HEALTHCARE REFORM

It has been a year and a half since President Obama signed into law the "Patient Protection and Affordable Care Act" (the "ACA") on March 23, 2010. 

Many of the protections provided in the ACA have already gone into effect:

  • The ban on denying health insurance coverage to children with preexisting conditions.
  • The ban on health plan practices rescinding coverage contracts once a disease or illness is discovered.
  • Elimination of lifetime limits on policy coverage.
  • Tax credits became available to some small businesses to help them provide coverage for workers.
  • Adult children up to age 26 can continue on their parents’ policies.
  • Uninsured adults with preexisting conditions can get health coverage as part of a high-risk pool.

Many other provisions, like the implementation of the state insurance exchanges, require some time to implement.  In addition, at least one provision – the “individual mandate” which requires everyone to secure coverage – has been challenged in the courts and is currently on appeal, although many stakeholders are continuing their efforts to implement it based on current law.  So even the limited federal reform that was passed last year will take some time to provide its promised results.

 

Despite its currently limited implementation, the federal government continues to offer a somewhat rosy view of the current purchasers’ market for healthcare:


 
Although the ACA focused primarily on the economics of securing coverage, the administration has unfurled recently a couple of initiatives that focus more on improvements in the quality of healthcare provided, which could a major impact on lowering the cost of care for everyone.  These initiatives include:

 

  • Issuance of a National Strategy on Quality Improvement in healthcare.
  • Issuance of proposed rules governing the formation and designation of Accountable Care Organizations ("ACOs") which are intended initially to be developed in the Medicare/Medicaid services, but which are anticipated to eventually serve most of the population if the model is successful.


Despite the government’s efforts, there is much work to be done in the marketplace to have a real impact on the way healthcare is provided in California.  That is why organizations like CHCC – that bring insurance purchasers and consumers together to impact the way healthcare services are provided and paid for – have a lot of important work left to do.