Section 3022 of the Patient Protection and Affordable Care Act (PPACA) provided for the creation of Accountable Care Organizations (ACOs). These provider-run organizations are responsible for the overall quality, cost and care of a defined group of Medicare fee-for-service beneficiaries. Each ACO must serve at least 5,000 beneficiaries per program.
ACOs are intended to help curb the ramp up in cost of providing health care, and are rewarded with financial incentive payments when successful. Currently, there are more than 250 ACOs – perhaps minus nine of the original 32 pioneer ACOs that recently announced they may exit the Medicare program. These programs cite the difficulty associated with collecting and reporting required data, accessing claims information and the quality of data benchmarking as some of the reasons they’ve not been successful.
[CLICK HERE to read the article, “Continued Growth of Public and Private Accountable Care Organizations,” at HealthAffairs.org, February 19, 2013.]
[CLICK HERE to read the article, “Nine Pioneer ACOs May Leave the Medicare Program,” at ExtendHealth.com, July 11, 2013.]
Another challenge the legislation is facing is that 21 states have decided not to expand Medicaid for the impoverished in their jurisdictions (six states are still undecided). It’s estimated that about two thirds of the low-income uninsured who would qualify for Medicaid under the healthcare law live in states that will not expand it.
This means that many lower-income Americans will have to pay high out-of-pocket expenses for medical care and, if unable to pay for emergency room visits, hospitals will have to pick up the tab. This means the hospitals may end up asking those states for more aid. In these scenarios, the law won’t be making much headway in curbing health care costs.
[CLICK HERE to read the article, “States’ refusal to expand Medicaid complicates health care for many uninsured,” at Marketplace.org, July 12, 2013.]
[CLICK HERE to read the article, “What the Affordable Care Act means for vets,” at The Chicago Tribune, July 10, 2013.]
Most recently, the administration announced it would delay penalties associated with the mandate that employers with more than 50 employees offer health care insurance to workers. One impact of the delay is that many of these workers will shop for coverage on insurance exchanges available at the end of this year. If prices are low enough and coverage good enough, they may decide to maintain their independent coverage and exempt themselves from corporate coverage, when offered.
That’s a big “if” of course, but presumably the more people that participate in the exchange pool, the lower the price should be for insurers to provide them coverage. Bear in mind, however, that while the penalty for employers has been delayed, the mandate has not.
[CLICK HERE to read the article, “5 things to know about the delayed PPACA mandate,” at BenefitsPro.com, July 8, 2013.]
[CLICK HERE to read the article, “Implementing the Affordable Care Act: Why Is This So Complex?” at The Brookings Institution, July 8, 2013.]
There’s no way around it — the health care law is complex. But all you really need to worry about is you and your expenses. If you could use some help figuring out the best financial scenario to pay for health care and other big-ticket expenses, we’re here for you.
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