With 2011 coming to an end, so has the first full year of implementation of the Affordable Care Act (ACA). CCHI has been on the front lines in working with state and federal leaders to implement the ACA. 2011 included the passage of the Colorado Health Benefits Exchange Act (SB200), which authorized Colorado to create its own state-based health exchange. The Colorado Health Benefits Exchange (known as “COHBE”) will be a regulated marketplace that will offer many Coloradans the option to purchase affordable and quality health insurance in the individual and small group markets, and if they qualify, subsidies and tax credits to help cover the costs. COHBE, when up and running in 2014, will help Coloradans get the health care they need, when they need it.
In 2011, the country also saw many changes for private health insurance, including required coverage of women’s preventative health services (to be implemented in August 2012), as well as the creation of a federal program to review insurance rate increases, and a final rule for the ACA’s Medical Loss Ratio, which requires insurers to spend the majority of consumer dollars on health care services and quality improvements. Finally, 2011 showed several important positive results of the ACA, including over 2.5 million more insured young people because of the ACA requirement that insurers allow young people under 26 to continue on their parents’ insurance, as well as rebates and reduced drug prices for Medicare beneficiaries who have fallen into the coverage gap in the Medicare prescription drug program.
Like 2011, 2012 will continue to see ACA provisions going into effect. These include:
- Hospitals will have to more clearly report their charity care spending to the IRS;
- A series of demonstration projects designed to strengthen Medicare by eliminating fraud, waste, and abuse;
- The Medicare Independence at Home demonstration, which will test out coordinated care medical teams providing care to certain high-need Medicare patients in their own homes;
- A Medicaid demonstration, which will allow bundled payments for medical care that include hospitalizations, as well as extending the Medicaid Accountable Care Organizations savings to pediatric providers within those organizations;
- A new annual tax on pharmaceutical companies; and
- On October 2012, Medicare payments for hospital readmissions will be reduced, to offset excessive readmissions to hospitals, such as early discharges from a hospital, which could result in a return visit.
However, what will be the biggest newsmaker of the ACA in 2012 will be the Supreme Court’s consideration of the ACA. The Court is expected to hear arguments on several issues, from the legality of the lawsuits themselves to the constitutionality of ACA provisions, including the individual mandate and Medicaid expansions. The arguments will begin on March 26, 2011. The decision is expected in June 2012.
We also expect that 2012 will include a lot of actions at the state level. Colorado will be continuing to establish COHBE. It also seems Colorado and other states will also have to make their own decisions about what will be their state’s Essential Health Benefits Package, per a recent Department of Health and Human Services bulletin. States will also be working to make sure their own laws align with the Affordable Care Act, including rate review and other requirements that health insurers have certain processes in place for Americans to appeal decisions.
As you can see there is a lot to expect in 2012. And we expect even more to happen through 2014 – the deadline for the ACA’s final goal – that all Americans have access to health coverage.
On to another year of health care reform!
Ashley Wheeland
Policy Associate
Colorado Consumer Health Initiative