Health care reform has been a hot-button topic for individuals as well as businesses ever since major federal legislation was passed last year.
The situation is no different in Enid, as personnel with St. Mary’s Regional Medical Center and Integris Bass Baptist Health Center are examining carefully how legislation will have an impact in coming years.
One of the most sweeping changes that will happen as a result of the legislation is about 32 million people who didn’t have health coverage before will now have access.
Those 32 million will be eligible for certain benefits from insurance exchanges set up in every state, said Stanley Tatum, chief executive officer of St. Mary’s.
“These exchanges will have a core set of benefits they will cover under an insurance plan,” he said.
The benefits will be for those who have certain illnesses or other ailments.
Each hospital will be reimbursed a certain amount for treating a patient who has an illness covered by the insurance exchange.
What that amount will be is yet to be determined, Tatum said.
But Tatum and Bass President Jeff Tarrant both agree the real effects of health care reform won’t be felt for a while.
“I believe it’s calendar year 2016 or 2017 before really all aspects (of health care reform) have been phased,” Tarrant said.
According to a presentation prepared by Tatum, a short-term effect of health care reform is an increase in insurance premiums due to rising medical costs and adverse selection.
There also will be pressure on some small businesses to provide health care coverage for employees.
Individuals, employers, drug companies and a number of other agencies will be subject to a variety of taxes and penalties as part of the reform, Tatum said.
However, if you are a small business that has less than 50 employees, you are exempt from any penalties.
Despite widespread negativity about health care reform, Tarrant and Tatum both agree there are some positive aspects.
Tarrant said one of the positives is the more widespread use of health care technology.
“There is language in the legislation that encourages use of electronic health information,” Tarrant said. “The reason in there is the government believes (that it will) promote safety and reduce cost over time.”
Tatum said one good aspect of health care reform is people with pre-existing conditions will now be allowed medical coverage as part of a temporary, high-risk pool.
“That is a good thing I think,” Tatum said.
According to Henry J. Kaiser Family Foundation, health care reform mandates residents who don’t have health coverage must pay a tax penalty of the greater of $695 per year up to a maximum three times that amount per family, or 2.5 percent of household income.
The penalty will be phased in, beginning in 2014.
The law also creates a temporary reinsurance program for employers providing health insurance coverage to retirees older than age 55 who are not eligible for Medicare. The program will reimburse employers or insurers for 80 percent of retiree claims between $15,000 and $90,000.
One other thing that will affect the hospitals is the cost of medical supplies will increase, Tatum said.
In 2013, businesses will have imposed on them a 2.3 percent excise tax on the sale of any medical device.
2010: Insurance companies were prohibited from placing lifetime limits on policyholders and from rescinding coverage. Health insurance companies were required to cover preventative services without co-payments.
2011: Primary care doctors get a 10 percent bonus payment for Medicare patients. Medicare Drug program will require drug companies to give patients a 50 percent discount in the “doughnut hole” gap.
2012: Annual fee of $2.8 billion assessed on drug manufacturers.
2013: Itemized deductions for unreimbursed medical expenses on tax returns increases from 7.5 percent to 10 percent of adjusted gross income. Payroll taxes for Medicare tax increases from 1.45 percent to 2.35 percent on earnings over $200,000 for individuals or $250,000 for families. All 50 states must offer a member-run health insurance company called a CO-OP. Any profits must be used to lower premiums, improve benefits or provide better quality to its members.
2014: Most Americans are required to have health care coverage. Employers will pay a fine if one of their full-time workers qualifies and receives a premium tax credit from the federal government. State-based health care exchanges will be available for individuals and small businesses to shop for insurance coverage. Pre-existing conditions on adults are eliminated.
2017: Employers with more than 100 employees may enter health care exchanges at the discretion of states.
2018: Excise tax will be enacted on “Cadillac” health plans that exceed $10,200 for individuals and $27,500 for families.