Preparing to implement the new requirements of the healthcare reform bill is probably the biggest challenge facing the healthcare management field.
Three major challenges include (1) the increasing number of persons who will have access to the healthcare system thanks to reform, (2) new channels that will bring people to receive services, and (3) the emphasis on preventive care. This article discusses these challenges.
Increased patient load. After September 23, 2010, insurance companies will no longer be able to deny insurance to children who have pre-existing conditions. This brings the individual insurance market on a level access field with employer-sponsored health plans, which could not deny coverage to any employee’s dependent children following passage of the 1996 Health Insurance Portability and Accountability Act (HIPAA). A similar provision for adults with pre-existing conditions goes into effect in 2014.
In addition, businesses with more than 50 employees will be required to offer health insurance to their employees. Those that do not will pay a fine for each employee.
New access channels. Persons who do not have access to health insurance through employers will be able to buy-in through health insurance exchanges that will be run by the state or federal government. States can also partner with other states in this effort. States will receive federal subsidies to develop the exchanges, which will include tools that let consumers and small businesses (those with 50 or fewer employees) compare benefits and costs of available plans. Health plans are not required to participate in the exchanges.
Preventive care. Health care reform focuses on preventing disease. According to the United States Department of Health and Human Services (n.d.), all new individual insurance and group health plans will have to offer preventive services for no additional out-of-pocket charges to consumers starting in 2011. Covered services include immunizations, cancer screenings and checkups. (It’s still unclear if this impacts existing health plans.)
The same services will be provided to Medicare beneficiaries at no additional charges and will be required of plans that participate in the health insurance exchanges.
Sources: United States Department of Health and Human Services (n.d.). Understanding the Affordable Care Act: Provisions. Retrieved from http://www.healthcare.gov/law/introduction/index.html