The Affordable Care Act at age five: a look back and a look ahead

Somewhere near their first birthdays, children learn to walk. At three years of age, they might start pedaling a tricycle, and at age five, they are poised to enter kindergarten. March 23, 2015, marks the fifth anniversary of the enactment of President Obama’s signature health reform law, the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). Has the ACA, at five years of age, made the same amount of progress as a child?

Critics argue that the ACA has failed, but proponents say that it is moving closer to achieving its goal of quality, affordable health care for all Americans. As a law that seeks to expand health insurance coverage for Americans, improve the functioning of health insurance markets, and control the efficiency and quality of health care, the ACA has “had a major positive impact, and one that will continue to bring efficiencies over time,” said Keith Fontenot, the managing director of government relations and public policy at Hooper, Lundy & Bookman, P.C.

Regardless of whether it has met its milestones, it is clear that the ACA has already made an impact. It has had significant effects on the uninsured rate, the affordability of coverage via the provision of subsidies, the use of preventive services, and the actions of large employers and insurers. Many ACA provisions have gone into effect over the last five years; however, due to design or delay, a number of significant reforms have yet to be implemented or fully realized.

This White Paper looks at the ACA’s impact on Medicare and Medicaid issues and its impact on the private insurance market. It also looks at major ACA changes facing health care providers and employers in the coming months.

Read further, “The Affordable Care Act at age five: a look back and a look ahead.”

The Medicare and Medicaid Guide—Highlights of All Explanations (White Paper)

Medicare is the single largest purchaser of health care in the United States, accounting for 23 percent ($522 billion) of the $2.3 trillion spent on health care in 2011, according to the Medicare Payment Advisory Commission. In 2012, Medicare covered 50.7 million people: 42.1 million aged 65 and older, and 8.5 million disabled, according to the 2013 Medicare Trustees Report. In 2011, Medicare paid for 27 percent of all hospital care, 23 percent of physician services, 44 percent of home health services, 25 percent of nursing home care, 20 percent of durable medical equipment, and 24 percent of prescription drugs.

Medicaid provides coverage for 58 million people, and accounts for 16 percent of all health care spending. With the expansion of Medicaid eligibility provided under the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148), Medicaid spending will continue to grow.

According to the Congressional Budget Office, the share of gross domestic product (GDP) devoted to federal health care spending will almost double in the next 25 years, from 4.6 percent of GDP in 2013 to 8 percent of GDP in 2038. With one-third of the U.S. population receiving health coverage through either Medicare or Medicaid, it will continue to be important for health care providers and practitioners, the legal and business advisors who support them, the legislators who pass laws amending the programs, and the administrators who regulate the programs, to stay on top of changes in the programs.

The Medicare and Medicaid Guide has been published since 1969. Available both in print and online, the Guide offers daily updates of new laws, regulations, court decisions, administrative decisions, and other guidance about these two health programs, in addition to over 500 explanations about how these programs work. The explanations cover all areas of both programs – who is eligible to get coverage; who is eligible to provide coverage; what types of services are covered; how the programs are financed and administered; how the government monitors fraud and abuse in the programs; just to name a few subject areas.

Wolters Kluwer editors have prepared a white paper which includes summaries of each explanation section of the Medicare and Medicaid Guide. It is designed as a supplement to what current subscribers of the Guide already receive with their subscriptions, but it can also be used as an introduction to the product for non-customers.

The complexity of the Medicare and Medicaid programs is often commented upon by judges when they write decisions based on the programs’ laws, regulations and other guidance. This overview highlights the complexity, but also provides a hint at the breadth of coverage in this product.

White Paper Addresses Controversial Contraceptive Coverage Requirement

The Health Law group at Wolters Kluwer Law and Business is pleased to announce the publication of a white paper entitled, “State Mandates for Insurance Coverage of Contraception Before and After Health Reform.”

Within the paper you will learn about the following:

Did you know that 28 states require employer-sponsored health insurance plans to cover FDA-approved contraceptive drugs and devices? Several are “red states,” but only one allows a for-profit business entity to be excused from the requirement on religious grounds.

The challenges to the federal requirement continue.  The Supreme Court has been asked to consider whether the Religious Freedom Restoration Act protects for-profit business entities. But state law on this subject still matters. Why?

The federal RFRA does not apply to state laws. Plans that lose their “grandfathered” status will be subject to both state and federal requirements. So in most of those 28 states, the right to coverage of contraceptives will remain protected.

Download our white paper to learn more!