ACA and Patient Responsibility
Among the important factors that people need to consider when thinking about health care is patient responsibility. While Obamacare has opened healthcare to many in the middle class with its government subsidies, keeping up to speed with its changes isn’t easy for anyone. According to the Galen Institute, there have been thus far 47 Affordable Care Act changes. Here are some to look out for:
Of all the Affordable Care Act changes, the biggest is in your taxes.
You’ll need to be sure that your tax returns are filed properly, which includes marking whether you were insured last year, and if your income rose or fell.
This happens on the 1095-A form.
It’s best to file early, so that you’ll not just claim any refunds that you may have coming, but so you’ll beat the squeeze as all of the Obamacare tax changes are absorbed by the system.
Among them is the slight increase in the price of Georgia insurance plans, which is measured according to the leading city, Atlanta.
It’s not much. In 2014, the lowest cost bronze plan prior to applying the tax credit was $202.
In 2015 it’s $205, which is an increase of 1.5%.
Low Cost Plan
In 2013 the administration delayed the low-income plan - it’s Basic Health Program, which will include people who are ineligible for medicaid, but cannot afford the current Bronze plans.
It’s scheduled to become available this year.
These are among the changes that are designed to protect consumers:
- Insurance companies cannot deny coverage for pre-existing conditions.
- Coverage of new and group plans may not be capped.
- People who opt for clinical trials cannot be dropped or limited by insurance plans.
The controversial Pay-for-Performance program deems doctors worthy of payment based on the value of their service as opposed to the number of patients.
One question, among many, is how to administer such a program without it becoming a burden on medical resources.
According to conservative think tank, The Heritage Foundation, Pay-for-Performance “encourages large investments to achieve relatively insignificant improvements, solely to obtain a moderately improved score. The small amount of improvement possible from this kind of endeavor would not likely have a significant benefit for patients.
“According to Tufts Medical Center researchers, ‘A hospital with 97.5% compliance may be penalized, and it may take a significant financial expenditure and use of staff resources to increase that compliance from 97.5% to 98.5% with minimal or unclear gains to patients.’”
But according to proponents, the main failing is one of getting the right values to rate. This year, incentives given to doctors for reporting their quality data have been stopped, and physicians who fail to report their quality data properly will have their medicare payments lowered.
On January 1st, employers with 100 employees fell under the Patient Protection and Affordable Care Act, which includes actions they must take under the provisions of ACA Employer Shared Responsibility. This includes penalties:
- For not offering minimum essential coverage to nearly all of their full-time employees and families.
- For not offering coverage that is affordable and of a minimum value.
- If any of their full-time employees get tax-credits or compensation through the government health exchange.
For more information, see the 47 changes to Obamacare.