Health Reform 101: Use this primer to navigate the changes ahead - Page 4 of 4

Otolaryngologists may want to monitor whether the hospitals at which they have privileges are considering participation in these programs. Physicians interested in participating should fully evaluate their capacity to join these programs beforehand, the AMA advises in its report, “New Payment and Delivery Reform Models” [http://www.ama-assn.org/ama1/pub/upload/mm/399/hsr-payment-reform-models…. Under these models, physicians will have to work collaboratively with other providers, and they may need to invest in tools and systems necessary to coordinate and measure performance, the AMA notes.

Patient Access

Physician practices should see a drop in the number of uninsured patients as the law’s health insurance access provisions take effect. Up to 32 million people could gain coverage, according to the Congressional Budget Office. Of that figure, about 16 million would get their coverage through Medicaid and the Children’s Health Insurance Program.

The biggest reforms start in 2014. That’s when the mandate for individuals to buy insurance, income-related tax credits to help individuals and families afford coverage and a Medicaid eligibility expansion kick in. At the same time, state-based health insurance exchanges, which aim to provide affordable coverage options, are supposed to launch.

The law also includes many insurance reforms that affect patients, including:

Elimination of pre-existing condition exclusions;
A requirement that health plans accept every employer or individual who applies;
Guaranteed renewability of coverage; and
Prohibition on premium rate differences, except those for rating area, age, tobacco use and whether the plan is for an individual or family.