Discussion Points. Why is the Affordable Care Act so Controversial? 5/1/2014. The Affordable Care Act: Separating Politics from Policy

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1 The Affordable Care Act: Separating Politics from Policy Marshall R. Burack, Esq. Akerman LLP Partner, Healthcare Practice Group Discussion Points Why is the so Controversial? Why Reform Healthcare? What is the? The Impact of the on Physicians? Akerman 2 Why is the so Controversial? Americans despise Obamacare but have no problem with the CNBC Survey: 1/3 of respondents don t know what the is Only 12% of respondents don t know what Obamacare is 46% of respondents oppose Obamacare Only 37% of respondents oppose the Akerman 3 1

2 Why Reform Healthcare? 1. Overall Healthcare Costs are Skyrocketing 2. Medicare Spending Growth is Fiscally Unsustainable 3. Overall Quality of Care is Deteriorating 4. Approximately 48 Million Americans Have Little or No Health Insurance Akerman 4 What is the Affordable Care Act? General Framework: Law designed to increase the number of individuals covered by health insurance or government programs and to expand the benefits under those insurance policies; and Series of laws and taxes to fund the cost of the expansion in coverage Akerman 5 Increase in number of individuals covered achieved by: Employer mandate 50 plus FTE must offer insurance Individual mandate individuals not covered by insurance must purchase insurance, but may be eligible for government subsidies Expansion of Medicaid by modifying "eligibility criteria" Other coverage inclusive provisions (e.g. expansion of dependent coverage) Akerman 6 2

3 Increase in covered benefits achieved by: ACA sets minimum benefits which insurance policies must provide Elimination of coverage denials based on pre-existing conditions Akerman 7 Funding achieved by: Tax on pharmaceutical & medical device manufacturers Medicare and Medicare Advantage reimbursement cuts Surtax on capital gains of dividends for high income taxpayers Program initiatives related to increased efficiency, decrease in utilization, and increase in fraud and abuse prevention and recoupment efforts Akerman 8 Employer Mandate Employers with more than 50 FTEs must provide insurance or pay a penalty Delayed until 2016 FTE is defined as 30 hrs per week (typically 32 hrs) Akerman 9 3

4 Individual Mandate Individuals must have health insurance or pay a penalty Health Insurance Marketplace facilitates purchase of insurance by individuals The annual penalty for 2014 is $95 per person (or $47.50 per child under 18) with up to a family maximum of $285 or 1 percent of the family s income whichever is greater In 2015, it's $325 for an individual and up to $975 for a family, or 2 percent of income. In 2016 and beyond, it's $695 for an individual and a $2,085 maximum for a family, or 2.5 percent of income. The penalties are to be assessed on tax returns. Financial subsidies for certain persons who acquire insurance as an Akerman 10 exchange Small Business Exchanges Delayed for 1 year until late 2014 for coverage commencing in 2015 Akerman 11 Medicaid Expansion Beginning in January 2014, individuals under 65 years of age with income i below b l 133 percent t of f the federal f d l poverty t level l l (FPL) will be eligible for Medicaid Supreme Court ruling allowed individual states to opt out Approximately half the states (included Florida) have opted out Akerman 12 4

5 The Impact on Physicians of the Insurance Related Provisions of the Affordable Care Act Expansion of the market for covered healthcare services Increase in primary care Less uncompensated care Accelerated shift from traditional fee-for-service models Higher deductibles and copays increased reluctance to go to the doctor Akerman 13 Highlights of Ancillary Provisions of the ACA with Particular Effect on Physicians: Reimbursement cuts, increased fraud & abuse enforcement, movement from fee for service to managed care, resulting in: Practice acquisition/employee physician Akerman 14 Highlights of Ancillary Provisions of the ACA with Particular Effect on Physicians: Accountable Care Organizations (ACO s) of Medicare Shared Savings Program (MSSP) Medicare ACO: Network of Providers which contracts with Medicare to facilitate the coordination of care for their fee for service patients in exchange for sharing in the savings resulting from such coordination and reduction in costs Primary Effect is expected increase in Hospital/Physician Integration Hospital Market share preserved through Physician Practice Acquisition or hospital-controlled ACO s Secondary Effect: Creation of networks for non- Medicare ACO purposes Akerman 15 5

6 Highlights of Ancillary Provisions of the ACA with Particular Effect on Physicians: Non-Medicare ACO s: Network of providers which contract with managed care plans to facilitate coordination of care for managed care members on a capitation, shared risk or full risk basis Accelerating trend away from traditional FFS reimbursement to other compensation models Profits achieved through decrease in hospital-based services and increase in comprehensive coordinated care (utilization management) Akerman 16 Contact Marshall R. Burack, Partner Healthcare Practice Group Akerman LLP One Southeast Third Avenue, 25 th Floor Miami, FL Tel: Akerman 17 6

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