Yesterday, the United States government both succeeded and stumbled in epic proportions. The health insurance marketplaces, a key provision of the Affordable Care Act (aka Obamacare), were implemented, and the government officially shut down.
To help your medical practice navigate these headlines, we’ve provided an overview of the issues below.
Health marketplaces open
As scheduled, enrollment in the health insurance marketplaces began with 36 federally-run exchanges and 15 state-run exchanges, including California, Washington, and Oregon. Other key dates include March 31, 2014, the closing of the enrollment period, January 1, 2014, when coverage begins, and December 15, 2013, the last date to enroll for coverage beginning January 1.
For the federally-run exchanges, the average individual will be able to enroll choose one of 53 qualified plans among four metallic tiers—bronze, silver, gold, platinum—issued by an average of eight insurers.
Individuals, who do not have insurance, will be penalized with a $95 tax per uninsured person (or one percent of income household income over the filing threshold) in 2014 and $325 per uninsured person (or two percent of household income over the filing threshold) in 2015.
While premiums are competitive (before tax credits, the second lowest cost silver plan will be less than $300 per month in 15 states), there are concerns about higher deductibles and reduced provider networks.
As a medical professional, this means you should be ready for a wave of newly insured patients in 2014 who may not have received basic primary care in several years. Make sure your staff is up to speed on the new rules for preventative care and use tools like online appointment booking to help ease the administrative burden.
For more information on the marketplaces, here are some of our favorite reads:
- In-depth report on premiums and source of federally-run exchange data
- Excellent tool that depicts US healthcare spend by payer over time
- Report by the Christensen Institute on ACA and Disruptive Opportunities
Congress was unable to pass a budget deal on Sunday, with a stalemate between the Senate and House of Representatives hinging around partisan conflicts, and at midnight the federal government shut down. The last shutdown occurred in 1996 and the 22-day government closing cost $1.5 billion.
It is worthy of note that one of the key points of debate in this shutdown is the repeal of the 2.3% medical device excise tax, which is intended to direct approximately $30 billion to the implementation of the ACA.
Nearly 800,000 government workers have been furloughed, among them almost 40,000 employees with the Department of Health and Human Services (HHS), and will not be able to work until the government re-opens. If the shutdown continues, health tech companies could experience a small impact related to policy activities since the 184-member agency of the Office of the National Coordinator for Health IT (ONC) has been reduced to a staff of 4.
The ONC will suspend its work in establishing standards, testing activities, management of the Certified Health IT Product List, and policymaking in the areas of privacy, security, and clinical quality measure development. However, other HHS activities will proceed, including doctors’ visits paid by Medicare and operations of the insurance marketplaces.
What a day! What do you think? Ask questions, post comments, and let us know what other policy topics you’d like us to cover.