Health Care Changes Beyond 2012 and What They Mean to You


There are some immediate changes in health care plans for 2012. As you might imagine, the changes won’t end next year. While the new plans roll out, there are other things you want to keep in mind for the future.

Barring the gutting or repeal of Obamacare, we can look forward to more restrictions beginning in 2014. While there are some benefits to the Patient Affordability and Care Act, the down side skews the equation in favor of problems for business owners, difficult decisions for people without health care insurance and the self-employed.

On the positive side, insurance companies cannot consider a person’s health status when insuring them. Kaching…that was the sound of your premiums going up to begin paying for coverage of more unhealthy people. Now, for the record, I am all in favor of insuring everyone, regardless of health status. None of us want our families to live without health care coverage. The financial consequences can be devastating for families if someone becomes very ill. But we need a better plan for paying for all this coverage than what we see today and in the near future. In two years almost everyone will be required to have some form of health insurance. In order to force this on people, health insurance “exchanges” will be created to accommodate the varying income levels of people. It is not entirely clear today how these exchanges will actually work to the benefit of the insureds or the insurance companies.

One of the criticisms of Obamacare is that it is a thinly disguised plan to force everyone out of private insurance and choice into these exchanges, which will be managed by some federal agency. Trying to understand the deluge of verbiage on this topic is like trying to nail Jello to the wall. The truth is no one seems to know how this would really work. In the breach, we already see companies adhering to new law to be by offering coverage extensions to children up to age 26 who are living at home with their parents. This raises more problems for companies who are trying to peer into the crystal ball to see what they’ll be on the hook for in two years.

Many companies admit they might just drop health insurance benefits for their employees. Rising costs, more liability, and confusing laws and rules, guarantee more owners will throw up their hands in disgust and opt out of the system. The owners are also looking at options that help them force more accountability and self-care on their employees. These options include Accountable-care organizations, reference-based pricing and defined contributions.

Accountable-care organization reward health providers who cut expenses while maintaining good performance. These organizations can be physician owned, physician and insurance company owned, or some other combination. Reference-based pricing lets the company declare what it is willing to pay for services. Employees are then responsible for finding health care providers willing to work for the amount offered. This price shopping still allows employees to choose a higher-priced provider, but the employee must pay the difference in prices. Defined contributions means the company gives employees a set amount of money to purchase plans where they wish. Any difference in prices must be absorbed by the employee. These plans are available on an exchange, so employees will have more choices in this plan.

All this presumes employees will see the benefit in these changes. Most people have gotten used to some form of HMO, PPO, or other network system with predictable premiums, co-pays, deductibles and so forth. This future is the wild west of health care and insurance exchanges. We will have to actually read the information from different companies, plans, and exchanges to decide where and how to best protect our families with health care. Unfortunately, most of us are ill-equipped to do this.

We need more information and education in order to make this complicated plan work. Or, better yet, we could scrap the plan before it fully vests and find a better way to insure Americans that allows doctors to practice medicine and keeps us all honest. Can someone please invent a better mousetrap soon?

Have a terrific day!

Patricia


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