The Affordable Care Acts insurance exchanges open Tuesday amid fierce political pushback, recent delays of important provisions and a whole lot of confusion among the public.
The online exchanges also known as marketplaces are the centerpiece of healthcare reform, and they will give consumers unprecedented power to examine an extensive menu of health plans and to compare prices and benefits side by side.
For Florida, where an estimated 3.8 million people live without health insurance, the exchanges could make an especially big impact. The state ranks near the top of the nation in terms of plan choices, with an average of 102 health plans to choose from on the states federally run exchange.
While much of the focus has been on the individual mandate upheld by the Supreme Court in June 2012 and requiring most Americans to have minimum essential health insurance in 2014 less attention has been given to the overall cost of the law.
With nearly 50 million uninsured Americans, the ACA aimed to insure nearly everyone at an estimated cost of more than $900 billion over the next decade, from 2010 to 2019.
Who pays for that?
Many assume that, like most anything else, more or better healthcare equals more cost.
That assumption is not necessarily correct, said Steven Ullmann, a professor at the University of Miami School of Business Administration and director of its Center for Health Sector Management and Policy.
Ullmann offered an example of a hospital that improved the quality of patients health while also lowering costs. The hospital, which Ullmann declined to name , had experienced a large number of patients who were repeatedly admitted with asthma and respiratory distress.
Social workers who visited the patients spotted a trend: In almost every household visited, they saw air-conditioning units with vents full of dust and mold.
Hospital administrators bought new air-conditioning units, at $90 apiece, for the patients. The number of patients admitted for asthma and respiratory distress fell dramatically saving the hospital the expense of caring for them and improving the health of patients.
Much of healthcare can be provided much more efficiently and, in so doing, provide higher quality, Ullmann said.
The law also is expected to lower healthcare costs in another way: by spreading the risk of insurance. By expanding health coverage to include both those least likely to become seriously ill and those already or likely to become sick, the law was projected to reduce uncompensated care, lowering healthcare costs for the country and even reducing the national deficit.
The Obama administration pledged that health reform would save more than $200 billion over 10 years, and more than $1 trillion in the second decade. More cost reductions are expected from emphasizing preventive services and rewarding providers that deliver positive outcomes for patients.
It will take more than healthcare savings to pay for it all, though.
New fees and taxes will be levied on individuals and businesses, including a 40 percent tax on so-called Cadillac plans, beginning in 2018, on high-cost, benefits-rich health plans. And new regulations will require doctors, hospitals and insurance companies to operate more efficiently, or pay penalties.
Budget cuts are also in the mix as federal funding will be reduced for hospitals that treat disproportionate numbers of uninsured individuals. The government currently sends about $11.6 billion a year to states to distribute to these hospitals including Jackson Health System in Miami-Dade but the health law called for payment cuts under the assumption that uninsured patients would enroll in insurance programs, including Medicaid.