PPACA & Health Sector
General Provisions Affecting Multiple Sectors
- Accountable Care Organizations. Under the Affordable Care Act, Medicare will launch a Shared Savings Program for groups of health care providers that join forces, with or without hospitals or health plans, to form legal entities that agree to take responsibility for the quality, cost, and overall care of a population of patients.
- American Hospital Association. Accountable Care Organizations – AHA Research Synthesis Report. June 2010.
- New England Journal of Medicine. Creating Accountable Care Organizations (video)
- Elliott Fisher et al. Creating Accountable Care Organizations: The Extended Hospital Medical Staff. Health Affairs, January 2007.
- Rita Numerof. Why Accountable Care Organizations Won’t Deliver Better Health Care—and Market Innovation Will. Heritage Foundation, April 18, 2011.
- Scott Gottlieb. Accountable Care Organizations: The End of Innovation in Medicine? AEI Health Policy Outlook, 2.16.11.
- The Real Promise of ‘Accountable Care’. Wall Street Journal. 3.4.13)
- ACOWatch is a blog published by healthcare insider and activist e-patient advocate Gregg Masters.
- National Association of ACOs.
- Comparative Effectivness Research
- Health Affairs‘ Comparative Effectiveness Briefing. Watch the briefing and download materials.
- New England Journal of Medicine, Comparativeness Effectiveness Research
- Health Information Technology
- ObamaCare Watch, Medical Innovation contains news about the impact of PPACA on medical innovation.
PPACA and Private Insurance
- Nondiscrimination Rules for Fully Insured Health Plans (Martindale). As of 2010, insurers can no longer deny or restrict coverage for children who have been diagnosed with an illness (that is, a preexisting condition). From 2014 on, all health plans will be prohibited from restricting coverage of preexisting conditions or charging higher premiums to individuals with health problems.
- Pre-Existing Condition Insurance Plan. From 2010 to 2014, a new, temporary program will offer uninsured adults with preexisting conditions coverage in special state-based “pools.”
- Pre-Existing Condition Insurance Plan. Health Affairs Policy Brief, 11.30.2010
- Medical Loss Ratio Requirements. On November 22, 2010, the Department of Health and Human Services released its interim final rule implementing the requirements of the new section 2718 of the Public Health Services Act (added by section 10101 of the Affordable Care Act), entitled, “Bringing Down the Cost of Health Care Coverage.” This provision is usually referred to as the “medical loss ratio” (or MLR) requirement, although the term “medical loss ratio” appears nowhere in section 2718. About two thirds of the stateshave required insurers to report their “anticipated loss ratio.”
- About 30 states require insurers in their individual markets to achieve MLR targets while about 20 states impose MLR targets on their group or small group markets, but the state MLR targets tend to be lower than the ACA targets.
- Medical Loss Ratio Requirements (NAHU)
- Modification of Section 833 Treatment of Certain Health Organizations. The Affordable Care Act amended section 833 of the Code, which provides special rules for the taxation of Blue Cross and Blue Shield organizations and certain other organizations that provide health insurance. Interim guidance can be found in Notice 2010-79, which also solicits comments on the application of the amended provision.
- Research and Analysis. Heritage Foundation, Insurance Market Reform
PPACA and Hospitals
- Additional Requirements for Tax-Exempt Hospitals. The Affordable Care Act adds requirements in the Internal Revenue Code that tax-exempt hospitals must meet to maintain their tax-exempt status. More information can be found in Notice 2010-39, which solicits written comments on the application of the new requirements. Comments must have been submitted by July 22, 2010.
- Research and Analysis. How Will Hospitals be Affected by Health Care Reform? (Urban Institute)
PPACA and Physicians
- Research and Analysis
- How Will Physicians be Affected by Health Care Reform? (Urban Institute)
- The Medicus Firm Physician Survey: Health Reform May Lead to Significant Reduction in Physician Workforce
- Health Reform, Primary Care, and Graduate Medical Education (John Iglehart, New England Journal of Medicine, 8.5.2010)