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85%With the ACA, 85 percent of each health insurance dollar mustbe spent on healthcare services and quality improvements.2010 The first provisionsimplemented in the ACA expanded accessto Medicaid coverage for low-income individualsand families who previouslyhad not qualified for the program. Otherprovisions were outlined in the Patient’sBill of Rights. The Bill works to give consumersthe control they need over theirown healthcare. This was achieved bystipulating the coverage insurance companieswould need to change or include in thepolicies they offer. These key changeswent into effect September 23, 2010 in thePatient’s Bill of Rights.»»Coverage for Americans with pre-existingconditions»»Coverage for free preventative care withno copayment»»Coverage for young adults on their parent’spolicy until age 26»»The end of lifetime limits on coverage,pre-existing conditions exclusions forchildren and arbitrary cancelation ofcoverageYou can go to http://www.healthcare.gov/law/features/rights/bill-of-rights/index.html to read all of the provisions in thePatient’s Bill of Rights.Once the ACA was passed, tax incentivesfor small businesses went into effect tohelp employers provide health insuranceto their employees in 2014. Work alsobegan on the creation of healthcare exchangesand new incentives were addedto expand the number of doctors, nursesand physician’s assistants in the primarycare workforce to serve the needs of themillions of new healthcare patients. Thisprovision includes scholarship fundingand loan repayment or forgivenessto increase the number of primary careprofessionals and encourage service inunderserved areas. Funding to supportand expand services at community healthcenters also went into effect to help meetthe needs of the newly insured.Stakeholders began building the foundationsfor several initiatives designed toimprove the health of Americans and ourhealthcare outcomes. The Prevention andPublic Health Fund was launched with$15 billion to invest in keeping Americanshealthy through programs aimed atpreventing health problems caused bylifestyle, such as smoking and obesity.Included in the ACA is a plan to reducecost and improve outcomes throughAccountable Care Organizations (ACO).The Department of Health and HumanServices (HHS) began drafting guidelinesfor the creation of these organizationswhen the ACA was passed. The goal isto coordinate the care of Medicare andMedicaid patients and to encouragehealthcare improvements by linking costto outcomes. According to the Centers forMedicare and Medicaid Services (CMS)two out of three Americans over 65 havemultiple chronic conditions. Coordinatingthe care for these patients could potentiallysave about $960 million over athree-year period. 2“New incentives were addedto expand the number ofdoctors, nurses and physician’sassistants in the primary careworkforce. This provisionincludes scholarship fundingand loan repayment orforgiveness to increase thenumber of professionalsand encourage service inunderserved areas.”Where are we now?What’s ahead throughout 2013? Plenty. Thiswill be the year of final approvals, checks anddouble-checks before millions of Americanssign up for health insurance for the first time inOctober. Here’s a preview of the year leadingup to the final implementation of the ACA inJanuary 2014.January»»Medicaid payment rates for primary careno less than 100% of Medicare 2013 and2014 rates»»Deduction for cost of retiree drug coverageoffset by Medicare Part D subsidy eliminated»»State-based Health Exchanges (SBE) approvedor conditionally approved by HHS»»Employers must notify employees of thehealth insurance exchanges and availablecoverage optionsFebruary»»Administrative simplification begins»»Final deadline for states to submit their federalpartnership plans to HHS for ExchangesApril»»Final regulations for Medicaid and premiumtax credit eligibility, appeals, cost sharingand premium support requirements andbenchmark benefit plan requirements»»Final rules from the Department of Treasuryoutlining individual mandate requirements26 InsideOut