Obamacare -- Transforming HEDIS Standards and Making Healthcare More Beneficial
Transforming HEDIS Standards
Obamacare, Patient Protection and Affordable Care Act (PPACA), or Affordable Care
Act (ACA) – call it whatever you will, but this is the future of healthcare in US and
one which the Obama administration has managed to put in place after failed or
nearly-there attempts by former Senators. It has transformed HEDIS standards by
aiming to make healthcare more beneficial, effic ient and affordable for every
American out there.
Its aims are reasonably easy to figure out – making health insurance more affordable
and worthwhile, expanding public as well as private coverage and bringing down the
uninsured rate, and reducing the financial burden of healthcare for people as well as
the government. For attaining these goals the ACA has introduced subsidies,
mandates and insurance exchanges for increasing affordability and coverage.
Another crucial factor is that insurance companies must cover all their applicants
within the latest minimum standards and also provide them with the same rates in
spite of their sex or pre-existing conditions. According to the Congressional Budget
Office, the ACA has the potential to reduce Medicare spending and future deficits.
The Big Changes
Guarantee issue is the most strategic provision in the ACA. It is great for the people
since everyone can get the same coverage and they wouldn’t need to worry about
any pre-existing conditions.
Health Insurance Exchanges
Health insurance exchanges have begun functioning in each state. This is an
important measure since these exchanges function as online marketplaces for
individuals as well as small businesses to buy insurance after comparing policies. The
enrolment period for plans beginning in 2015 runs from November 15, 2014 to
January 15, 2015. Persons not covered by Medicare, Medicaid or any employer-
sponsored plans or public insurance programs will have to pay penalty or get
themselves private insurance.
Poorer people are offered subsidies as part of the ACA when they purchase insurance
through these exchanges. Families and individuals in the low-income range and
within 100% and 400% of the classified federal poverty level are eligible for federal
subsidies administered on the basis of a sliding scale. Small businesses are also
eligible to receive subsidies.
Delayed Employer Mandate
In fact, as part of the employer mandate, businesses having 50 or more staff
members but not offering health insurance to their full-time staff, in spite of the
government subsidizing the healthcare of each of the full-time employees, were
required to pay tax penalty. But this mandate has been postponed to 2015.
More Efficient Medicare Payment
The ACA has also aimed to make Medicare’s payment system more efficient. As part
of the new system of payment, a single payment is all that is required to be made to
the healthcare center and the physician group for a treatment episode instead of
making separate individual payments to various service providers. The donut hole,
which is the result of coverage gap in Medicare Part D, will gradually shrink and get
closed completely by the 2020.
Medicaid Eligibility Expansion
Among the improvements made to Medicaid is the expansion of eligibility to families
and individuals having income up to 133% of the classified federal poverty level
though the 5% income disregard provision raises the eligibility limit to 138% of the
poverty level. The Supreme Court has, however, allowed some states to opt out of
this Medicaid expansion.
Overall, in spite of concerns raised by many, Obamacare or the Affordable Care Act
is set to improve healthcare service for America’s citizens. It is the future and
appears, overall, to be a bright one. It is probably, to date, the most important
highlight of President Obama’s administration.