Articles Posted in Affordable Care Act

In Georgia, seven insurers have announced plans to participate in the Health Insurance Exchange that will exist by virtue of the Affordable Care Act (ACA). The ACA authorized creation of State health insurance “exchanges” (HIX) – an online market place in which consumers can shop for and buy health insurance. The following insurers have indicated they will participate in the Georgia HIX: Blue Cross and Blue Shield of Georgia, Kaiser Foundation Health Plan, Peach State, Alliant, Coventry, Aetna and Coventry. The insurance plans will debut as part of the Georgia HIX in 2014.

When the health insurance plans are available, small businesses, families and individuals will have a new way to get insurance. The ACA intends for consumers to be able to compare the benefits and costs of competing plans and use an online calculator to assist them in determining which plan is best for them. The ACA will expand health insurance coverage, increasing the number of insured patients. Presently, nearly two million non-elderly Georgia residents are uninsured. Purported benefits of the ACA that will affect Georgia patients and providers include: greater ease in obtaining coverage for individuals difficult to insure due to pre-existing conditions; continued cost-saving home- and community-care programs;greater resources for Medicaid, lowering costs of prescription drugs and raising reimbursement to some health care providers; enhanced preventive care coverage; and allowing young adults to stay on parents’ health plans
For physicians, however, more insured patients under the auspices of the ACA is not all good news. While much remains to be seen, some problems have been predicted. For example, some physicians may experience delayed payment under the ACA, under which individuals have a three-month grace period to individuals who have not paid their premiums. Health plans may hold off on processing claims who have not paid for two months. After three months, a health plan may deny claims and leave the doctor to seek payment from the patient. Under traditional insurance, the health plan would remain liable to pay the doctor even if the premium has not been paid. Patients are not accustomed to keeping up with and paying insurance premiums. Further, under the ACA the patient may be able to sign up for another plan in the HIX and begin seeing another doctor. Many of the newly insured patients will also be individuals who have not had insurance before (or for a considerable time) and may therefore involve more complicated health issues.
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While only slightly more than two-thirds of primary care physicians in the United States used electronic medical records (EMR) in 2012, this is an increase of 50% over the 46% that reported using them in 2009. This data is documented in a Commonwealth Fund International Health Policy Survey, which was published in Health Affairs.

The use of electronic medical records can make physicians’ offices more efficient and improve the quality of patient care by making their medical history available to any physician treating them. Unfortunately, many physicians still prefer to maintain voluminous files containing patient information and illegible handwritten comments and progress notes.

Make no mistake about it, electronic medical records are the way of the future for medical practices of all sizes. With the passage of the Patient Protection and Affordable Care Act (PPACA), and its constitutionality ruling by the United States Supreme Court last June 28, 2012, healthcare reform is on its way. A mandate requiring electronic medical records for all practitioners is a part of PPACA and is set to take effect in 2014. Some mandates included in the Health Insurance Portability and Accountability Act (HIPAA) have been included in and strengthened under the PPACA.

Funding for the EMR legislation will cover a span of 10 years. By the end of that time, it is hoped that all practices will have implemented electronic medical records. Incentive programs are available through the federal government. Some professionals meeting federal requirements for EMRs can get up to $44,000 through the Medicare Electronic Health Records Incentive Program. Others who are providing service to patients in a Health Professional Shortage Area might qualify for incentives in excess of $44,000. Incentives for institutions are significantly higher, starting at $2 million, but the requirements are stiffer than for individual professionals.

Naturally there are requirements established by the federal government to make certain the incentive funding is being used properly. For example, there are specific formats for use in the areas of medical billing, patient medical history and employee communication.

Ultimately, the use of modern technology to comply with the electronic records mandate of PPACA will make our healthcare system better, provide better care to the patients and make it more affordable to all.
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According to an economist with Moody’s Analytics, the new health care law is set to negatively impact hiring in 2013; this is based on what human resource firms are saying, anyways. They are predicting that some businesses are going to be taking on more part-time employees rather than hiring full-time employees, in addition to reducing the hours for permanent employees.

The reason is the Patient Protection and Affordable Care Act (PPACA). Under PPACA, businesses that have 50 or more full time employees must provide health insurance to employees who work at least 30 hours a week. If employers fail to offer health insurance, they will face a penalty of $2,000 for every worker in excess of the first 30.

This mandate for employers does not take effect until January 1, 2014. However, in order to determine whether employees average enough hours to qualify for benefits, employers have to track their work schedules for at least three months and up to 12 months before 2014. As a result, employers are already starting to restructure their payrolls and will continue to do so into 2014.

Approximately 25 percent of businesses do not provide health insurance to employees who work at least 30 hours per week, according to a consulting firm study. The survey further revealed that 50 percent of those businesses intend to make necessary changes so that fewer employees will meet the 30 hour threshold provided by PPACA.

The companies intending to grow that have 40 to 45 employees are most affected, since they are apprehensive about crossing over the 50 employee threshold. For example, a Melville advertising group with 45 employees had intended to hire another 10 but will no longer do so to stay under the limit. Others simply intend to have more part-time employees that they do not need to offer health coverage to.

Employers who have a large number of part-time or low-wage employees will especially be burdened. Under the PPACA, employees are supposed to pay no more than 9.5 percent of their wages for health insurance premiums, causing employers to be forced to contribute more for low-wage employees than those who are higher paid.

According to the International Franchise Association, 31 percent of all franchisees surveyed intend to reduce their number of employees to get below the magic 50 employee threshold. Additionally, employers have indicated that they plan to reduce the work schedule of employees to get below the 30 hour per week requirement.

The constitutionality of the Patient Protection and Affordable Care Act (PPACA) was upheld by the United States Supreme Court on June 28, 2012. This complex act is focused on reducing the number of people who do not have health care. Contained in it are numerous mandates, subsidies and tax credits which employers need to be educated about.
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