Every year since 2010 new parts of the Patient Protection and Accountability Care Act (PPACA) are implemented. This year most of the focus is on preparing for state health exchanges, accountable care organizations (ACO’s) and new pilot programs designed to reduce the cost of care while improving quality.
There are a few changes, however, that will affect consumers:
1. All insurance carriers are required to communicate their plan coverage in a uniformly standard way set out by the U.S. Department of Health and Human Services (HHS). This standard is meant to help consumers better understand what is included in their benefits coverage. The HHS requires insurance carriers to provide a mini-summary of coverage to its members and a glossary of standard insurance terms.
2. At the end of 2012, annual W-2 Forms will include the full value of employer-sponsored health insurance coverage that the employee is enrolled in. This requirement is for informational purposes only. Health benefits are not considered income, and therefore, not taxed. Smaller businesses with less than 250 W-2 Forms may opt out of the requirement for 2012.
3. By October 2012, online billing will be introduced. Health care remains one of the few industries that relies on paper records. The new law institutes a series of changes to standardize billing and requires health plans to begin adopting and implementing rules for the secure, confidential, electronic exchange of health information. Using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and, most importantly, improve the quality of care.
U.S. Supreme Court Review
Another important event occurring this year is the U.S. Supreme Court review of the PPACA law. The U.S. Supreme Court announced in the fall of 2011 that they would schedule 5 ½ hours to hear oral arguments regarding the constitutionality of several areas of the new law. This development is significant to the fate of the health care reform law because the Supreme Court will ultimately decide whether or not the law is constitutional. It is expected that the Supreme Court will issue its decision by June 2012.
The Court has agreed to review four questions that were raised in various lower court challenges to PPACA:
· Individual Mandate: Did Congress exceed its authority under the Commerce Clause of the Constitution in requiring that individuals maintain “minimum essential coverage” beginning in 2014, or pay a tax assessment?
· Severability: If the individual mandate provision is nullified as unconstitutional, is it “severable” from the rest of the legislation, or will some or all of the other PPACA provisions also be nullified?
· Anti-injunction Act: Are private individuals and states procedurally barred from challenging the constitutionality of the individual mandate by the Anti-Injunction Act, which prohibits legal challenges to taxes until after the tax is collected?
· Medicaid: Did Congress exceed its constitutional authority in expanding the Medicaid program?
My prediction for the Supreme Court ruling is a 4-3 decision in favor of making no changes. It will be up to the new incoming administration to make any changes.