Health Insurance Navigator

By Lisa Zamosky

The Affordable Care Act, which became law in March, 2010, is being phased in over a period of roughly four years. One of the law’s most significant elements – the requirement that insurers cover everyone regardless of their health condition – won’t take effect until 2014.

But last year, we saw a number of provisions implemented that have had an impact on millions of Americans, including:

• About 900,000 seniors on Medicare who hit the Part D gap in prescription drug coverage called the “donut hole” saved money last year because of discounts on prescription drugs
• Free preventive care for people with both private insurance and Medicare also became available. We know that more than 20 million people with Medicare coverage took advantage of free preventive services last year
• Adult children are now able to stay on their parents’ health plan until age 26, which has resulted in 2.5 million young adults who were previously without coverage getting insurance

Health Reform in 2012

As another year gets under way, additional parts of the law are scheduled to take effect, most of which for 2012 are aimed at making changes to the way health care is delivered.

This year, as one example, hospitals’ Medicare payments will be tied to their performance on a number of clinical metrics. And they’ll lose Medicare money if patients are readmitted to the hospital for causes that could have been prevented.

The law also allows hospitals and doctors to join forces and develop what are called Accountable Care Organizations (ACOs). The primary goal of ACOs is to improve patients’ care by paying providers for quality, which is intended to encourage better coordination among health care providers and ultimately reduce health care costs.

Electronic health records have taken center stage as an important aspect of improving healthcare, and this year health plans will be required to implement rules for confidentially sharing health information electronically. Efforts to standardize billing are also underway for 2012.

And although discounts for seniors with Medicare who hit the “donut hole” took effect last year, in 2012 an even bigger break on generic drugs is available: 14% as compared with 7% in 2011.

Big Decisions Ahead

But nearly all aspects of the law at this point are overshadowed by the fact that beginning March 26, the Supreme Court is scheduled to begin hearing arguments about whether or not the law’s requirement that nearly all Americans buy health insurance – the so-called “individual mandate” – is constitutional.  A decision is expected by the end of June, 2012.

If the Court determines this central tenant of the law unconstitutional, a new question is then raised: Without the individual mandate, can the rest of the health reform law survive?

Stay tuned to find out, and share your thoughts in the comments section below.