The Affordable Care Act: Is Healthcare Becoming More Affordable?

Size: px
Start display at page:

Download "The Affordable Care Act: Is Healthcare Becoming More Affordable?"

Transcription

1 The Affordable Care Act: Is Healthcare Becoming More Affordable? Houston Economics Club Federal Reserve Bank of Dallas, Houston Branch November 17, 2014 Vivian Ho, PhD James A. Baker III Institute Chair in Health Economics Director, Health Policy Forum Professor, Department of Economics at Rice University Professor, Department of Medicine at Baylor College of Medicine

2 Outline Changes in health insurance Marketplace plans (Healthcare.gov) Medicaid Large Employer Plans Small businesses Fiscal impact of the ACA The ACA and Medicare

3 Source: Gallop.com Daily News

4 Source: Gallop.com Daily News

5 Source: Congressional Budget Office, Updated Estimates of the Insurance Coverage Provisions of the Affordable Care Act, April 2014.

6 Marketplace Insurance Plans Healthcare.gov April 2014: 5.4 million selected plans through 36 federally facilitated marketplaces (FFMs) 2.6 million enrolled in HI through 14 state based marketplaces. In the FFM, 87% used tax credits to enroll in a plan.

7 Kathleen Sebelius Former US Secretary of Health and Human Services Sylvia Mathews Burwell Current US Secretary of Health and Human Services

8 Marketplace Insurance Plans Average Monthly Premiums before and after Tax Credits, Tax Credit Amount, and Percent Reduction in Premium after Tax Credits for Individuals Who Selected Plans with Tax Credits through the 2014 Federally-facilitated Marketplace Metal Level Percent of Individuals Who Selected Plans with Tax Credits Average Premium before Tax Credits Average Tax Credit Amount Average Premium after Tax Credits Average Percent Reduction in Premium after Tax Credits Bronze 73% $289 $221 $68 76% Silver 94% $345 $276 $69 80% Gold 65% $428 $220 $208 51% Platinum 64% $452 $232 $220 51% All Metal Level 87% $346 $264 $82 76% Source: ASPR Research Brief, June 18, 2014.

9 Source: Health Reform Monitoring Survey Texas, Issue Brief #8, September, 2014.

10 $263 x 12 = $3156. Source: ASPR Research Brief, June 18, 2014.

11 How do Marketplace premiums compare to premiums purchased by large employers for their workers?

12 Average Annual Premiums for Single and Family Coverage, $2,196 $5,791 $2,471* Single Coverage $6,438* $2,689* Family Coverage $7,061* $3,083* $8,003* $3,383* $9,068* $3,695* $9,950* $4,024* $10,880* $4,242* $11,480* $4,479* $12,106* $4,704* $12,680* $4,824 $13,375* $5,049* $13,770* $5,429* $15,073* $5,615* $15,745* $5,884* $16,351* $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 $18,000 * Estimate is statistically different from estimate for the previous year shown (p<.05). SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, Source: KFF.org Employer Health Benefits Survey 2013

13

14

15 Source: Health Reform Monitoring Survey Texas, Issue Brief #3, April 14, 2014.

16 Source: Health Reform Monitoring Survey Texas, Issue Brief #3, April 14, 2014.

17 Source: Health Reform Monitoring Survey Texas, Issue Brief #6, July 7, 2014.

18 Employer Provided Health Insurance Source: 19th Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care, 2014

19 Employer Provided Health Insurance Source: 19th Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care

20 Employer Provided Health Insurance Employers face new costs under the ACA Fees that insurers pay to the federal government, which they may pass on to employers. 2015: report whether and what insurance offered to employees. 2015: requirement for large employers to provide affordable coverage to their workers.

21 Employer Provided Health Insurance Excise tax on high-cost coverage ( Cadillac tax ) Plan sponsors must pay a 40% tax on the difference between $10,200 (self-only coverage) or $27,500 (family coverage) and the actual cost of any employer-sponsored insurance Dollar amounts increase, indexed to inflation Includes total cost of coverage (both employer AND employee share of premium) Not in effect until 2018, but many employers starting to think about and prepare plan design changes now

22 How much will insurance coverage and premiums change in 2014? TABLE 3: Changes in Per-capita Employer Spending Due to the ACA, Simulated as if the ACA is Fully Implemented in 2012 All Employers Small firms (100 or fewer employees) Mid-size firms (101-1,000 employees) Large firms (More than 1,000 employees) Total per-capita employer spending Total per-capita employer spending Total per-capita employer spending Total per-capita employer spending Without Reform ACA % Difference $3,653 $3, % $4,126 $3, % $3,509 $3, % $3,683 $3, % Note: Persons reporting ESI coverage in households where no policyholder is identified are included in the total calculations but not the firm size groups. Source: Urban Institute Analysis, HIPSM 2012

23 February 25, 2014

24 Fiscal Impact of the ACA Source: Congressional Budget Office,

25 Fiscal Impact of the ACA The insurance coverage provisions are only one way in which the ACA affects the federal budget. Other provisions are projected to reduce budget deficits. Smaller annual updates to Medicare provider payment rates. Reduced Medicare Advantage payment rates. Lower DSH payments In their most recent comprehensive estimates (July 2012), CBO and JCT predicted that the ACA s overall effect is to reduce federal deficits.

26 Healthcare Spending Source: Congressional Budget Office presentation to Stanford Institute for Economic Policy Research, May 13, 2014.

27 Healthcare Spending

28 Source: Health Affairs, 33, No. 1 (2014):67-77.

29 Medicare Spending Year Calendar Year Expenditures Medicare Trust Funds, Oct-June Source: CMS.gov, National Health Expenditure Data, and Actuarial Studies

30 How is Medicare Bending the Cost Curve? Accountable Care Organizations Bundled Payments for Care Improvement Hospital Readmissions Reduction Program

31 Accountable Care Organizations Reimbursing health care providers using the current fee-for-service system rewards providers for quantity, not quality. No one provider takes responsibility for the overall health of the patient. On the other hand, capitated payment systems provide incentives to deny services. We have a fragmented health care delivery system, leading to waste, which drives up costs.

32 Accountable Care Organizations Section 3022 of the Affordable Care Act established the Medicare Shared Savings Program for Accountable Care Organizations (ACOs) as a potential solution to balance the incentives to overprovide vs. underprovide services. An ACO is a group of health care providers caring for a specific patient population who will share savings with Medicare that are achieved through delivering quality health care.

33 Accountable Care Organizations ACO must agree w/medicare to participate for at least 3 years. Must be legally structured in a manner to receive and distribute payment within that ACO. Include primary care providers sufficient to cover beneficiaries, which must number at least 5,000 Demonstrate that it meets quality criteria related to patient/caregiver satisfaction, care coordination, and patient safety.

34 How are patients assigned to the ACO? Organization and providers decide to participate in an ACO (PCPs must be exclusive to one ACO; Specialists can be part of multiple ACOs) Patients assigned to PCPs providing most primary/preventive care relative to other primary care physicians in other ACOs or non-aco organizations. If unassigned, consider other provider types.

35 Medicare ACO results as of September ACOs caring for 5.6m elderly Americans 64 saved Medicare enough $ to earn bonuses summing to $445m. Overall savings to Medicare of $372m. Quality measures also improved for ACOs.

36 Bundled Payments Traditionally, Medicare makes separate payments to providers for each of the individual services they furnish to beneficiaries for a single illness or course of treatment. e.g., A patient admitted to a hospital with heart failure will generate a payment for the hospital, payment for multiple physician services, and perhaps post-discharge costs (skilled nursing facility or hospital readmission). Medicare is experimenting with offering a provider one bundled payment to cover all services associated with an illness or course of treatment. Hospital admission for heart failure and for the subsequent 30 days, regardless of when the patient is discharged.

37 Bundled Payment Participating Facilities Model Organization Name City State Episodes Model 1 JFK Medical Center Edison NJ All DRGS Model 1 Robert Wood Johnson University New Brunswick NJ All DRGS Model 2 Baptist Medical Center San Antonio TX Congestive Heart Failure Model 2 Model 3 Hospital of the University of Pennsylvania Encompass Home Health of Houston Philadelphia PA UTI, Stroke, Revision of the hip/knee, etc. Houston TX UTI, Stroke, Revision of the hip/knee, etc. Model 4 Valley Baptist Medical Center - Harlingen Harlingen TX Spinal fusion, Major joint replacement of the lower extremity, etc.

38 Hospital Readmissions Reduction Program CMS reduced payments to acute care hospitals with excess readmissions, effective 10/1/12 Initially targets AMI, Heart Failure, and Pneumonia Excess readmission ratio Comparison of hospital s risk-adjusted readmission performance to national average Based on 3 years of discharge data with minimum of 25 cases per condition per hospital Payment reductions applied to all Medicare admissions if riskadjusted readmission rate exceeds average Capped at 1% in FY 2013; 2% in FY 2014; 3% in FY 2015 Source: https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions- Reduction-Program.html

39 Hospital Readmissions Reduction Program Analysis of year-1 results 2,189 (66.7%) will receive payment cuts. Percent of Hospitals Highly Penalized Large (400+ beds) 40% Teaching 44% Safety Net 44% Small (<200 beds) 20% Non-Teaching 33% Non-Safety Net 30% Source: K.E. Joynt, A.K. Jhan, JAMA 2013: 309(4):

40 Source: U.S. Department of Health and Human Services, May 7, 2014

41 Is Health Care Becoming More Affordable: For the previously uninsured? Yes. Several million have received subsidies to purchase insurance through the Marketplace, or received Medicaid in expansion states. For workers covered by large employers? On the positive side, premium growth has slowed, which may or may not be related to Obamacare. On the negative side, insurers must now pay fees associated with the ACA.

42 Is Health care Becoming More Affordable: For workers covered by small employers? No. Premiums are expected to rise on average. There is no good estimate of how much premiums will rise, or which small firms will offer coverage. There are likely to be some big winners and losers. For the taxpayer? The ACA is estimated to be deficit reducing in the long run. However, health care is consuming an increasing portion of the federal budget. While ACA measures may reduce Medicare spending somewhat, we must do much more to reduce the federal debt.

43 Thank you! For a copy of these slides, please

Hospitals and the Affordable Care Act (ACA)

Hospitals and the Affordable Care Act (ACA) Hospitals and the Affordable Care Act (ACA) General Housekeeping If you experience any technical difficulties during the webinar, please contact GoToMeeting.com Corporate Account Customer Support at: 1-888-259-8414

More information

Healthcare Reform (ACA) Update Greater Magnolia Chamber of Commerce

Healthcare Reform (ACA) Update Greater Magnolia Chamber of Commerce Healthcare Reform (ACA) Update Greater Magnolia Chamber of Commerce FREDDY WARNER System Executive, Public Policy & Government Relations Memorial Hermann Health System March 27, 2014 PRESENTATION OUTLINE

More information

The Affordable Care Act

The Affordable Care Act The Affordable Care Act What does it mean for internists? Joshua Becker MD 10/14/2015 VII. 2015 Reforms and Beyond Payment Penalties under Medicare s Pay-for-Reporting Program Value-Based Payment Modifier

More information

Health Reform Monitoring Survey -- Texas

Health Reform Monitoring Survey -- Texas Health Reform Monitoring Survey -- Texas Issue Brief #1: Were Texans Satisfied with the Cost of Health Care and Health Insurance Prior to the Affordable Care Act? February 10, 2014 Vivian Ho, PhD, Elena

More information

Health Reform: The Cost of Failure and the Implications of Success

Health Reform: The Cost of Failure and the Implications of Success Health Reform: The Cost of Failure and the Implications of Success Bowen Garrett John Holahan June 17, 2010 National Association for Business Economics www.healthpolicycenter.org The Affordable Care Act

More information

The meeting was called to order at 5:27 by the Chairman of the Executive Committee, Joseph Szot, M.D.

The meeting was called to order at 5:27 by the Chairman of the Executive Committee, Joseph Szot, M.D. Minutes Carver College of Medicine Fall Faculty Forum: Health Care Reform Legislation - Its Implementation and Impact on UI Health Care Tuesday, October 26, 2010 Presenters: Vice-President Jean Robillard,

More information

3/28/2014. Spencer Berthelsen, M.D. Texas Club of Internists

3/28/2014. Spencer Berthelsen, M.D. Texas Club of Internists Spencer Berthelsen, M.D. Texas Club of Internists April 4, 2014 Cost The US spends twice as much per capita as the average of other industrialized nations Institute of Medicine 30% of healthcare dollars

More information

Lynn A. Blewett, Ph.D. Professor, University of Minnesota

Lynn A. Blewett, Ph.D. Professor, University of Minnesota Lynn A. Blewett, Ph.D. Professor, University of Minnesota Westlake Forum III Healthcare Reform in China and the US: Similarities, Differences and Challenges Emory University, Atlanta, GA April 10-12, 2011

More information

HEALTHCARE REFORM CARE DELIVERY AND REIMBURSEMENT MODELS. April 10, 2014

HEALTHCARE REFORM CARE DELIVERY AND REIMBURSEMENT MODELS. April 10, 2014 HEALTHCARE REFORM CARE DELIVERY AND REIMBURSEMENT MODELS April 10, 2014 1 MARKETPLACE UPDATE 2 MARKETPLACE - ESSENTIAL HEALTH BENEFITS 3 MARKETPLACE - METAL LEVELS 4 WHAT IS THE HEALTH INSURANCE MARKETPLACE

More information

Program Objectives 9/2/2014. Affordable Care Act: Smooth or White Waters Ahead? History of Healthcare Reform

Program Objectives 9/2/2014. Affordable Care Act: Smooth or White Waters Ahead? History of Healthcare Reform Affordable Care Act: Smooth or White Waters Ahead? Kathleen Bradbury-Golas, DNP, RN, NP-C, ACNS-BC Assistant Professor, Felician College Family Nurse Practitioner, Virtua Atlantic Shore Family Practice

More information

Health insurance Marketplace. What to expect in 2014

Health insurance Marketplace. What to expect in 2014 Health insurance Marketplace What to expect in 2014 Overview The Affordable Care Act (ACA) includes several provisions geared to extend greater access to health insurance benefits to more people. Beginning

More information

Accountable Care Organizations: An old idea with new potential. Stephen E. Whitney, MD, MBA Testimony to Senate State Affairs September 22, 2010

Accountable Care Organizations: An old idea with new potential. Stephen E. Whitney, MD, MBA Testimony to Senate State Affairs September 22, 2010 Accountable Care Organizations: An old idea with new potential Stephen E. Whitney, MD, MBA Testimony to Senate State Affairs September 22, 2010 Impetus for ACO Formation Increased health care cost From

More information

The Patient Protection & Affordable Care Act: Next Steps in Maine. February 8, 2013 1

The Patient Protection & Affordable Care Act: Next Steps in Maine. February 8, 2013 1 The Patient Protection & Affordable Care Act: Next Steps in Maine February 8, 2013 1 Maine Medical Association Voluntary membership association of over 3,600 Maine physicians, residents, and medical students

More information

Accountable Care Organizations: Forging Stakeholder Partnerships for Health Care Performance and Efficiency

Accountable Care Organizations: Forging Stakeholder Partnerships for Health Care Performance and Efficiency Accountable Care Organizations: Forging Stakeholder Partnerships for Health Care Performance and Efficiency Julie Lewis Director of Health Policy Dartmouth Institute for Health Policy and Clinical Practice

More information

What is an Accountable Care Organization. Amit Rastogi, MD President/CEO PriMed

What is an Accountable Care Organization. Amit Rastogi, MD President/CEO PriMed What is an Accountable Care Organization Amit Rastogi, MD President/CEO PriMed Goals Why is U.S. healthcare undergoing dramatic change How reimbursement structures are likely to change What is the timeline

More information

How Health Reform Will Affect Health Care Quality and the Delivery of Services

How Health Reform Will Affect Health Care Quality and the Delivery of Services Fact Sheet AARP Public Policy Institute How Health Reform Will Affect Health Care Quality and the Delivery of Services The recently enacted Affordable Care Act contains provisions to improve health care

More information

Health Reform Monitoring Survey -- Texas

Health Reform Monitoring Survey -- Texas Health Reform Monitoring Survey -- Texas Issue Brief #20: Insured Texans lack clear understanding of their health insurance plans March 2016 Shao-Chee Sim, PhD, Elena Marks, JD, MPH, Vivian Ho, PhD, and

More information

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION At the end of this session, you will be able to: Identify ways RT skills can be utilized for

More information

Getting Ready for 2014: The Big Year for Healthcare Reform Anne Arundel County SHRM. David Johnson jdjohnson@rcmd.com November 15, 2012

Getting Ready for 2014: The Big Year for Healthcare Reform Anne Arundel County SHRM. David Johnson jdjohnson@rcmd.com November 15, 2012 Getting Ready for 2014: The Big Year for Healthcare Reform Anne Arundel County SHRM David Johnson jdjohnson@rcmd.com November 15, 2012 0 Topics for Discussion 1. Recap of Supreme Court Decision on Affordable

More information

The Continued Need for Reform: Building a Sustainable Health Care System

The Continued Need for Reform: Building a Sustainable Health Care System The Continued Need for Reform: Building a Sustainable Health Care System Sustainable reform must address cost and quality, while expanding coverage through a vibrant and functional marketplace As the largest

More information

National Healthcare Reform: Implications for Nursing Education and Practice

National Healthcare Reform: Implications for Nursing Education and Practice National Healthcare Reform: Implications for Nursing Education and Practice UMass Graduate School of Nursing Alumni Association Program June 4, 2010 Katharine London 2 Goals for Today s Presentation Explain

More information

Affordable Care Act: Train Wreck or Golden Opportunity?

Affordable Care Act: Train Wreck or Golden Opportunity? Affordable Care Act: Train Wreck or Golden Opportunity? Annual Meeting of The American Society for Automation in Pharmacy January 16, 2014 Brad Kile, PhD " Disclosure Brad Kile is an independent consultant

More information

The Affordable Care Act and North Carolina

The Affordable Care Act and North Carolina The Affordable Care Act and North Carolina Christopher J. Conover, PhD Center for Health Policy and Inequalities Research Duke University March 12, 2014 Roadmap What is in the ACA as it relates to healthcare/

More information

ACA Implementation Timeline

ACA Implementation Timeline ACA Implementation Timeline Published: March 5, 2013 Updated: July 5, 2013 Producer: Sophie Novack Director: Jessica Guzik National Journal Presentation Credits Most ACA Reforms Implemented 2013-2014 Jan.

More information

Healthcare Reform: Preparing Your Practice For Implementation of the. HMWC Healthcare Education Leadership Program. Affordable Care Act (ACA)

Healthcare Reform: Preparing Your Practice For Implementation of the. HMWC Healthcare Education Leadership Program. Affordable Care Act (ACA) Healthcare Reform: Preparing Your Practice For Implementation of the HMWC Healthcare Education Leadership Program Affordable Care Act (ACA) September 12, 2013 Main Provisions Signed into law on March 23,

More information

illinois health insurance marketplace

illinois health insurance marketplace illinois health insurance marketplace healthcare reform is coming. find answers here. healthcarereform.illinois.gov The Affordable Care Act. What it means for you. In March of 2010, the Affordable Care

More information

Premium Tax Credits: Answers to Frequently Asked Questions

Premium Tax Credits: Answers to Frequently Asked Questions Updated July 2013 Premium Tax Credits: Answers to Frequently Asked Questions Beginning in 2014, millions of Americans will become eligible for a new premium tax credit that will help them pay for health

More information

THE FUTURE OF EMPLOYER BASED HEALTH INSURANCE FOLLOWING HEALTH REFORM

THE FUTURE OF EMPLOYER BASED HEALTH INSURANCE FOLLOWING HEALTH REFORM THE FUTURE OF EMPLOYER BASED HEALTH INSURANCE FOLLOWING HEALTH REFORM National Congress on Health Insurance Reform Washington, D.C., January 20, 2011 Elise Gould, PhD Health Policy Research Director Economic

More information

Plenary Session 1. Health Dimensions Group. 2010 Health Dimensions Group

Plenary Session 1. Health Dimensions Group. 2010 Health Dimensions Group Plenary Session 1 Kathleen M. Griffin, PhD Health Dimensions Group March 31, 2011 Hospital, Post Acute and Long-Term Care Collaboration in Health Care Reform: Critical Success Factors National Summit:

More information

Despite Criticism, The Affordable Care Act Does Much to Contain Health Care Costs

Despite Criticism, The Affordable Care Act Does Much to Contain Health Care Costs Despite Criticism, The Affordable Care Act Does Much to Contain Health Care Costs Stephen Zuckerman and John Holahan October 2012 Introduction Critics of the Affordable Care Act (ACA) have argued that

More information

Value Based Care and Healthcare Reform

Value Based Care and Healthcare Reform Value Based Care and Healthcare Reform Dimensions in Cardiac Care November, 2014 Jacqueline Matthews, RN, MS Senior Director, Quality Reporting & Reform Quality and Patient Safety Institute Cleveland Clinic

More information

Overview of Policy Options to Sustain Medicare for the Future

Overview of Policy Options to Sustain Medicare for the Future Overview of Policy Options to Sustain Medicare for the Future Juliette Cubanski, Ph.D. Associate Director, Program on Medicare Policy Kaiser Family Foundation jcubanski@kff.org Medicare NewsGroup Journalism

More information

Affordable Care Act at 3: Strengthening Medicare

Affordable Care Act at 3: Strengthening Medicare Affordable Care Act at 3: Strengthening Medicare ISSUE BRIEF Fifth in a series May 22, 2013 Kyle Brown Senior Health Policy Analyst 789 Sherman St. Suite 300 Denver, CO 80203 www.cclponline.org 303-573-5669

More information

Affordable Care Act and Adolescents and Young Adults

Affordable Care Act and Adolescents and Young Adults Affordable Care Act and Adolescents and Young Adults Overview of Summit Welcome and Introductions Affordable Care Act 101 Affordable Care Act and Impact on Adolescents and Young Adults Federal Update on

More information

Virtual Mentor American Medical Association Journal of Ethics November 2011, Volume 13, Number 11: 817-821.

Virtual Mentor American Medical Association Journal of Ethics November 2011, Volume 13, Number 11: 817-821. Virtual Mentor American Medical Association Journal of Ethics November 2011, Volume 13, Number 11: 817-821. OP-ED The Affordable Care Act A New Way Forward Vivian Ho, PhD On March 23, 2010, President Obama

More information

HEALTH CARE REFORM CHECKLIST

HEALTH CARE REFORM CHECKLIST HEALTH CARE REFORM CHECKLIST As a small employer, you need to be aware of the new regulations tied to the Affordable Care Act. Refer to this checklist to ensure you understand each one and that you re

More information

Running Head: COST-CONTROLLING MEASURES OF THE A.C.A. 1. Lesser Politicized Cost-Controlling Measures of the Affordable Care Act: Literature Review

Running Head: COST-CONTROLLING MEASURES OF THE A.C.A. 1. Lesser Politicized Cost-Controlling Measures of the Affordable Care Act: Literature Review Running Head: COST-CONTROLLING MEASURES OF THE A.C.A. 1 Lesser Politicized Cost-Controlling Measures of the Affordable Care Act: Literature Review Robin Persun Excelsior College COST-CONTROLLING MEASURES

More information

Accountable Care Organizations and Behavioral Health. Indiana Council of Community Mental Health Centers October 11, 2012

Accountable Care Organizations and Behavioral Health. Indiana Council of Community Mental Health Centers October 11, 2012 Accountable Care Organizations and Behavioral Health Indiana Council of Community Mental Health Centers October 11, 2012 What is an ACO? An accountable care organization is a group of providers or suppliers

More information

The Potential Impact of Health Care Reform in Los Angeles County

The Potential Impact of Health Care Reform in Los Angeles County The Potential Impact of Health Care Reform in Los Angeles County Beyond Health Care Reform: A Vision of the Future SEIU Local 721, September 25, 2010 Dylan H. Roby, PhD Assistant Professor & Associate

More information

Walden University Q & A continued from Webinar Todd Linden

Walden University Q & A continued from Webinar Todd Linden Walden University Q & A continued from Webinar Todd Linden General Note: The answers to these questions are my opinion. The mountain of rules and regulations that will be produced from this legislation

More information

HEALTHCARE CHANGES AFFECTING YOUR PRACTICE. Vinay Kumar MD, FACS, ABVM Endovascular options Dallas, Texas

HEALTHCARE CHANGES AFFECTING YOUR PRACTICE. Vinay Kumar MD, FACS, ABVM Endovascular options Dallas, Texas HEALTHCARE CHANGES AFFECTING YOUR PRACTICE Vinay Kumar MD, FACS, ABVM Endovascular options Dallas, Texas HEALTH CARE CHANGES 1 st Major overhaul of health care system since WWII introduction of 3 rd party

More information

ACA Premium Impact Variability of Individual Market Premium Rate Changes Robert M. Damler, FSA, MAAA Paul R. Houchens, FSA, MAAA

ACA Premium Impact Variability of Individual Market Premium Rate Changes Robert M. Damler, FSA, MAAA Paul R. Houchens, FSA, MAAA ACA Premium Impact Variability of Individual Market Premium Rate Changes Robert M. Damler, FSA, MAAA Paul R. Houchens, FSA, MAAA BACKGROUND The Patient Protection and Affordable Care Act (ACA) introduces

More information

The New Health Insurance Marketplace. Choices and Opportunities for Small Groups

The New Health Insurance Marketplace. Choices and Opportunities for Small Groups The New Health Insurance Marketplace Choices and Opportunities for Small Groups What is the Affordable Care Act? The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010

More information

Educational Presentation: Affordable Care Act. City of Boston PEC Meeting April 8, 2014

Educational Presentation: Affordable Care Act. City of Boston PEC Meeting April 8, 2014 Educational Presentation: Affordable Care Act City of Boston PEC Meeting April 8, 2014 Discussion Topics Affordable Care Act Plan Design Implications ACA Wellness Guidelines Assuring Administrative Compliance

More information

THE AFFORDABLE CARE ACT IMPACT ON YOUR MEDICAL PRACTICE

THE AFFORDABLE CARE ACT IMPACT ON YOUR MEDICAL PRACTICE THE AFFORDABLE CARE ACT IMPACT ON YOUR MEDICAL PRACTICE Dennis Olmstead, MPA Vice President Practice Economics & Payer Relations Pennsylvania Medical Society Kaiser Health Tracking Poll Poll (March 2013)

More information

GAO PATIENT PROTECTION AND AFFORDABLE CARE ACT. Effect on Long-Term Federal Budget Outlook Largely Depends on Whether Cost Containment Sustained

GAO PATIENT PROTECTION AND AFFORDABLE CARE ACT. Effect on Long-Term Federal Budget Outlook Largely Depends on Whether Cost Containment Sustained GAO United States Government Accountability Office Report to the Ranking Member, Committee on the Budget, U.S. Senate January 2013 PATIENT PROTECTION AND AFFORDABLE CARE ACT Effect on Long-Term Federal

More information

Health Reform Monitoring Survey -- Texas

Health Reform Monitoring Survey -- Texas Health Reform Monitoring Survey -- Texas Issue Brief #11: Effects of the Affordable Care Act on health insurance coverage in Texas as of March 2015 April 30, 2015 Vivian Ho, PhD and Elena Marks, JD, MPH

More information

Health Reform Monitoring Survey -- Texas

Health Reform Monitoring Survey -- Texas Health Reform Monitoring Survey -- Texas Issue Brief #10: Marketplace Plans: Premiums, Network Size and Market Competition November, 2014 Woohyeon Kim, Elena Marks, Marah Short, Hannah Crowe, and Vivian

More information

Insurance Coverage Provisions of the Affordable Care Act CBO s March 2015 Baseline

Insurance Coverage Provisions of the Affordable Care Act CBO s March 2015 Baseline Insurance Coverage Provisions of the Affordable Care Act CBO s March 2015 Baseline Table 1. Direct Spending and Revenue Effects of the Insurance Coverage Provisions of the Affordable Care Act Table 2.

More information

Medicare Shared Savings Program

Medicare Shared Savings Program Medicare Shared Savings Program Eastern Michigan Chapter of HFMA Insurance and Reimbursement Committee April 30, 2015 Presenter: Kenneth B. Lipan, FHFMA Director of Finance: Clinical Integration, Unified

More information

The Pediatric ACO: When Things Go Bump in the Night

The Pediatric ACO: When Things Go Bump in the Night The Pediatric ACO: When Things Go Bump in the Night Angelo P. Giardino, MD, PhD Chief Medical Officer Texas Children s Health Plan, Houston Chief Quality Officer for Medicine Texas Children s Hospital

More information

Health Care Reform: What s in the Law

Health Care Reform: What s in the Law Health Care Reform: What s in the Law Professor Sidney D. Watson March 2013 On June 28, 2012, the United States Supreme Court upheld the Affordable Care Act, also known as ObamaCare. The Supreme Court

More information

Health Care Reform Management Alert Series Roadmap of Plan Changes Needed For Upcoming Plan Years

Health Care Reform Management Alert Series Roadmap of Plan Changes Needed For Upcoming Plan Years Health Care Reform Management Alert Series Roadmap of Plan Changes Needed For Upcoming Plan Years Seyfarth Shaw has generously given permission to Lawyers Alliance for New York to circulate this chart

More information

Insure Tennessee. What is Insure Tennessee?

Insure Tennessee. What is Insure Tennessee? Coverage for Tennessee s uninsured that is market-based, promotes personal responsibility, addresses cost, and is a big step towards real healthcare reform in Tennessee. What is Insure Tennessee? 2 What

More information

INDIVIDUAL HEALTH INSURANCE GUIDE. Introduction. What is the Health Insurance Marketplace?

INDIVIDUAL HEALTH INSURANCE GUIDE. Introduction. What is the Health Insurance Marketplace? INDIVIDUAL HEALTH INSURANCE GUIDE Introduction On November 15th, 2014, the second annual Open Enrollment Period for Individual Health Insurance begins. The Affordable Care Act (ACA) requires all US citizens

More information

The Estimated Effect of the Affordable Care Act on Medicare and Medicaid Outlays and Total National Health Care Expenditures

The Estimated Effect of the Affordable Care Act on Medicare and Medicaid Outlays and Total National Health Care Expenditures The Estimated Effect of the Affordable Care Act on Medicare and Medicaid Outlays and Total National Health Care Expenditures Testimony before the House Committee on the Budget January 26, 2011 by Richard

More information

ASSESSING THE RESULTS

ASSESSING THE RESULTS HEALTH REFORM IN MASSACHUSETTS EXPANDING TO HEALTH INSURANCE ASSESSING THE RESULTS March 2014 Health Reform in Massachusetts, Expanding Access to Health Insurance Coverage: Assessing the Results pulls

More information

Participating Accountable Care Organizations (ACOs) that meet quality performance standards will be eligible to receive payments for shared savings.

Participating Accountable Care Organizations (ACOs) that meet quality performance standards will be eligible to receive payments for shared savings. Background Sec. 3022 of the Patient Protection and Affordable Care Act (PPACA) requires the Secretary to establish the Medicare Shared Savings Program by Jan. 1, 2012 Program goals: Promote accountability

More information

Definition: The Patient Protection and Affordable Care Act (PPACA)

Definition: The Patient Protection and Affordable Care Act (PPACA) Definition: The Patient Protection and Affordable Care Act (PPACA) - Also known as Obamacare or ACA - is a federal law that makes significant reforms to the United States health care system. Main Components

More information

Building a Post Acute Network: Care Management and ACOs

Building a Post Acute Network: Care Management and ACOs Building a Post Acute Network: Care Management and ACOs A high level summary of proposed rules for ACOs and the shared savings program most relevant to post acute providers. Prepared By: Kathleen M. Griffin,

More information

The ABCs of Population Health Management Jennifer Houlihan, MSP Director of CIN Strategy, Integration and Population Health

The ABCs of Population Health Management Jennifer Houlihan, MSP Director of CIN Strategy, Integration and Population Health The ABCs of Population Health Management Jennifer Houlihan, MSP Director of CIN Strategy, Integration and Population Health A view from the marketplace Employers seek Other health Systems for Clinically

More information

Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion

Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion Table of Contents Expanded Coverage... 2 Health Insurance Exchanges... 3 Medicaid Expansion... 8 Novartis Pharmaceuticals Corporation

More information

List of Insurance Terms and Definitions for Uniform Translation

List of Insurance Terms and Definitions for Uniform Translation Term actuarial value Affordable Care Act allowed charge Definition The percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%,

More information

Health Care Reform: Seizing the Opportunity to Transform the Care Delivery System for Our Elders

Health Care Reform: Seizing the Opportunity to Transform the Care Delivery System for Our Elders May 5, 2011 Health Care Reform: Seizing the Opportunity to Transform the Care Delivery System for Our Elders WAHSA 2011 Spring Conference & Annual Business Meeting: New Thoughts, New Directions Kathleen

More information

Timeline: Key Feature Implementations of the Affordable Care Act

Timeline: Key Feature Implementations of the Affordable Care Act Timeline: Key Feature Implementations of the Affordable Care Act The Affordable Care Act, signed on March 23, 2010, puts in place health insurance reforms that will roll out incrementally over the next

More information

Health Insurance Exchanges and the Medicaid Expansion After the Supreme Court Decision: State Actions and Key Implementation Issues

Health Insurance Exchanges and the Medicaid Expansion After the Supreme Court Decision: State Actions and Key Implementation Issues Health Insurance Exchanges and the Medicaid Expansion After the Supreme Court Decision: State Actions and Key Implementation Issues Sara R. Collins, Ph.D. Vice President, Affordable Health Insurance The

More information

Changing Economics in an Era of Healthcare Reform

Changing Economics in an Era of Healthcare Reform R E F O R M Changing Economics in an Era of Healthcare Reform Nathan S. Kaufman, Managing Director, Kaufman Strategic Advisors, LLC As health systems prepare for healthcare reform, they are focusing significant

More information

Impact of the Health Insurance Annual Fee Tax

Impact of the Health Insurance Annual Fee Tax Impact of the Health Insurance Annual Fee Tax Robert A. Book, Ph.D. February 20, 2014 Executive Summary The Affordable Care Act's "annual fee on health insurance is a unique tax levied on health insurance

More information

Health Care Reform & The Health Insurance Marketplace. Presented by Mikal A Jeffries, CEBS Account Manager

Health Care Reform & The Health Insurance Marketplace. Presented by Mikal A Jeffries, CEBS Account Manager Health Care Reform & The Health Insurance Marketplace Presented by Mikal A Jeffries, CEBS Account Manager 1 Health Care Reform Review Goals of Health Care Reform Increase number of Americans with health

More information

Massachusetts US Census Bureau 2011

Massachusetts US Census Bureau 2011 Massachusetts US Census Bureau 2011 Population: 6,587,536 Average persons per household: 2.48 Female persons: 51.6% Persons under 18: 21.3% Caucasian: 84.1% African American: 7.8% Asian: 5.6% Latino: 9.9%

More information

PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems

PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems By Kathleen M. Griffin, PhD. There are three key provisions of the law that will have direct impact on post-acute care needs

More information

Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA)

Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA) Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA) Patricia A. Davis, Coordinator Specialist in Health Care Financing Jim Hahn Analyst in Health Care Financing Paulette C. Morgan

More information

Structuring Your ACO Business Model To Achieve Success in a Post Acute Continuum. 2011 Annual Summit of the Executive Operators Forum

Structuring Your ACO Business Model To Achieve Success in a Post Acute Continuum. 2011 Annual Summit of the Executive Operators Forum Structuring Your ACO Business Model To Achieve Success in a Post Acute Continuum 2011 Annual Summit of the Executive Operators Forum Healthcare Reform and What it Means to You Loren Claypool CIO, Extendicare

More information

Accountable Care Organizations & Other Reimbursement Reforms: The Impact on Physician Practices

Accountable Care Organizations & Other Reimbursement Reforms: The Impact on Physician Practices Accountable Care Organizations & Other Reimbursement Reforms: The Impact on Physician Practices Martin Bienstock, Esq. Wilson Elser Martin.Bienstock@WilsonElser.com The New York Times Take... For the first

More information

Healthcare Reform: Impact on Care for Low-Income and Uninsured Patients

Healthcare Reform: Impact on Care for Low-Income and Uninsured Patients Competency 4 Healthcare Reform: Impact on Care for Low-Income and Uninsured Patients Updated June 2014. Presented by: Lewis Foxhall, MD VP for Health Policy Professor, Clinical Cancer Prevention UT MD

More information

OHIO CONSUMERS FOR HEALTH COVERAGE POLICY PRIORITIES FY 2012-13. Medicaid Make Improvements to Improve Care and Lower Costs

OHIO CONSUMERS FOR HEALTH COVERAGE POLICY PRIORITIES FY 2012-13. Medicaid Make Improvements to Improve Care and Lower Costs OHIO CONSUMERS FOR HEALTH COVERAGE POLICY PRIORITIES FY 2012-13 Ohio Consumers for Health Coverage supports robust implementation of the Patient Protection and Affordable Care Act (ACA) in Ohio, making

More information

Center for Medicare and Medicaid Innovation

Center for Medicare and Medicaid Innovation Center for Medicare and Medicaid Innovation Summary: Establishes within the Centers for Medicare and Medicaid Services (CMS) a Center for Medicare & Medicaid Innovation (CMI). The purpose of the Center

More information

Federal Health Care Reform: Implications for Hospital and Physician partnerships. Walter Kopp Medical Management Services

Federal Health Care Reform: Implications for Hospital and Physician partnerships. Walter Kopp Medical Management Services Federal Health Care Reform: Implications for Hospital and Physician partnerships Walter Kopp Medical Management Services Outline Overview of federal health reform legislation Implications for Care delivery

More information

Summary of Major Provisions in Final House Reform Package

Summary of Major Provisions in Final House Reform Package SPECIAL BULLETIN Monday, March 22, 2010 This summary is five pages. Summary of Major Provisions in Final House Reform Package The U.S. House of Representatives late yesterday voted to pass landmark health

More information

PHYSICIANS. 202.420.7896 888 16 th St. NW, Suite 800, Washington DC 20006 www.npalliance.org

PHYSICIANS. 202.420.7896 888 16 th St. NW, Suite 800, Washington DC 20006 www.npalliance.org N A T I O N A L PHYSICIANS A L L I A N C E My name is Dr. Valerie Arkoosh. I am an Anesthesiologist at the University of Pennsylvania School of Medicine and the President of the National Physicians Alliance.

More information

Medicare Shared Savings Program

Medicare Shared Savings Program Medicare Shared Savings Program Shared Savings Program http://www.cms.gov/savingsprogram/ Centers for Medicare & Medicaid Services February 2012 Medicare Shared Savings Program (Shared Savings Program)

More information

Medicare Advantage: The overlooked cornerstone of healthcare reform

Medicare Advantage: The overlooked cornerstone of healthcare reform Medicare Advantage: The overlooked cornerstone of healthcare reform June 8, 2013 Grace-Marie Turner Galen Institute Medicare: Still basically the 1965 model A social insurance program to help pay for hospital

More information

Reforming and restructuring the health care delivery system

Reforming and restructuring the health care delivery system Reforming and restructuring the health care delivery system Are Accountable Care Organizations and bundling the solution? Prepared by: Dan Head, Principal, RSM US LLP dan.head@rsmus.com, +1 703 336 6536

More information

An Employer s Guide to Health Care Reform

An Employer s Guide to Health Care Reform An Employer s Guide to Health Care Reform Important details to navigate employer-provided benefits amidst a changing health care landscape. PAGE 1 Navigating a new health care landscape Health care reform,

More information

The Affordable Care Act and the Health Insurance Marketplace

The Affordable Care Act and the Health Insurance Marketplace The Affordable Care Act and the Health Insurance Marketplace Are You Ready? The Affordable Care Act is here! In March 2010, President Obama signed into law the Affordable Care Act (ACA), putting comprehensive

More information

Texas Affordable Care Act Implementation: Challenges and Opportunities

Texas Affordable Care Act Implementation: Challenges and Opportunities Texas Affordable Care Act Implementation: Challenges and Opportunities Texas Robert Greenwald Clinical Professor of Law Director, Center for Health Law and Policy Innovation of Harvard Law School January

More information

Facilities contract with Medicare to furnish

Facilities contract with Medicare to furnish Facilities contract with Medicare to furnish acute inpatient care and agree to accept predetermined acute Inpatient Prospective Payment System (IPPS) rates as payment in full. The inpatient hospital benefit

More information

What Providers Need To Know Before Adopting Bundling Payments

What Providers Need To Know Before Adopting Bundling Payments What Providers Need To Know Before Adopting Bundling Payments Dan Mirakhor Master of Health Administration University of Southern California Dan Mirakhor is a Master of Health Administration student at

More information

A Study by the National Association of Urban Hospitals September 2012

A Study by the National Association of Urban Hospitals September 2012 The Potential Impact of the Affordable Care Act on Urban Safety-Net Hospitals A Study by the National Association of Urban Hospitals September 2012 Introduction One by one and provision by provision, the

More information

Exchange 101. August 2013

Exchange 101. August 2013 Exchange 101 August 2013 455430 27517 Penalties for individuals 2017 and beyond: Annual adjustments 2016: Greater of $695 or 2.5% of taxable income 2015: Greater of $325 or 2% of taxable income 2014: Greater

More information

Wells Insurance. 2015 ACA Compliance Update

Wells Insurance. 2015 ACA Compliance Update Wells Insurance 2015 ACA Compliance Update Wells Insurance Today s Agenda Cost-Saving Strategies Deadlines & Implications for you Plan Design Changes Reinsurance Fees Employer Penalty Rules Reporting of

More information

And Changes under Healthcare Reform affecting businesses

And Changes under Healthcare Reform affecting businesses And Changes under Healthcare Reform affecting businesses 1 Individual Mandate 2 First there were two choices Under the Affordable Care Act every individual must have Minimum Essential Healthcare Coverage

More information

Nuts and Bolts of. Frank G. Opelka, MD FACS American College of Surgeons. Vice Chancellor for Clinical Affairs Professor of Surgery LSU New Orleans

Nuts and Bolts of. Frank G. Opelka, MD FACS American College of Surgeons. Vice Chancellor for Clinical Affairs Professor of Surgery LSU New Orleans Nuts and Bolts of Accountable Care Organizations Frank G. Opelka, MD FACS American College of Surgeons ACS Advocacy & Health Policy, Vice Chancellor for Clinical Affairs Professor of Surgery LSU New Orleans

More information

Health Reform. Employer Penalty Delay: What are the Consequences? Impact of the Delay on Employers

Health Reform. Employer Penalty Delay: What are the Consequences? Impact of the Delay on Employers Health Reform Employer Penalty Delay: What are the Consequences? Martin Haitz (484) 270-2575 martin.haitz@marcumfs.com Issued date: 07/29/13 The employer penalty provisions and two reporting requirements

More information

Restructuring Medicare Cost Sharing: Options and Implications

Restructuring Medicare Cost Sharing: Options and Implications Restructuring Medicare Cost Sharing: Options and Implications Alliance for Health Reform Washington, D.C. Juliette Cubanski, Ph.D. Associate Director, Program on Medicare Policy Kaiser Family Foundation

More information

Two Choices. The Affordable Care Act requires every individual to either: 1. Maintain Minimum Essential Coverage, or

Two Choices. The Affordable Care Act requires every individual to either: 1. Maintain Minimum Essential Coverage, or Information last updated September 9, 2014 1 Two Choices The Affordable Care Act requires every individual to either: 1. Maintain Minimum Essential Coverage, or 2. Make a Shared Responsibility Payment.

More information

NJ CUPA HR The Affordable Care Act & Its Implication for Employers April 4, 2014

NJ CUPA HR The Affordable Care Act & Its Implication for Employers April 4, 2014 NJ CUPA HR The Affordable Care Act & Its Implication for Employers April 4, 2014 About NJBIA Represents 21,000 companies of all sizes and types, which employ over 1 million workers in the State. Advocate

More information

Physicians ACO. Don McCormick President. Company Logo

Physicians ACO. Don McCormick President. Company Logo Physicians ACO Don McCormick President Company Logo Why Congress and CMS want ACOs Cost of health care is too high Quality of health care is too low Evidence for both conditions is undeniable Congress

More information