With no mandate yet in place for healthy individuals to purchase health care insurance, expansions in coverage for higher risk individuals will likely result in a deteriorating payer mix and little impact on reducing costs.
Changes include:
- Hospital payment cuts for Medicare patients resulting in an added cost-shift to the commercial market
- Modest increases in Medicare and Medicaid payments to providers, which will help maintain provider access for these patients
- New insurance market rules including the extension of over-age dependent coverage to age 26
- New taxes on high income earners
- Medicare payment reform initiatives rewarding quality and efficiency
Healthcare reform:
2014 to 2017: 32 million newly insured Americans
Half of the great influx of newly insured members will come from Medicaid and the other half will come through individual and employer mandates. Changes include:
- Medicaid expanded to 133 percent of the federal poverty level, resulting in a reduction in charity care and a potential reduction in cost-shifting to the commercial market
- Individual mandate to purchase coverage and subsidies to 400 percent of the federal poverty level, including penalties that may encourage young, healthy individuals to enter the insurance pool
- Guaranteed-issue plans with no underwriting, resulting in higher medical costs for insurers
- Employer mandate for businesses with more than 50 employees
- State-based exchanges providing information on options to health insurance purchasers
*Info provided by Providence Health Plan
Sorry, comments are closed for this post.