Payments will be based on patient outcomes that can be measured and not on a fee-for-service model that rewards providers for every service they provide without considering whether those services were necessary or even beneficial.
For all its ambitious goals, however, the health law is also an experiment on a scale not seen since the Medicare and Medicaid programs were signed into law in 1965. No one knows how many of the estimated 48 million uninsured Americans the law is intended to help will buy health insurance or pay a penalty.The Congressional Budget Office projects that seven million eligible Americans who previously had no health insurance will sign up for a plan during the open enrollment period, which began Oct. 1 and runs through March 31.
Eligible Americans and legal immigrants can sign up at any time during those dates. For coverage to begin on Jan. 1, they must enroll by Dec. 15.
Health and Human Services Secretary Kathleen Sebelius said during a visit to Miami in September that the White House considers it an important measure of success to meet the CBO’s enrollment projection.
Perhaps the most significant measure of success will be how many people who couldn’t afford insurance or find an insurer will now have a choice.
“Some of it is about changing the way people get care,” Sebelius said, “but also putting some incentives for people to get preventive services, get checkups, find things early, get it taken care of, fill your prescription drugs and follow the doctor’s orders so that you don’t end up back in the hospital. That’s all going to be much more possible with insurance more affordable and available for lots of folks.”
With so much to keep track of, here are some points to consider while you navigate the changing landscape of healthcare.
WHO can sign up?
The health law’s individual mandate is a cornerstone of reform that will affect a large number of the estimated 48 million people under 65 who now do not have insurance.
Those who fall into that category, their children and anyone claimed as a dependent on their income taxes must have health insurance beginning in 2014.
More than half of Americans, about 55 percent of the population, had employment-based insurance in 2011, according to the Census. Most of them will not need to buy policies on the exchanges, which are primarily for uninsured people or those whose employer-based coverage is too expensive or lacking in benefits. Another 12 percent of Americans are insured through Medicaid or the Children’s Health Insurance Program, both of which are federal-state partnerships for the poor and disabled.
Some people are exempt or don’t qualify for coverage:
• People 65 or older on Medicare do not have to sign up.
• Undocumented immigrants are not eligible for coverage.
• Also exempt: members of Native American tribes and individuals who cannot afford coverage because the cost of premiums exceeds 9.5 percent of household income.
• Anyone whose income is below the threshold for filing a tax return also is exempt, as are people who would have been eligible for Medicaid through the health law’s expansion.
Florida is one of more than 20 states that did not expand Medicaid, which according to the Urban Institute would have provided coverage to more than one million state residents. The Florida Legislature chose not to accept more than $50 billion in federal funds over 10 years to expand Medicaid. That left an estimated 995,000 people — mostly the poorest Floridians and minorities — without any financial assistance for coverage.