News

When the Affordable Care Act passed in March of 2010, 2014 (the year when the most fundamental coverage changes resulting from the ACA occur) seemed a long way off.

Well, 2014 doesn’t feel so far away now, does it? In fact, for those who are most immediately affected—the uninsured, small businesses, and individuals who buy their own health insurance in the private market place—enrollment for new coverage will begin later this year.

And 2013 will be a year of enormous activity for those who actually have to implement the law. President Obama, we are told, believes people will understand and appreciate health care reform when it goes more fully into effect. Whether or not that happens depends on how well the reforms are implemented this year.

To help people and policy makers understand the changes that are occurring this year, our center published a timeline that can be used to anticipate, plan for, and follow along with key events in the health reform journey. Some notable changes include:

• Primary care providers who take Medicaid patients should already see a difference in the amount they are paid to care for them. Starting January 1 and for two years (2013 and 2014), the federal government will provide 100 percent of the funding required to bring primary care payments for Medicaid patients up to Medicare levels. That’s a big change in Michigan (and most other states), where those providing primary care services for Medicaid patients are generally compensated well below the actual cost of care. The federal government hopes states will continue to pay physicians at these higher rates after 2014. It will be interesting to see how many do.
• Many employer health plans must include contraceptive coverage with no cost sharing starting in 2013. While some employers are challenging this provision in the courts, so far there have been no stays of this requirement that would affect implementation in any significant way.
• States that implement state-based exchanges (now called “health insurance marketplaces” by the U.S. Department of Health and Human Services) must have them up and running before October 1, 2013. Sometime before then, states must decide on rates and publicize plans to be offered—even if they are not running their own exchanges.
• Health plans, employers, some higher-income individuals, and some providers will see tax and fee increases, to begin to fund the expansion of coverage.
• The “donut hole” in drug coverage for seniors will continue to shrink in 2013.
• And, though not on the timeline itself, governors across the country will be deciding whether or not to expand Medicaid coverage, now that it is an optional part of the law as a result of the decision by the Supreme Court in June of 2012. Most governors will make this decision in conjunction with their budget proposals, so look for lots of announcements over the next month or two.

All these changes and more will take place over the next few months. And while some opponents of the Affordable Care Act are hoping these key implementation steps fail in some way, most Americans should be hoping they succeed. The promise and the hope of health reform is that access to care and population health will both improve. 2013 is an important year in the effort to get us there.