Health Reform: What to Watch!

Affordable Care Act – what's next?

Lot's of debate is happening on the Supreme Court decision. The reality is that SCOTUS left it up to the political process with the current status being full speed ahead on implementation. Here are some key points for all of us to stay involved with:

1. Health Exchange Set-Up: What will Georgia do? If they do not set up the State Exchange the Feds can run it according to the law.

2. Coverage Mandates and Premiums: The Department of Health and Human Services will establish coverage requirements. What will happen to insurance premiums? What will be the amount of money needed to subsidize (Exchanges).

3. Physician Reimbursements and Doctor Networks: Medicare is due to be slashed to help fund exchange subsidies. Stay in touch with your doctor’s business office on what they will accept and your responsibility.

4. Will Georgia participate in the expanded Medicaid program now that punitive measures have been thrown out?   

Without major political change, I believe this law will drive us toward a two-tier system of healthcare. The tiers will be physicians who completely opt out of accepting insurance for business reasons...and those that continue to accept insurance. With the latter bracket probably declining, I am very fearful that "healthcare supply" will decrease and rationing will happen. This is already compounded by a shortage of physicians. Remember the word "Capitation" which simply means putting an upper limit on income. This is defacto rationing.   

While the Mandate "Tax" is getting all the press, far more attention is needed to the subsidized health insurance exchanges and what that will cost U.S. taxpayers.  Surveys show some employers will reduce or eliminate benefits. This will push more of us to the subsidized exchanges driving the taxpayer bill up even more.  Exchange plans will be required to provide robust (and costly) benefits (this is a new entitlement).

I could go on and it is noteworthy that some have improved benefits but unfortunately it is likely short lived due to the financial unsustainability of the new system. There are solutions but the politics remain in the way.

If you want to know what I suggest, read the previous posts on Consumer Directed Healthcare.

Editor's Note: is a health, long-term care and life insurance professional, and blogger for Cumming Patch.

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

Neil Stapley July 01, 2012 at 01:04 PM
So what are the alternatives? The republicans want to open up competition to drive down costs and allow you to buy insurance out of state. The only thing that this will drive down is the level of coverage as the insurance companies seek to recover the lost revenue from reduced premiums. Or will they start buying up said out of state companies that are not already owned by them. Or will they start buying up more medical facilities and when Joe Bloggs turns up with his out of state reduced cost insurance be turned away because oh sorry we don't accept that insurance or his deductable/copay is doubled because he has out of state coverage or sorry this facility/dr is not in network. Or they will hire more investigators to find an inaccuracy in his application for coverage "oh so Joe you are not covered because you lied on your application, you middle name is spelt Lee not Lea". Lets put this into persepctive. Profit for the big 6 insurance companies topped $12bn in 2010 that money is not going into the industry, so the only economic impact of the health exchanges that you and industry fear is you your own. Would any of the fairtax people be crying if the IRS was shut down tomorrow and all those CPA's and tax specialists loose their job no they wouldn't so I take the same view on health insurance proffesionals If it puts a few or all of you out of buisness so be it boo hoo find something else to do.
John Wagner July 01, 2012 at 03:21 PM
This blog was intended to review the laws provisions and implications. While the politics are crazy, it is really important people understand what is coming and plan accordingly. The trends I pointed out are happening now. I believe the major reform issues are: provider access, help for needy people, insurance for major illnesses, sensible tort/regulation, with financial balance fostered by competition. I can tell you with a high degree of certainty the major problem in healthcare coming is supply and our new law makes it worse. More emphasis on consumer directed plans would help. Your personal comments were inappropriate based on false assumptions.
Neil Stapley July 01, 2012 at 06:11 PM
My comments are based on current practices of your industry and the financial industry in general. Practices that are designed to make executives in your industry richer at the expensive of the rest of us. The money that has been pumped into the financial services sector due to illegal and immoral practices is what is causing our economic ruin not the president and countless individuals before him who have tried to reform healthcare for the benifit of the people as opposed to the benifit of the banking and insurance execs. My comments are not inappropriate the 1000's of people who have been bankrupted by your industry all because they had the misfortune to fall ill. So frankly as I said before I will not shed one tear for your industry or crooks.
Concerned American July 05, 2012 at 12:01 PM
John you are absolutely correct on this! If Georgia doesn't implement its own exchange then the Federal Government will. Have any politicians come up with a plan for this? As much as I dislike the new law the fact is we should be coming up with plans to implement it here in Georgia. I am so concerned with this new law. I see how the VA takes care of our veterans and it's horrible. Maybe Georgia should come up with a law mandating the Federal Government take better care of our veterans.
SOGTP July 05, 2012 at 03:28 PM
Concerned American - Congress has not authorized money for the federal exchanges. If Georgia does not implement these exchanges, the feds have no money to implement their federal exchanges.


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