the Affordable Healthcare Act, now coined “Obama Care” was passed. The Supreme Court, in a 5-4 ruling, upholds the law, including its much-disputed mandate that almost all people in the U.S have coverage or pay a fine (Associated Press, June 2011) this making President Obama one of the first Presidents to carry out one of the biggest transition in healthcare history, but at what cost?
Political Viewpoints
The “cost” of reform is the question that is fueling much of the debate amongst political parties. With a federal deficit marking its fourth straight year in access of $1 trillion dollars and equating to approximately seven percent of economic output (Rueter, October 5, 2012) Healthcare reforms remains a politically charged subject to say the least. CBO and JCT now estimate that the insurance coverage provisions of the ACA will have a net cost of $1,168 billion over the 2012–2022 period—compared with $1,252 billion projected in March 2012 for that 11-year period—for a net reduction of $84 billion (CBO, July 2012) however, there is concern that this reduction will be covered through heavy taxation on benefits and fees to businesses.
There will also be a shift in business practice for providers moving from a pay for service module to a quality based payment module. The Democratic Party is presenting its argument for healthcare reform on a platform of all Americans should have access to health care. Republicans are fighting back and their argument is predicated on the cost of this plan, not necessarily on the fundamental disagreement that Americans should have access to care. Separately, Affordable Healthcare Act, the way it is written to enacts the concept of “bigger government” or more government control which is a fundamental difference in thinking between the two parties. One thing is for certain Democrat or Republican, the enactment of the Affordable Healthcare Act will inevitably affect each and every American in one way or another.
Affordable Healthcare Act Simply put, the Affordable Healthcare Act Law will extend coverage to 33 million Americans who would otherwise be uninsured (Klein, June 24, 2012) and includes health insurance reforms that will roll out over four years and beyond, with most changes taking place by 2014. That is the short version. The law itself is spread out over 2,409 pages which brings me to my first concenr, how may business pans do you know that have 2,409 pages of requirements and that have succeeded. For the purposes of this review, I will try to highlight the big changes related to access.
• For families living below the poverty line, that is making about $29,000 annually with a family of four, these families will qualify and be covered through the Medicaid plan.
• Those making between 133 and 400 percent of the poverty line or $88,000 for a family of four will get tax credits on a sliding scale to help pay for private insurance.
• Families making less than 400 percent of the poverty line will not have to pay more than 6.3 percent of their income in premiums and those in the 300-400 percent range up to 9.5 percent of their annual income.
The big difference between today and tomorrow is that tomorrow or as of 2014, everyone will have access to healthcare and those who have opted not to carry insurance will be required to do so dependent upon their living or face penalty. Consequently, employers and providers will be impacted and charged with the responsibility to make provision to both self-funded and fully- funded plans to accommodate the requirements and subsidize the cost for those with a cap on their premiums. Furthermore providers, need to gear up for lower negotiated rates with Medicare reimbursement and the impact that will have on the organizations payer mix, needless to say there is a lot of unknown. For those in the business of healthcare, what you need to know is that you will need to be able to provide better service, to more patients at less cost. The key here is that healthcare organizations now need to translate their services into Accountable Care and integrate a new business model that supports the quality, increase in volume and projected decrease in the amount reimbursed for care starting at the point of service.
Access to Care
By design, the Affordable Healthcare Act is intended to meet four specific goals: to give all Americans access to affordable healthcare options, allow individuals and smaller sized businesses to compare healthcare plans on an equal level, improve the quality of care, and lower costs. Interwoven as sub-goals are stricter regulations for insurance companies and a specific measure to reduce healthcare fraud which has said to have retuned more than $2.5 billion to the Medicare Trust Fund in fiscal year 2009 alone (Healthcare.Gov, October 2012.) Though controversy remains high and opinions differ as to if the AHA will achieve these goals one thing is without question, these reforms will provide millions of people with access to coverage that have been previously uninsured.
It is difficult for anyone to predict how this will impact individuals at the point of service other than to say that buried in the 2,409 pages of law is legislation that specifically sets out to expand coverage to young adults and retirees as well as, those with pre-existing conditions. This coupled with tax credits for middle to low income families, transition of low income families to be covered under Medicaid and a new focus on free preventative care in the battle to prevent disease and illness makes it safe to say that at the point of service the biggest change will be the availability of service.
In reference to emergency care, the Federal EMTALA law (Emergency Treatment and Active Labor Act,) governing healthcare’s responsibilities to treat patients in a medical or psychiatric emergency regardless of their ability to pay for service and without delaying treatment remains firmly in place. From a point of service and access, in my opinion I do not believe the patient will have a different experience; however, it will be interesting to see how the delivery of these emergency services will now impact healthcare organizations from a payment standpoint, specifically with the inevitable increase in Medicaid participants and anticipated decrease in reimbursement rates.
Impact to businesses and employees
Before we look at what will be required of us as healthcare consumers and employers let’s review what we are dealing with. In an article written titled “Cliff Notes Version of the Affordable Healthcare Act,” Carolyn McClanahan, Physician/Financial Planner and contributor to Forbes Magazines does a nice job of providing a brief summation that simplifies AHA and how this impacts insurance. She states, “It is important to understand how insurance will change. First, you cannot be turned down for coverage because you have an illness. Second, everyone is required to have coverage. It is the only way coverage is financially viable. Third, people who have difficulty affording coverage will get assistance paying for it unless they are under the 133% poverty level. Those people will go on Medicaid unless their state refuses to expand Medicaid.” (McClanahan, July 2012.) Perhaps the best way to look at what s on the horizon and what we need to prepare for is in a timeline format.
Between August and December of 2012 all health insurance plans beginning on or after August 1, 2012 must provide preventative healthcare services for women with no cost-sharing requirements.
In addition, a Summary of Benefits and Coverage (SBC) must be provided as part of all annual enrollments beginning on the 1st day of open enrollment and upon request for all plan years on or after September 23, 2012. An SBC is not required to include “accepted benefits” for example a stand-alone dental or vision plan. The must also be distributed at the time of new enrollment outside of the standard open enrollment period. There is a charge to the employer of $1000.00 per failure to provide the
SBC.
Looking forward to 2013, activities related to the Affordable Healthcare Act move into full swing. In January, healthcare consumers will see a decrease in their FSA salary reduction option, which is opportunity to withhold pre-taxed dollars to offset unreimbursed medical expense. In 2013 healthcare consumers will be allowed to take advantage of $2500.00 in pre-taxed saving versus the $3000.00 allowed in 2012. High income earners will also subject to an increase of 0.9% in Medicare tax and a new 3.8% Medicare tax will be imposed on unearned income. Some examples of unearned income may be spousal maintenance, Unemployment payments and Capital Gains.
From a business perspective, employers will see the eliminations of any previous deductions for subsidized retiree prescription drug expenses and will begin paying “fee payments.” Fee payments will be required for both fully funded and self-funded programs and will be calculated per covered life. Other Employer responsibilities will include assuming responsibility for ensuring that their group insurance plan that the data within is in compliance with HIPAA Certification guidelines, reporting the value of health insurance coverage for tax year 2012 and in March of 2013 providing employees with information about then availability of exchange coverage, in short, coordinating coverage options and the transition to those options based on the employees eligibility. Of course, the failure to comply with these regulations also comes at a cost. Employer and healthcare consumers alike are subject to fees and penalties for failures to compile with these regulations. This is where the question of “who is paying for this reform inlays?”
Conclusion
In conclusion, change is coming and quite frankly is already underway however, it has left Americans, Republicans and Democratic alike, with more questions than answers. Maybe this would not be so if the legislation was 2,000 pages versus 2,409 or maybe the quandary would remain the same. In the vast world of available information, it is interesting to me or not so interesting that if seeking such information, you would be hard pressed to find any formable and/or specific information outlining how the proposed Healthcare Reform will impact the U.S. bottom line. The danger in this is it leaves us to more of our philosophical debates and fluff versus what we are all really scared about, what if this fails? Will we be able to recover? How will that affect America’s economy? Would we be faced with a full collapse of our healthcare system?
With the lack of transparency surrounding the risk analysis of this program and any hard and fast projected financial outcomes, it leaves the program open to the substantial amount of ridicule it has endured. Admittedly, I am far from a political mastermind or world renowned economist but it seems to me if you want buy in on a program of this magnitude, the best way to obtain that is through education and transparency of outcomes. I know this is not an easy task taking into consideration the size of this audience, but I would like to be able to trust that the leader of the free world is up to the task versus asking me and the rest of America to simply believe in Hope and Change. For me, at this point, it seems more like we are hanging onto “hope this change will work.”
Reference List
Associated Press (June 2012). The history of the US Healthcare Reform effort. Retrieved from: http://www.foxnews.com/us/2012/06/27/us-health-care-reform-efforts-through-history/ Calmes, J. (July 2012). Delicate Pivot as Republicans Blast Rivals on Medicare Cuts, New York
Times, Retrieved from: http://www.nytimes.com/2012/07/07/us/politics/mixed-message-as-republicans-claim-health-law-cuts-medicare.html?_r=0
McClanahan, C. (July 2012). Cliff Note Versions of the Affordable Healthcare Act, Forbes
Magazine, Retireved from; http://www.forbes.com/sites/carolynmcclanahan/2012/07/09/cliffs-notes-version-of-the-affordable-care-act/ Showalter, J.S. (2012). The Law of Healthcare Administration, 6th ed. Washington, DC; AUPHA Press.
CBO (2012). CBO Releases two Analysis Related to the Affordable Care Act, Retrieved from: http://www.cbo.gov/publication/43473 Klein, Exzra (June 2012). 11 Facts about the Affordable Care Act, Washington Post, Retrieved from: http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/06/24/11-facts-about-the-affordable-care-act/
Ottawa Online
Nicol Britten
BUS 7303 Legal, Ethical & Political Aspects of Health Care Management
Armando Nunez
October 4th, 2012
Table of Contents
Abstract……………………………………………………………………...Page 3
Introduction………………………………………………………………….Page 4
Political Viewpoints…………………………………………………………Pages 4-5
Affordable Healthcare Act (AHA)………………………………………….Pages 5-6
Access to Care……………………………………………………………….Pages 6-7
Impact; Businesses and Employees………………………………………….Pages 8-9
Conclusion…………………………………………………………………..Pages 9-10
References…………………………………………………………………..Page 11
Abstract
Today, Citizens of the United States and American business is on the verge of one of the biggest changes in American healthcare history. Whether you on the right side (Republican), or the left side (Democratic), of the argument one thing is for certain, if you live in this great country changes in the way you seek healthcare are imminent. In addition, those working in healthcare face the additional responsibility of preparing and planning business strategies to ensure an organizations vitality and survival in during this time transition. This paper will touch on the U.S. history in healthcare as well as, …show more content…
explore the Affordable Healthcare Act (AHA) and the potential impact AHA will have to providers and employers.
Introduction
For Centuries we as a country have debated whether the government should play a role in helping people have access to and afford healthcare. Yet the argument goes beyond government’s role, the debate includes complex issues surrounding both the fundamental right of access to healthcare and who should and will pay for it. From President Roosevelt’s support of creating national health insurance in 1935 to Presidents Richard Nixon’s passion to require all employers to cover workers 1974, which was later derailed by the Watergate scandal, to President Ronald Regan’s signing of the COBRA Act in1986, requiring all employers to allow former employees to remain on company insurance for a period of 18 months at the former employees cost, healthcare and how to pay for it continues to be one of the hottest topics blazing the campaign trail.
When President Obama decided to run for office he took no exception, matter a fact, President Obama made Healthcare his primary campaign topic and so Healthcare Reform is born. In June of 2012, the Affordable Healthcare Act, now coined “Obama Care” was passed. The Supreme Court, in a 5-4 ruling, upholds the law, including its much-disputed mandate that almost all people in the U.S have coverage or pay a fine (Associated Press, June 2011) this making President Obama one of the first Presidents to carry out one of the biggest transition in healthcare history, but at what cost?
Political Viewpoints
The “cost” of reform is the question that is fueling much of the debate amongst political parties. With a federal deficit marking its fourth straight year in access of $1 trillion dollars and equating to approximately seven percent of economic output (Rueter, October 5, 2012) Healthcare reforms remains a politically charged subject to say the least. CBO and JCT now estimate that the insurance coverage provisions of the ACA will have a net cost of $1,168 billion over the 2012–2022 period—compared with $1,252 billion projected in March 2012 for that 11-year period—for a net reduction of $84 billion (CBO, July 2012) however, there is concern that this reduction will be covered through heavy taxation on benefits and fees to businesses.
There will also be a shift in business practice for providers moving from a pay for service module to a quality based payment module. The Democratic Party is presenting its argument for healthcare reform on a platform of all Americans should have access to health care. Republicans are fighting back and their argument is predicated on the cost of this plan, not necessarily on the fundamental disagreement that Americans should have access to care. Separately, Affordable Healthcare Act, the way it is written to enacts the concept of “bigger government” or more government control which is a fundamental difference in thinking between the two parties. One thing is for certain Democrat or Republican, the enactment of the Affordable Healthcare Act will inevitably affect each and every American in one way or another.
Affordable Healthcare Act Simply put, the Affordable Healthcare Act Law will extend coverage to 33 million Americans who would otherwise be uninsured (Klein, June 24, 2012) and includes health insurance reforms that will roll out over four years and beyond, with most changes taking place by 2014. That is the short version. The law itself is spread out over 2,409 pages which brings me to my first concenr, how may business pans do you know that have 2,409 pages of requirements and that have succeeded. For the purposes of this review, I will try to highlight the big changes related to access.
• For families living below the poverty line, that is making about $29,000 annually with a family of four, these families will qualify and be covered through the Medicaid plan.
• Those making between 133 and 400 percent of the poverty line or $88,000 for a family of four will get tax credits on a sliding scale to help pay for private insurance.
• Families making less than 400 percent of the poverty line will not have to pay more than 6.3 percent of their income in premiums and those in the 300-400 percent range up to 9.5 percent of their annual income.
The big difference between today and tomorrow is that tomorrow or as of 2014, everyone will have access to healthcare and those who have opted not to carry insurance will be required to do so dependent upon their living or face penalty. Consequently, employers and providers will be impacted and charged with the responsibility to make provision to both self-funded and fully- funded plans to accommodate the requirements and subsidize the cost for those with a cap on their premiums. Furthermore providers, need to gear up for lower negotiated rates with Medicare reimbursement and the impact that will have on the organizations payer mix, needless to say there is a lot of unknown. For those in the business of healthcare, what you need to know is that you will need to be able to provide better service, to more patients at less cost. The key here is that healthcare organizations now need to translate their services into Accountable Care and integrate a new business model that supports the quality, increase in volume and projected decrease in the amount reimbursed for care starting at the point of service.
Access to Care
By design, the Affordable Healthcare Act is intended to meet four specific goals: to give all Americans access to affordable healthcare options, allow individuals and smaller sized businesses to compare healthcare plans on an equal level, improve the quality of care, and lower costs. Interwoven as sub-goals are stricter regulations for insurance companies and a specific measure to reduce healthcare fraud which has said to have retuned more than $2.5 billion to the Medicare Trust Fund in fiscal year 2009 alone (Healthcare.Gov, October 2012.) Though controversy remains high and opinions differ as to if the AHA will achieve these goals one thing is without question, these reforms will provide millions of people with access to coverage that have been previously uninsured.
It is difficult for anyone to predict how this will impact individuals at the point of service other than to say that buried in the 2,409 pages of law is legislation that specifically sets out to expand coverage to young adults and retirees as well as, those with pre-existing conditions. This coupled with tax credits for middle to low income families, transition of low income families to be covered under Medicaid and a new focus on free preventative care in the battle to prevent disease and illness makes it safe to say that at the point of service the biggest change will be the availability of service.
In reference to emergency care, the Federal EMTALA law (Emergency Treatment and Active Labor Act,) governing healthcare’s responsibilities to treat patients in a medical or psychiatric emergency regardless of their ability to pay for service and without delaying treatment remains firmly in place. From a point of service and access, in my opinion I do not believe the patient will have a different experience; however, it will be interesting to see how the delivery of these emergency services will now impact healthcare organizations from a payment standpoint, specifically with the inevitable increase in Medicaid participants and anticipated decrease in reimbursement rates.
Impact to businesses and employees
Before we look at what will be required of us as healthcare consumers and employers let’s review what we are dealing with. In an article written titled “Cliff Notes Version of the Affordable Healthcare Act,” Carolyn McClanahan, Physician/Financial Planner and contributor to Forbes Magazines does a nice job of providing a brief summation that simplifies AHA and how this impacts insurance. She states, “It is important to understand how insurance will change. First, you cannot be turned down for coverage because you have an illness. Second, everyone is required to have coverage. It is the only way coverage is financially viable. Third, people who have difficulty affording coverage will get assistance paying for it unless they are under the 133% poverty level. Those people will go on Medicaid unless their state refuses to expand Medicaid.” (McClanahan, July 2012.) Perhaps the best way to look at what s on the horizon and what we need to prepare for is in a timeline format.
Between August and December of 2012 all health insurance plans beginning on or after August 1, 2012 must provide preventative healthcare services for women with no cost-sharing requirements.
In addition, a Summary of Benefits and Coverage (SBC) must be provided as part of all annual enrollments beginning on the 1st day of open enrollment and upon request for all plan years on or after September 23, 2012. An SBC is not required to include “accepted benefits” for example a stand-alone dental or vision plan. The must also be distributed at the time of new enrollment outside of the standard open enrollment period. There is a charge to the employer of $1000.00 per failure to provide the
SBC.
Looking forward to 2013, activities related to the Affordable Healthcare Act move into full swing. In January, healthcare consumers will see a decrease in their FSA salary reduction option, which is opportunity to withhold pre-taxed dollars to offset unreimbursed medical expense. In 2013 healthcare consumers will be allowed to take advantage of $2500.00 in pre-taxed saving versus the $3000.00 allowed in 2012. High income earners will also subject to an increase of 0.9% in Medicare tax and a new 3.8% Medicare tax will be imposed on unearned income. Some examples of unearned income may be spousal maintenance, Unemployment payments and Capital Gains.
From a business perspective, employers will see the eliminations of any previous deductions for subsidized retiree prescription drug expenses and will begin paying “fee payments.” Fee payments will be required for both fully funded and self-funded programs and will be calculated per covered life. Other Employer responsibilities will include assuming responsibility for ensuring that their group insurance plan that the data within is in compliance with HIPAA Certification guidelines, reporting the value of health insurance coverage for tax year 2012 and in March of 2013 providing employees with information about then availability of exchange coverage, in short, coordinating coverage options and the transition to those options based on the employees eligibility. Of course, the failure to comply with these regulations also comes at a cost. Employer and healthcare consumers alike are subject to fees and penalties for failures to compile with these regulations. This is where the question of “who is paying for this reform inlays?”
Conclusion
In conclusion, change is coming and quite frankly is already underway however, it has left Americans, Republicans and Democratic alike, with more questions than answers. Maybe this would not be so if the legislation was 2,000 pages versus 2,409 or maybe the quandary would remain the same. In the vast world of available information, it is interesting to me or not so interesting that if seeking such information, you would be hard pressed to find any formable and/or specific information outlining how the proposed Healthcare Reform will impact the U.S. bottom line. The danger in this is it leaves us to more of our philosophical debates and fluff versus what we are all really scared about, what if this fails? Will we be able to recover? How will that affect America’s economy? Would we be faced with a full collapse of our healthcare system?
With the lack of transparency surrounding the risk analysis of this program and any hard and fast projected financial outcomes, it leaves the program open to the substantial amount of ridicule it has endured. Admittedly, I am far from a political mastermind or world renowned economist but it seems to me if you want buy in on a program of this magnitude, the best way to obtain that is through education and transparency of outcomes. I know this is not an easy task taking into consideration the size of this audience, but I would like to be able to trust that the leader of the free world is up to the task versus asking me and the rest of America to simply believe in Hope and Change. For me, at this point, it seems more like we are hanging onto “hope this change will work.”
Reference List
Associated Press (June 2012). The history of the US Healthcare Reform effort. Retrieved from: http://www.foxnews.com/us/2012/06/27/us-health-care-reform-efforts-through-history/ Calmes, J. (July 2012). Delicate Pivot as Republicans Blast Rivals on Medicare Cuts, New York
Times, Retrieved from: http://www.nytimes.com/2012/07/07/us/politics/mixed-message-as-republicans-claim-health-law-cuts-medicare.html?_r=0
McClanahan, C. (July 2012). Cliff Note Versions of the Affordable Healthcare Act, Forbes
Magazine, Retireved from; http://www.forbes.com/sites/carolynmcclanahan/2012/07/09/cliffs-notes-version-of-the-affordable-care-act/ Showalter, J.S. (2012). The Law of Healthcare Administration, 6th ed. Washington, DC; AUPHA Press.
CBO (2012). CBO Releases two Analysis Related to the Affordable Care Act, Retrieved from: http://www.cbo.gov/publication/43473 Klein, Exzra (June 2012). 11 Facts about the Affordable Care Act, Washington Post, Retrieved from: http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/06/24/11-facts-about-the-affordable-care-act/