COMMENTARY
Health care reform
BY ESTEBAN LÓPEZ, MD Starting in 2014, key provisions of the Affordable Care Act (ACA) will be implemented, and doctors across the United States will experience the biggest change the health care industry has seen. As physicians, we have a responsibility to be well informed of the new law’s impact on our practices — both as doctors and as employers. And with this great challenge comes great opportunity — to make the most of what the doctor ordered.
Understanding the changes As you know, some health care changes have already taken place. Children may now continue on a parent’s insurance until age 26, and preventive care services are fully covered (including screening labs, immunizations, and cancer screening). To ensure premium dol- lars are spent primarily on health care, ACA generally requires insur- ance companies to spend at least 80 percent of all premium dollars on health care services and health care quality improvement (85 per- cent for large employer plans). In 2014, we’ll see more trans- formation. Though there are some exceptions, most Americans will be required to have insurance cover- age. Those without insurance will
“As you prepare for the changes ahead, it’s
equally important to prepare your patients on this complex topic.”
be subject to a minimum penalty of $95 — an amount that will increase over the coming years. All Americans required to have insurance will qualify regardless of preexisting conditions. Plus, Americans will have a new and easier way to shop for insurance.
Esteban López, MD
Buying insurance Your patients may continue to buy insur- ance directly from an insurer, but now
they have other options. Under ACA, two new types of in- surance exchanges or marketplaces have been created to sell insurance online. The first exchange, sometimes referred to as the Health Insurance Marketplace, is for individuals. This exchange is scheduled to open this month and will allow in- dividuals to purchase insurance to be effective Jan. 1, 2014. On the exchange, consumers can view and compare health in- surance plans offered by all insur- ers participating on the exchange, consider the various benefits and premiums, and enroll in a plan. This also is where approximate- ly 2.5 million Texans will discover they are eligible for various levels of premium tax credits and finan- cial assistance to help lower their cost of coverage. It’s important to note that there is no publicly spon- sored plan; all insurance coverage provided on the exchanges will be through participating insurance companies.
The other exchange is for small businesses (those with fewer than 50 employees) — including many health care practices. If you fall into this category, you could bene- fit from searching for insurance on this exchange, known as the Small Business Health Options Program
(SHOP). As a small business owner, you will want to consider all your options when selecting a health insurance plan for your employees. Keep in mind that on the SHOP exchange, small employers may be eligible for two years of tax credits.
Providing the essentials
As your practice starts to adjust to the new changes, you’ll also want to keep in mind that starting in 2014, all health plans will cover 10 categories of benefits considered essential to good health. These are called essential health benefits — with no dollar caps on this type of coverage.
October 2013 TEXAS MEDICINE 55
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