When the new government took office and decided to repeal the Affordable Care Act (ACA), Americans wondered what their health insurance options would be. As a medical and billing company providing insurance eligibility verification services, we had reported on the likely coverage options that physicians could expect consumers to retain in 2017. Now, with Senate Republicans unveiling their new health care bill, we have written a new blog on how health insurance coverage is likely to change if it is passed. Here is a brief look at the proposed changes from Obamacare.
Pre-existing conditions: The Senate bill weakens protections for pre-existing conditions. Under the ACA, insurers could not deny anyone health coverage on the grounds that they had a pre-existing condition or charge them a higher price. Moreover, every plan had to include “essential health benefits” or the same minimum level of coverage. The revised policy allows insurers to sell plans that do not meet these regulations. Though this does not mean that essential health benefits need not be covered, insurers could deny coverage to people with pre-existing conditions or charge them more based on their health.
The latest version of the AHCA allows states to set up high-risk insurance pools or policies to cover people with pre-existing conditions who find it too hard to get health insurance. However, even those who receive tax credits to purchase a deregulated plan would still end up seeing higher out-of-pocket costs, including high deductibles and premiums.
Medicaid: The new bill includes deep cuts to Medicaid, gradually putting an end to ACA’s planned Medicaid expansion. The proposed rollback on Obamacare’s Medicaid provisions includes a cap on federal spending on a per-person basis and a slower rate of growth of Medicaid spending.
The current version offers some concessions too. It would allow states to increase Medicaid spending in the event of a health emergency that pushes up per-person costs. It would also allow states to apply for waivers to go above the caps to provide home-and-community-based services (HCBS) for people with disabilities.
Taxes: The GOP bill will do away with the ACA’s taxes on medical companies and eliminate its penalties on individuals who don’t buy insurance and employers who don’t provide. It will, however, keep three ACA taxes: the 3.8 percent tax on investments by the wealthy, 0.9 percent Medicare payroll tax, and a tax on health insurance CEOs personal earnings
Other proposals: Other measures in the new Senate bill include:
- A $45 billion fund to help people with opioid addiction
- $70 billion to states to help stabilize health care costs, subsidize the cost of care for lower-income people, and allow states to implement new reforms
- Health Savings Accounts (HSAs), the tax-advantaged medical savings account available to taxpayers enrolled in a high-deductible health plan (HDHP), can be used to pay for health insurance premiums
- A health plan with narrow coverage but cheaper premiums for people in the individual market
Controversies continue to rage about the proposed changes. In May, the American Medical Association released a statement expressing concern over the proposed legislation which will reduce coverage for individuals and the “possibility of going back to the time when insurers could charge them premiums that made access to coverage out of the question”. The AMA called for action to improve the system and urged the Senate to work with healthcare industry stakeholders to ensure affordable and meaningful coverage for Americans, with special regard for vulnerable populations.
According to a recent NPR report, the president of the AMA says they are especially concerned about Medicaid reductions. He said that the AMA is partnering with the American Hospital Association, American Diabetic Association, American Heart Association and other groups to protect coverage for individuals.
Regardless of the outcome of the debates and negotiations, physicians will continue to need insurance eligibility verification services to confirm coverage for patients. Insurance verification specialists check patients’ coverage by contacting the insurance company directly. They enquire about the patient’s deductible, co-payment, and co-insurance responsibilities and also verify if a referral or pre-authorization will be required. This is important to help patients understand their cost-sharing obligations. Patient eligibility verification is performed before services are provided, which allows patients to make arrangements to pay their bills. Along with efficient medical billing and coding services, insurance verification will reduce denials and bad debt, improve cash flow and increase patient satisfaction.
Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.