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Providers

Opportunities Created by Health Care Reform

One of the key goals of health care reform is to increase the number of people covered by health insurance. Government figures suggest that when fully implemented, the new law will give more than 32 million uninsured Americans access to coverage. This change will almost certainly affect the size and demands of the patient population, which will impact provider business over time.

Based on the coming changes, outlined below, health care providers can anticipate an increase in activity from both new and existing patients:

Individual Mandate

The law will require most Americans to buy health insurance by 2014 - or pay a penalty for not buying it.

Subsidies to Make Insurance More Affordable

The government will offer payments to help offset the cost of insurance for some people and tax credits to some small businesses to help offset the cost of health insurance.

Expanded Eligibility for Medicaid

This program, which helps people with low incomes pay for medical care, will now accept more people.

New Rules for All Insurers to Benefit Consumers

No one will be excluded from coverage or have to wait for a pre-existing condition to be covered. Benefit plans will be allowed fewer coverage limitations. Young adults will be able to keep dependent coverage until age 26.

Preventive Care

The new law requires non-grandfathered health insurance plans to cover 100 percent of the costs of certain preventive care and health screenings which are intended to help people stay healthy and avoid more serious and costly treatments later in life.

Increased Prescription Assistance

Medicare beneficiaries who buy prescription drugs using Medicare Part D will receive additional money in 2010 and reductions in out-of-pocket costs in future years to help narrow a gap that existed before health care reform - the so-called "doughnut hole."

As more individuals acquire insurance, and as the rules impose greater limitations on out-of-pocket expenses, providers are likely to see a reduction in uncompensated care.

The new law also intends to simplify some administrative processes. Rules related to eligibility verification and claims status, claims remittance/payment, and electronic funds transfers will be developed by the U.S. Secretary of Health and Human Services and implemented between January 1, 2013 and January 1, 2016. By streamlining and standardizing claims processing, providers may have an opportunity to reduce overhead and track claims more easily.