Obamacare – Key Takeaways

Source – http://en.wikipedia.org/wiki/Obamacare

Source – http://www.healthcare.gov/law/timeline/

I’m quoting and commenting on some of the terms of Obamacare below.  Note, I had to do some breathing exercises to get past the ‘Funding’ section of the wiki.  I don’t think it matters

Centers for Medicare & Medicaid Services (CMS) will begin the Readmissions Reduction Program, which requires CMS to reduce payments to IPPS hospitals with excess readmissions, effective for discharges beginning on October 1, 2012.

Excellent!  We will second guess the hospital administrators who boot ill patients for cost reasons or insurance reimbursement limitations.  Hopefully the symptom of this issue doesn’t involve the docs  though, because I would *hate* to be second guessing someone who’s spent their life studying to have the ability to diagnose and treat patients (and is presumably good at it).

Income from self-employment and wages of single individuals in excess of $200,000 annually will be subject to an additional tax of 0.9%. The threshold amount is $250,000 for a married couple filing jointly (threshold applies to joint compensation of the two spouses), or $125,000 for a married person filing separately.[92] In addition, an additional Medicare tax of 3.8% will apply to unearned income, specifically the lesser of net investment income or the amount by which adjusted gross income exceeds $200,000 ($250,000 for a married couple filing jointly; $125,000 for a married person filing separately.)[93]

Oh, that’s just sucks in California.  Wonderful, pretty much everyone I know will be paying more in taxes, and of course, we pay a good amount already.

Insurers are prohibited from discriminating against or charging higher rates for any individual based on gender or pre-existing medical conditions.

I like this one.  As someone who changes jobs much more, it’s nice to not have to consider carrying cobra as I move on just to cover something from the last couple of years.  As I get older, that’s going to be more important.

A $2,000 per employee penalty will be imposed on employers with more than 50 employees who do not offer health insurance to their full-time workers (as amended by the reconciliation bill).[30] “Full-time” is defined as, with respect to any month, an employee who is employed on average at least 30 hours of service per week.[128]

I suppose this is ok because any company reaching over 50 employees should be generating enough cash flow to offer decent benefits, otherwise, how will they attract talent in this day and age?

CMS begins using the Medicare fee schedule to give larger payments to physicians who provide high-quality care compared with cost.

I don’t know what this means.  Will physicians actually get more money paid to them or will they just got an increment to the already low Medicare fee schedule for high-quality care?  How do they define high-quality care?  I guess we’ll find out in 01/2015 when this is effective.

All existing health insurance plans must cover approved preventive care and checkups without co-payment.

That’s a direct hit to the primary care, family and general internist specialities (others too I’m sure).  I suppose this will create the market for a bunch of new walk-in clinic systems nationwide.  I assume that the amount of money paid to the service provider here is a flat rate, so the organization providing these services will then move to increasing volume to generate appropriate cash flow to run their business.  I believe that will result in sub-optimal care.

Overall thoughts

I’m somewhat impressed at the depth of this bill and initiative.  A lot of thought and effort has gone into completely overhauling our medical system.  However, I’m walking away with a few thoughts:

  • This is better for the overall society in the US, particularly because everyone will have access to some amount of healthcare and overall state/federal costs from helping those without insurance will become more predictable.  I’m not convinced that they will decrease.
  • Funding for this program will come from the people who have created opportunities for themselves and pulled themselves out of the situation where they cannot afford healthcare.
  • The healthcare providers will suffer as part of this initiative.  I suspect a number of them will not find the financial rewards that originally incentivized them to enter this profession.  Ultimately, this will lead to fewer potential practitioners entering the rigorous academic programs to provide quality care.  We need to consider the restrictions on how to become a practitioner here in the US (foreign medical graduate restrictions, alliances with schools outside the US, immigration reform to keep up with increasing patient demand in the face of decreasing financial returns).
  • More institutions will rise up and take control of delivering healthcare.  Gone will be the days of personal 1:1 private practice care to the masses.
  • There will still be a divide in the basic care provided by what Obamacare outlines and the high end boutique health care provided to the 1%-ers who can afford to pay their individual practitioners above and beyond what their healthcare insurance provider will pay for the services.
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5 thoughts on “Obamacare – Key Takeaways

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