Policy & Regulation News

Keeping an Eye on the Affordable Care Act: 2015 in Review

"Not since the passage of Medicare and Medicaid in the Johnson administration has there been such a quantum change in our ability to deliver comprehensive care."

By Jacqueline DiChiara

- The Affordable Care Act (ACA) has come a long way over the past 12 months. It is intended, as the name implies, to make health insurance more affordable and make sure more patients greater levels of overall coverage.

affordable care act healthcare reform

Here is a 2015 roundup of exclusive interview insights, reader commentary, and collected overview of ACA progress.

January: ACA provisions need strengthening

Although the ACA aimed to advance coverage for women under a series of new provisions, challenges reportedly ensued, according to a survey from Urban Institute.

The ACA granted health coverage eligibility to almost 19 million uninsured women. ACA provisions kept insurance companies from charging women more for health coverage and offered preventative coverage options such as birth control and mammograms sans copay.

Despite new ACA provisions, women were still almost 25 percent  more likely than men to discuss medical issues or an ability to pay their medical bills.

March: physicians struggling to stay ahead

Physicians were beginning to experience hardship following ACA implementation,  said Chris Franklin, Executive Vice President of Locum Tenems, to RevCycleIntelligence.com.

Many physicians “mentioned that hitting the Meaningful Use deadlines and milestones for EHR implementation had been particularly expensive, time-consuming and burdensome for them. … Many also mentioned more regulation and ‘red tape’ from the government and insurers who manage the plans.”

“Operating with more efficiency and using team-based medicine will be more important than ever, especially as value-based reimbursement becomes more common.”

“[The ACA’s] future remains in the hands of elected officials and judges. The only thing we know now is that the ACA is the playbook we all have to use.”

April: spending down, concerns up

According to research released from the Commonwealth Fund, premium growth had decelerated since ACA’s implementation. A “dramatic” drop in spending per Medicare beneficiary was noted.

“This slowdown came during a time when some critics had warned that health insurance reforms might increase the costs of health insurance for people with private insurance,” said researchers Cathy Schoen, MA, David Radley, PhD, MPH, and Sara R. Collins, PhD.

“Concerns are mounting that the recent wave of hospital mergers and hospital acquisition of physician practices will result in higher prices paid to private insurers, regardless of the quality of care provided.”

“Although the Affordable Care Act offers a platform from which to build, securing a more affordable future will likely require action beyond those reforms, focusing on costs of care, particularly for the privately insured,”

May: a focus on Medicaid managed care

According to CMS, healthcare coverage provided under the ACA has a series of kinks to work out regarding coordination and alignment efforts with private insurance markets.

“Greater alignment between Medicaid managed care plans and qualified health plans will help these individuals transition between sources of coverage,” said CMS in a proposed rule, CMS-2390-P, intended to update Medicaid managed care policies.

“[This] rule proposes to modernize the Medicaid managed care regulatory structure to facilitate and support delivery system reform initiatives to improve health care outcomes and the beneficiary experience while effectively managing costs.”

June: the industry waits for King v. Burwell decision

The ACA underwent a ruling of approval from the Supreme Court regarding King v. Burwell.

“The most surprising part of the development or evolution of the implementation of the ACA has been the number of states that at least so far have not taken advantage of the Medicaid expansion,” stated Ralph S. Tyler, Partner Venable LLP, Former Chief Counsel at the FDA, and Former Insurance Commissioner of Maryland, to RevCycleIntelligence.com.

“The fact that there are large states in our country which have not taken advantage of the Medicaid expansion is unfortunate and, more fundamentally, a large gap in the coverage that was intended to be provided.”

“While the court’s decision in King was undeniably an important one, it’s really a status quo decision. King leaves in place the Affordable Care Act and allows it to continue to operate as distinguished from the transformative and disruptive impact if the case had come out the other way.”

July: transparency a focus

The Centers for Medicare (CMS) announced a Covered California proposed rate increase of only 4 percent for 2016.

“[The ACA] is working as intended to spur competition and transparency in the Marketplaces, keeping premium increases low and leading to affordable new choices for consumers,” stated Kevin Counihan, CEO of the Health Insurance Marketplaces.

“The [ACA] brings an unprecedented level of scrutiny and transparency to health insurance rate increases,” said CMS. “[Insurance] companies must provide easy to understand information to their customers about their reasons for significant rate increases, as well as publicly justify and post on their website any unreasonable rate increases.”

August: ACA discussions make waves

The Alliance to Fight the 40 penned a letter to the House of Representatives stating the Cadillac Tax will likely be financially problematic.

“Illogically, the cost of benefit plan features designed to promote better health and reduce costs such as on-site clinics, wellness programs, employee assistance plans, flexible spending accounts, health reimbursement arrangements, and both employer and employee pre-tax contributions to health savings accounts are included when determining if the tax thresholds are crossed,” the letter explained.

“Even the cost of preventive benefits such as cancer screenings and immunizations is included, despite the fact that the ACA requires such benefits to be provided with no employee cost-sharing.”

Also in August, Xtelligent Media readers anonymously expressed their views about the Affordable Care Act’s greatest challenges and opportunities.

“I understand the mandatory part of the ACA regarding health insurance is a little too much, however, one [needs] to shift cost of healthcare,” said one ACA expert.

“When the government [starts] to pay for everything, taxes might increase and I am sure you won't be pleased. [The ACA] makes healthcare more competitive and health insurance compete for your business."

"The ACA does nothing to lower healthcare costs … Less than one half of one percent of the country is eligible for subsidies and pay less, but … [can] anyone out there who doesn't get subsidies or cost share reduction say that they aren't paying at least twice as much in premiums[,] … anywhere from 4 to 10 times more out of pocket in their plans as compared to before the ACA?,” stated a health plan representative.

“"The ACA now is stealing over 1/2 a billion more dollars from Medicare to use on ACA costs. The ACA authors claim that Medicare Advantage (MA) Plans cost more than Traditional Medicare and so they are cutting reimbursements that Congress itself set up in [the] first place.”

“Sounds fair, right? Except we see a totally different story if we simply look at how much Medicare spends and the % of the spending that goes to MA Plans compared to % of people covered by MA plans vs. Fee-For-Service Medicare!" 

September: readers speak out

Xtelligent Media readers voiced their opinions once again about whether or not the ACA brings about success.

“Without a doubt, the ACA [has] been the single most important positive change in [healthcare]. Not since the passage of Medicare and Medicaid in the Johnson administration has there been such a quantum change in our ability to deliver comprehensive care,” said one Pediatric Cardiologist.

“In Nevada alone, the uninsured rate for children has fallen from ~12% to 2%. We have had no substantial increase in our own employee health insurance rates and we have provided health insurance coverage for our employees for more than 3 decades well before ACA.”

Another reader, an Educational Director, believed the ACA hinders the economically disadvantaged:

“We recommend minimum standards for schooling, prisoner care, environmental standards, yet, when it comes to healthcare, we, what is considered to be the wealthiest nation, treat our poor, and let's be fair, those who chose not to cover themselves or their families, in such a primitive way.

A third reader offered an opinion about what ACA advocates must consider:

“[Since] the ACA was signed, premiums have already more than doubled in our plans and cost sharing has risen sharply in order to make up for the new taxes and reimbursement cuts in the ACA, and it is my understanding only about 1/3 of the cuts have been implemented?”

“MA insurers don't really get to pick benefits and premiums and offer plans the way [they] would like to, they have to fit into the [formulas] that CMS uses and as reimbursements get cut, cost sharing and/or premiums have to be raised in order to offset those losses.”

October: a focus on core matters

The United States Department of Health and Human Services (HHS) awarded over $175 million in ACA funding this month with an objective to strengthen primary healthcare accessibility.

“The most critical step in connecting people to quality health care is a primary care provider,” asserted HSS Secretary Sylvia Burwell.

“These awards provide financial support directly to health professionals, including physicians, registered nurses, and physician assistants, to help individuals – particularly the 17.6 million uninsured who have recently gained coverage – find the primary care services they need.”

“These awards not only strengthen our primary health care workforce, but increase access to primary care in urban, rural and frontier locations nationwide,” said Jim Macrae, Acting Administrator of the Health Resources and Services Administration (HRSA).

“Collectively, these programs are serving millions of Americans who rely on the National Health Service Corps and NURSE Corps clinicians for essential health care services.”

November: making value a priority

This month, CMS confirmed healthcare consumers have received $2.4 billion premium rebates since 2011.

“Thanks to the Affordable Care Act, there are now programs in place to give consumers maximum value for their premium dollar,” stated Kevin Counihan, CEO of the Health Insurance Marketplace.

“We are pleased that the tools created under the health care law are working as intended to give consumers access to high-quality health insurance coverage and keep cost affordable.”

December: a repeal makes waves

Earlier this month, the United States Senate voted to repeal sections of the ACA, subsequently cutting Planned Parenthood funding by millions of dollars.

“This appalling legislation guts the ACA, the greatest advance for women’s health in a generation. It would repeal Medicaid expansion, blocking millions more people from getting the health care they need,” stated Debra L. Ness, President of the National Partnership for Women & Families.

““It would defund Planned Parenthood, denying millions of women high-quality preventive care, including birth control, cancer screenings, screenings and treatment for sexually transmitted infections, and abortion care.”