Getting Patients Ready for ObamaCare in Greenville and South Carolina
The month of October is scheduled to be the roll out of the Patient Protection and Affordable Care Act, otherwise known as Obamacare. As seems typical for named government programs, the Obamacare program doesn’t seem to show any signs of offering increased patient protection or affordability out of the gate.
What You Need To Know:
The Stated Goals of the Affordable Care Act are to:
1) expand access to health care.
2) make health care more affordable, and
3) improve the quality and effectiveness of health care services.
To maintain continuity, I will describe the Patient Protection and Affordable Care Act as Obamacare for the remainder of this blog post. The new law is over 2,700 pages in length and has thus far resulted in over 17,000 additional pages of new regulations. As a result, some significant changes are set to be implemented and the impact of them will be more fully felt after a number of the law’s major provisions become effective in January 2014.
Obamacare has been described by pundits as having many “moving parts,” including two important mandates – one that applies to individuals and one that applies to employers. Additionally, new entities are being created, most notably the Health Insurance Marketplaces, also known as “exchanges,” which will operate in all 50 states.
I’ve provided some questions & answers explaining the law’s provisions and requirements which I believe would be most important to the chiropractic patient.
What is set to take place October 1?
October 1, 2013 is the date that “exchanges” in all 50 states are (by statute) supposed to be operational, and capable of helping millions of uninsured Americans to:
- determine eligibility for Qualified Health Plans (QHPs);
- compare costs and coverage between health insurance plans;
- find out if they are eligible for federal subsidies to help pay their insurance premiums;
- and buy insurance coverage that meets certain federal standards.
In some instances, where states elected not to establish their own state-run exchanges, the federal government will be establishing and operating these entities.
October 1, 2013 also marks the beginning of the initial “open enrollment” period for health insurance that is set to run through March 31, 2014.
What are the new exchanges?
These entities are intended to function as a Web-based interactive “marketplaces” for health insurance in each state. Uninsured people will be able to log onto their state’s exchange website to review the various available plans and purchase a policy online. Many exchanges will offer toll-free phone lines and some will have “walk-in” offices as well. States were given a significant amount of flexibility in choosing how they wished to establish their exchange, provided their exchanges complied with a set of uniform standards defined by federal authorities. A number of states declined to establish exchanges. In those instances the new marketplaces will be established and managed by the federal government. South Carolina is one of the 26 states which chose to not establish their own exchange.
Who is eligible to purchase insurance in the exchanges?
The exchanges are intended for individuals and families that are uninsured. People with employer-sponsored coverage generally won’t buy on the exchange, nor will those on Medicare, Tricare or other veterans’ health care plans.
What is the individual mandate?
Starting in 2014, individuals are required to have health insurance coverage (from some source) that meets certain basic standards or they will pay a financial penalty. The penalty collection process is being folded into the Internal Revenue Service process and fees will be assessed when individuals file their 2014 Federal tax return in 2015. Technically, under the law most Americans are required to be insured by January 1, 2014; however, Executive Branch officials have stated that penalties will not be imposed on individuals who obtain coverage by April 1, 2014 – providing, essentially, a penalty-free 6 month period dating from October 1, 2013 when the exchanges are due to be operational.
Will the various plans offered in the exchanges and other marketplaces cover chiropractic benefits?
A significant number of plans will include coverage for chiropractic services—but some will not. Obamacare establishes a set of “Essential Health Benefits” (EHBs) that defines the benefits required to be offered to consumers in broad categories but do not specify specific services to be included. It is important to note that some of these essential benefits fall within the scope of practice of doctors of chiropractic in most states including South Carolina. In implementing the law, the Department of Health and Human Services granted states a significant degree of “flexibility” to further define specific services to be included in the set of EHBs to be offered in the state exchanges, by allowing states to choose a “benchmark” plan that will serve as a model for all qualified health plans available in the exchanges and in the small group and individual markets. Based on information gathered to date (September 2013) the American Chiropractic Association believes the majority of the newly offered plans in the various state exchanges will offer some level of coverage for the services provided by doctors of chiropractic.
Are major problems expected with the law’s implementation?
The new law is very complicated and as I stated before, there are many “moving parts.” How efficiently the law works in practice, especially as its “mandate” provisions are implemented and Americans become more aware of their obligations under the law, including the “penalties” they face for non-compliance, is unknown. It is very clear that many Americans, perhaps the majority of them, remain confused and only partially educated as to how the law is expected to impact them. Recent polls reveal that a majority of Americans favor repeal of the law. Given the law’s complexity and the degree of flexibility given the states in terms of operating the new exchanges, difficulties are expected. Critics of the law believe that substantial problems will develop especially over the next year. It seems reasonable to conclude that some states will do a far better job of running their exchange than others. This is likely to be the case with the availability of services provided by doctors of chiropractic.
Where can I go for additional information?
The following are some of the main governmental sources available for additional information:
The Department of HHS Affordable Care Act Website: www.hhs.gov/healthcare
The Department of HHS Educational Information on the Health Insurance Market place: www.healthcare.gov
The Centers for Medicare and Medicaid Services (CMS) Health Insurance Marketplace: marketplace.cms.gov
The U.S. Small Business Administration (SBA) Website: www.sba.gov/healthcare
SBA Blog on Reporting Requirements: www.sba.gov/community/blogs/community-blogs/health-carebusiness-pulse/new-guidance-information-reporting-requirements-under-affordable-care-act
IRS Small Business Resource Center: www.irs.gov/Businesses/Small-Businesses-&-Self-Employed
The following private sector entities have may have useful information available:
U.S. Chamber of Commerce Health Law 101: www.uschamber.com/health-reform
The National Federation of Independent Business (NFIB), Understanding the New Health Law:
NFIB Publication “The Healthcare Playbook – A Small Business Guide to the Patient Protection and Affordable Care Act (PPACA)”: www.nfib.com/Portals/0/PDF/AllUsers/advocacy/ppaca-healthcare-law-guidenfib.pdf
Kaiser Family Research Foundation, Healthcare Gateway: kff.org/health-reform/
Obamacare preserves a major role for insurance agents and brokers—and chiropractic patients may wish to consult their local professional(s) working in this industry.
I would like to thank the above web sources and my national association, the American Chiropractic Association, for assistance in my gathering of information for this blog post.
You can be confident that whether or not Obamacare stands, I will be ready to serve Greenville with the highest standard of care with affordable payment options to all who have need.