The Future of the Affordable Care Act

August 8, 2016

With November fast approaching, the Affordable Care Act (ACA) faces a huge challenge: can it survive past President Obama’s last term in office? Democratic nominee Hillary Clinton has promised to “defend and expand” the ACA, making a “public option” available and delivering healthcare to more and more people across the US. On the other side of the fence, Republican nominee Donald Trump has vowed to “make America great again” by repealing Obamacare and implementing a series of health care reforms.

Right now there’s no way to know how the 45th President of The United States will change the Affordable Care Act, but there are ways for businesses to be prepared for what comes next. New rules were released in February 2016, detailing the ACA changes for next year and beyond. Consumers should watch for these three new Obamacare changes coming in 2017.

Increased access to information about the sizes of insurers’ networks

Along with health plan costs, consumers often look at which doctors and hospitals are available in their networks. The new rules released in 2016 dictate three ACA updates:

  • Insurers are required to provide a 30-day notice if a provider is removed from a network, giving the consumer time to evaluate options and make other plans if necessary.
  • Insurers are required to continued coverage for up to 90 days for those in active treatment. This rule could greatly help those who rely on insurance for cancer treatment or for women who are in the later stages of their pregnancies.
  • Each plan’s network will be categorized into three sizes: basic, standard, and broad.

More warning for bill from out-of-network medical providers

Dealing with insurance coverage and finding a good medical provider can be difficult—especially when they’re rolled into one. Finding a good medical provider in your insurance network can be confusing, and patients often complain about receiving unexpected bills from providers they thought were in their network.

A small change in the ACA rules will help to prevent this. It requires that charges for ancillary care (such as radiology or genetic testing) count toward the patient’s out-of-pocket insurance maximum ONLY in cases where the patient is warned 48 hours or more before hospitalization or undergoing a medical procedure. Kaiser Health News notes, “That’s important because once a patient hits that out-of-pocket maximum, the insurer is responsible for all in-network medical costs for the rest of the year.” 

Out-of-pocket costs to be regulated

Along with the previously listed changes, the new rules aim to simplify comparison shopping—or negotiating to get the best deal on health care. According to KHN, one of the biggest changes the new rules offer is “requesting that next year insurers voluntarily offer plans with a standard set of coverage costs—from deductibles to co-payments for drugs or doctor visits.” Because this change is voluntary, insurers may not be inclined to change, but the rule may make it simpler to find a health care provider that matches your budget.

With the Affordable Care Act approaching its seventh birthday, businesses should expect health care upgrades. However, it can be difficult to keep up with the changes. Asure Software’s People Success Platform includes advanced ACA healthcare reform software, ensuring that you and your business comply with even the newest developments.

Sources:

https://www.hillaryclinton.com/issues/health-care/
http://www.latimes.com/business/hiltzik/la-fi-mh-hillary-clinton-reveals-her-plan-obamacare-20160223-column.html
https://www.donaldjtrump.com/positions/healthcare-reform
http://www.forbes.com/sites/dandiamond/2015/07/31/donald-trump-hates-obamacare-so-i-asked-him-how-hed-replace-it/#68885ea95d5e
Three Changes Consumers Can Expect In Next Year’s Obamacare Coverage
https://www.federalregister.gov/articles/2016/03/08/2016-04439/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2017