Obamacare -- Transforming HEDIS Standards and Making Healthcare More Beneficial

Obamacare Transforming HEDIS Standards and Making Healthcare More Beneficial

Obamacare, Patient Protection and Affordable Care Act (PPACA), or Affordable Care Act (ACA) – call it whatever you w ill, 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 benef icial, 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 minimu m 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 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 c onditions.

Health Insurance Exc hanges 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 employersponsored 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 Efficie nt 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 treat ment episode instead of making sepa rate 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.