The Effects of Obamacare and What has Changed

When the Affordable Care Act, more popularly known as Obamacare, was passed in Congress, many thought the problems of a large uninsured portion of the population would be solved. Unfortunately, theory does not always translate into practice. Although more people today are insured, problems with reimbursement rates and disgruntled citizens who refuse to apply, still present obstacles for doctors and hospitals. 

More people are insured, which means less people in emergency rooms

Before, many would simply wait until they were too sick to work, and then go to the ER. Unfortunately, that usually meant they would end up being hospitalized. But Dr. Ira Potter, who practices in one of the poorest regions of Kentucky, told the Louisville Courier-Journal that now his low-income patients are receiving subsidies for insurance, or have been moved to Medicaid. With help from the government, he said, they can now afford to pay for a physician.

Reimbursements are low—meaning many doctors won’t take Obamacare

Dr. Bob Russo, radiologist and president of the Connecticut State Medical Society, told National Public Radio that low rates and administrative headaches that come along with the program could make it a “financial loser”. He pointed out that if doctors can’t be convinced that they're not losing money doing their job, there will be problems. “And they haven't been able to convince people of that," he said.

The problem is not just in Connecticut; numerous companies have cut their reimbursement rates for plans that fall under Obamacare. When Blue Shield of California was designing the new health plans it would offer under Obamacare, the insurer asked doctors and hospitals in its network to accept rates as much as 30 percent lower than what it previously paid.

Only 60 percent of the doctors and 75 of the hospitals that participate in the Blue Shield of California’s group plans chose to participate in plans purchased through the state’s insurance exchange. Some of the state’s most prestigious hospitals, including Cedars-Sinai Medical Center in Los Angeles and University of California medical centers, dropped out altogether.

Hospital charity care is being tied to Obamacare signups

To a number of people, Obamacare carries a whiff of socialism. The end result is that for many hospitals in rural areas, many will still go uninsured and risk getting sick despite the fact that they would be eligible for insurance coverage. William Parsons, 40, told a reporter that he has no health insurance and doesn't intend to apply. "Goin' to the doctor just isn't something I like to do. ... No good comes of going."

Parsons is not an exception. Many hospitals are now reevaluating their charity care policies and demanding that those who would normally be eligible at least attempt to sign up for subsidized insurance. According to a high risk pregnancy specialist, Dr. Gilbert Webb, even insurance for one time procedures like pregnancies are affected. As an example, Southern New Hampshire Medical Center in Nashua now states that applicants who do not purchase federally-mandated health insurance when they are eligible to do so will not receive charitable care.

Katherine Arbuckle, senior vice president and chief financial officer at Ascension Health based in St. Louis, told the Washington Post that the question is whether a patient can pay or simply doesn’t want to. “How do you treat those who decline [coverage]? Do they get free services when others have paid?” she asked.

In reality, Obamacare is still in the shakedown phase. In order to ensure that the program is as effective as possible, it needs to be tweaked in certain areas in order to ensure that the most vulnerable populations are covered. Combined with better education about the program, Obamacare should prove to be more successful in years to come.

Information Credit: Vitals

How Will the Affordable Care Act Affect Medicare?

The Patient Protection and Affordable Care Act, also known as Obamacare, is set to take full effect next year. The legislation is set to cut $716 billion from Medicare and will bring some significant changes to the program. The Affordable Care Act has already expanded Medicare coverage to include preventive care, and it’s slowly closing the coverage gap in Medicare Part D. 

The Affordable Care Act aims to improve the quality of hospital care for seniors by rewarding hospitals that provide quality care with increased funding, and penalizing those who provide poorer care with decreased funding. Although the legislation does cut some Medicare programs, these cuts aren’t intended to affect benefits; instead, they’re meant to increase Medicare’s cost-effectiveness by moving the money to areas of the program where it can be put to better use.

How Are Medicare Benefits Changing?

The Affordable Care Act broadens existing Medicare benefits, making it possible for seniors on Medicare to receive preventive care with no out-of-pocket costs. Seniors can now get check-ups, cancer screenings, vaccines and other forms of preventive care for free. These changes have been in effect since 2011.

Another important change in Medicare benefits under the Affordable Care Act concerns the so-called “donut hole,” or the coverage gap in Medicare Part D. Under Medicare Part D, many seniors must pay for their own prescription drug costs. As of 2012, seniors receiving Medicare became eligible for discounts on brand-name and generic prescription drugs. These discounts will grow each year until 2020, when the coverage gap should close completely, and Medicare recipients will only need to pay co-pays for their prescription drugs.

The Affordable Care Act also aims to reduce federal spending on Medicare Advantage, a form of supplemental Medicare insurance administered by private insurance companies. Medicare Advantage, which was originally intended to reduce federal spending on Medicare, has turned out to cost the government 14 percent more per patient than traditional Medicare. It is hoped that cutting federal spending on Medicare Advantage will lower overall Medicare costs.

What Is the Value-Based Payment Provision?

Under the Affordable Care Act, providers who offer high-quality care to Medicare patients stand to receive a one percent increase in Medicare payments in 2014, and a two percent increase in Medicare payments in 2015. Conversely, those who provide a lower standard of care — as measured by high re-admittance rates and patient dissatisfaction — stand to lose up to two percent of their payments from Medicare by 2015.

In this way, the Affordable Care Act intends to improve the quality of care seniors receive.Quality care is something that professionals in the field will have to focus on. Though it may have gone unmentioned before, health care employees had better take notice or suffer the consequences. Human services will be especially influential in this regard and it is anticipated that more positions in human resources will be created to address the importance of quality care. To learn more about earning a human services degree online, you can research online for a program that fits you. 

Where Are the Medicare Cuts Coming From?

According to the Congressional Budget Office, the anticipated total cost of Medicare over the next 10 years will be about $7.5 trillion. Between 2013 and 2022, the Affordable Care Act plans to cut $716 billion from Medicare. Of that amount, $415 billion comes from federal payments to care providers and private insurance companies. The rest of the cuts come from parts of the program that are not considered to be cost effective, such as the Medicare Disproportionate Share Program, which compensates hospitals for treating lower-income Medicare recipients who do not have supplemental insurance.

How Does the Affordable Care Act Change Medicare Funding?

The Affordable Care Act changes Medicare funding by reallocating the $716 billion in cuts to other parts of the program, where it’s believed the money can be put to better use. The new law will also levy a 0.9 percent tax on members of the top tax bracket in order to raise money for the new law.

The legislation also allows for the creation of an Independent Payment Advisory Board, which will have the authority to recommend reduced provider payments if Medicare spending grows too fast in the future. Payments from Medicare to health care providers will also grow at a slower rate. These two things are intended to keep Medicare costs down in the future. Medicare is expected to cost $900 billion per year by 2022.

The Affordable Care Act has expanded Medicare benefits to include preventive care like checkups, vaccines and cancer screenings. Over the next several years, it will gradually close the coverage gap in Medicare Part D, which provides prescription drug coverage to seniors. It will also cut spending on Medicare Advantage and tie providers’ payments to the quality of the care they give. The Affordable Care Act intends to fund these changes and keep Medicare solvent in the future with $716 billion in cuts to other parts of the program and with a 0.9 percent tax increase on members of the top bracket.

About the Author: Contributing blogger Alisa Martin has more than 15 years of experience in public health policy. She currently works with his local government to improve public health services.

How Obamacare Is Helping People Get Health Insurance

English: Barack Obama signing the Patient Protection and Affordable Care Act at the White House (Photo credit: Wikipedia)

Efforts to transform the American Health Care System in the so-called Obamacare plan seem not to be working as it was promised. Observers are afraid of a disastrous result with democrats and republicans setting up their own health marketplaces that have to be ready for the consumers to make a health care choice by October 1, 2013. Considered by some as just an experiment, Obamacare is not helping people get health insurance because applying for it is not easy anyway, and many people are absolutely clueless how to make and educate decision when it comes to health insurance, if nobody seems interested at all in educating citizens about the insurance options. 

Decreasing Rather Than Increasing Your Chances 

Curiously, it is supposed that the best and easy way to receive the benefits of the Obamacare plan is through your employer, but everyday more and more companies reduce their number of workers or reduce the working hours to avoid providing their employees with such health coverage. People who are left out of a company plan is expected to approach the health marketplaces to come in October, but there is not enough information on how to purchase coverage and how much they will have to spend on it. 

Getting Ready for a Duteous Application 

Now, the government said that it would never be so easy to buy health care insurance, and that anyone could do it much in the same fashion they buy at Amazon or similar online stores. However, what Obama did not say is that the application includes around 15 pages that require the completion of nearly 21 steps and that many of these steps require further answers to more questions and requirements. Moreover, after the application is submitted, at least three federal agencies will review it to check your identity and veracity of the information, including a verification performed by the IRS. 

Shopping at Amazon, Dream On 

If you think it will be that easy to buy health care insurance when the enrollment season begins this fall, you are probably dreaming. Obama's Affordable Care Act requires the above process to learn more about your financial situation, because it is meant to provide generous support to lower income people. However and regardless of your financial status, once approved for Obamacare, the hardest part is choosing a health plan because all the information that is provided in pure insurance jargon that not all people understand along with a number of additional steps before you can actually purchase health insurance. 

Fortunately, for some, unfortunately for many others, taking out health insurance will be mandatory starting in 2014, so that American citizens are uncertain about what the future is bringing. For people who actually have health insurance through Medicaid or Medicare, it is expected that nothing will change, as they can continue under such health coverage, same as workers who receive other types of health insurance from their employers. However, for people who do not carry health insurance yet, the panorama is not promising, but seems to add more hassle than benefit to their lives.