Is U.S. health-care reform on track for 2014? - NewsChannel5.com | Nashville News, Weather & Sports

Is U.S. health-care reform on track for 2014?

Updated: July 11, 2013 10:02 AM
© iStockphoto.com / Karen Roach © iStockphoto.com / Karen Roach

By Karen Pallarito
HealthDay Reporter

THURSDAY, July 11 (HealthDay News) -- At the heart of President Barack Obama's sweeping yet controversial health-reform law is the largest expansion of health insurance in decades, and it's set to take effect on Jan. 1, 2014. But some observers wonder whether it will get off the ground as scheduled.

The law requires most adults to purchase health insurance or face a penalty -- the so-called individual mandate. It seeks to broaden health insurance coverage by:

  creating state health insurance exchanges where individuals can buy coverage on their own -- in some cases, with federal subsidies;
  expanding Medicaid, the government insurance program for poorer Americans;
  and requiring all but the smallest employers, those with 50 or more workers, to offer health insurance or pay a fine.

But in a surprise announcement last week, the Obama administration delayed the employer mandate, granting companies another year -- until 2015 -- to work through federal rules and reporting requirements.

Could the "individual mandate" be next? Is further upheaval in store?

"It does call into question, 'Is this just a one-time thing or the beginning of more delays and changes,'" said Steve Wojcik, vice president of public policy at the National Business Group on Health, in Washington, D.C.

With the 2014 deadline fast approaching and a lack of definitive guidance from the federal government on implementing some parts of the law, the Affordable Care Act -- dubbed "Obamacare" -- remains a work in progress.

"I'm actually in the middle of still reading proposed regulations for exchanges," said Cristine Vogel, an associate director in the Chicago-based health-care practice of Navigant Consulting, Inc.

Timothy Jost, a professor at Washington and Lee University School of Law in Lexington, Va., said core parts of the law, including the exchanges and individual mandate, can operate without the employer mandate. "I think the train is still on track, although not moving as quickly as I would like," he said.

Half of states sit out Medicaid expansion

The Affordable Care Act faced its most significant challenge last year when the U.S. Supreme Court considered whether requiring most consumers to have health insurance, or pay a penalty, was constitutional. The high court upheld this individual mandate last June. But it also ruled that states could opt out of expanding Medicaid -- the federal-state health insurance program for the poor and disabled.

Expanding Medicaid to more low- and middle-income people is one of the ways the architects of the health-reform law envisioned reducing the ranks of the nation's uninsured by up to 30 million people.

Under the law, people making up to 138 percent of the federal poverty level may qualify for coverage under the Medicaid expansion. (That's as much as $15,856 for an individual or $32,499 for a family of four.)

So far, though, only 23 states and the District of Columbia plan to participate in the Medicaid expansion. The remaining states are mostly led by Republican governors who refuse to go along with expansion.

Low-income individuals in states that do not expand Medicaid eligibility will not be penalized for not having health coverage. But the poorest among them -- people living below the poverty line -- won't be able to access federally subsidized coverage through the state health exchanges, either. That leaves nearly 10 million of 15 million potentially eligible adults without coverage, according to a recent Associated Press analysis of Urban Institute data.

"This rips the heart out of health-care reform because it denies access to America's most vulnerable," said Lawrence Gostin, professor of global health law at Georgetown University School of Law.

Will the health exchanges open in time?

Another 24 million people will be enrolled in health plans through the state health insurance exchanges by 2023, according to a Congressional Budget Office estimate. The administration hopes to enroll 7 million people in the first year of eligibility.

Recently, though, Congress' Government Accountability Office reported that health officials are running behind schedule on many aspects of health exchange formation, including testing data systems that will be used to determine eligibility for coverage.

On Friday, the Obama administration published regulations scaling back the requirement that state health insurance exchanges, or marketplaces, verify consumers' income and health insurance status to obtain coverage under the law. Instead, the exchanges will rely more heavily on self-reported information until 2015, according to the Washington Post.

In a recent interview with CNBC, Todd Park, chief technology officer with the U.S. Department of Health and Human Services, said the state health insurance exchanges are "on track" and will be up and running on Oct. 1 for open enrollment.

Self-reporting will streamline the enrollment process, said Dan Schuyler, director of exchange technology at the Salt Lake City-based consulting firm Leavitt Partners. But, he added, "it also opens the door to deliberate fraud, abuse and unintentional eligibility errors."

Is Obamacare in trouble? Depends on whom you ask

Republican opponents of the Affordable Care Act assert that the Obama administration is playing politics by delaying provisions of the law, particularly the employer mandate, until after 2014 mid-term Congressional elections, The Hill reported.

By 2023, the law will reduce the number of people without health insurance by 25 million, still leaving 31 million uninsured, according to Congressional Budget Office (CBO) estimates.

House Budget Committee Chairman Paul Ryan (R-Wis.) wants the CBO to reevaluate the estimate of the law's impact in light of the recent delays, according to The Hill.

Alden Bianchi, group leader of the law firm Mintz Levin's employee benefits practice in Boston, doesn't believe recent changes suggest the federal law's implementation is in trouble, as Republican opponents assert.

"The exchanges won't be perfect on Day One. The underlying electronic infrastructure that communicates among HHS (Health and Human Services) and the various state exchanges won't be up and running. But will people be able to get access to health care? Yeah, and that's really what exchanges are for," said Bianchi, who represented former Gov. Mitt Romney's administration for Massachusetts' 2006 health reform legislation.

David Smith, Leavitt Partners' director of payer services, downplayed the possibility that the White House would put the brakes on the state insurance exchanges or the individual mandate.

"Politically, the administration can't afford a delay of the more critical pieces of the law and will move mountains to implement them on time while managing expectations," he said.

More information

To learn more about the Affordable Care Act visit the U.S. Department of Health and Human Services.

Health News Copyright © 2013 HealthDay. All rights reserved.

  • Medical News HeadlinesMedical News HeadlinesMore>>

  • New Laser Treatment Stops Some Epileptic Seizures

    New Laser Treatment Stops Some Epileptic Seizures

    Tuesday, April 22 2014 6:00 PM EDT2014-04-22 22:00:21 GMT
    More than two million adults in the United States have epilepsy and 150,000 more will develop the condition each year. Usually, medication can control seizures, but about 30 percent of patients do not respond. Now, patients have a new treatment option that uses lasers to stop the seizures.
    more>>
    More than two million adults in the United States have epilepsy and 150,000 more will develop the condition each year. Usually, medication can control seizures, but about 30 percent of patients do not respond. Now, patients have a new treatment option that uses lasers to stop the seizures.

    more>>
  • Heating Up Breast Cancer

    Heating Up Breast Cancer

    Monday, April 21 2014 6:15 PM EDT2014-04-21 22:15:09 GMT
    Two years ago, doctors told Lisa Ridgeway she had triple negative breast cancer, a very aggressive disease with no cure. Lisa had surgery, radiation, and chemo, but her cancer came back two more times. Now she’s trying something new.
    more>>
    Two years ago, doctors told Lisa Ridgeway she had triple negative breast cancer, a very aggressive disease with no cure. Lisa had surgery, radiation, and chemo, but her cancer came back two more times. Now she’s trying something new.

    more>>
  • Migraine Relief: Stopping Pain & Relieving Pressure

    Migraine Relief: Stopping Pain & Relieving Pressure

    Friday, April 18 2014 5:15 PM EDT2014-04-18 21:15:06 GMT
    Meredith Messerli is thankful she can study without pain. The college freshman spent two years of her life battling severe migraines.more>>
    Meredith Messerli is thankful she can study without pain. The college freshman spent two years of her life battling severe migraines.more>>
  • Hope For Lanie: Curing SMA

    Hope For Lanie: Curing SMA

    Thursday, April 17 2014 5:15 PM EDT2014-04-17 21:15:09 GMT
    SMA attacks the body's motor neurons and causes paralysis. There is no cure, but for the first time doctors are studying an experimental therapy that targets more than just symptoms.more>>
    SMA attacks the body's motor neurons and causes paralysis. There is no cure for SMA but for the first time doctors are studying an experimental therapy that targets more than just symptoms, it targets mutated SMN genes, which are responsible for SMA.more>>
  • Washing Lungs & Breathing Better

    Washing Lungs & Breathing Better

    Wednesday, April 16 2014 5:15 PM EDT2014-04-16 21:15:09 GMT
    Imagine not being able to breathe without struggling: every breath you take is work; every breath you take could be your last. That was the case for one man who became dependent on an oxygen tank to stay alive.more>>
    Imagine not being able to breathe without struggling: every breath you take is work; every breath you take could be your last. That was the case for one man who became dependent on an oxygen tank to stay alive.more>>
  • Ocular Melanoma: Saving Lives, Saving Eyes

    Ocular Melanoma: Saving Lives, Saving Eyes

    Friday, April 11 2014 5:15 PM EDT2014-04-11 21:15:07 GMT
    Ocular melanoma, also called uveal melanoma, is a rare type of melanoma that targets the eye. It can be a deadly if it isn't spotted early enough. Now, there's a way to treat patients that's saving lives and saving eyes.more>>
    Ocular melanoma, also called uveal melanoma, is a type of melanoma that targets the eye. It affects about 2,000 people a year in the United States. Although rare – it can be a deadly if it isn't spotted early enough. Now, there's a way to treat patients that's saving lives and saving eyes.more>>
  • Memory Palace: Coping With Chemo Brain

    Memory Palace: Coping With Chemo Brain

    Thursday, April 10 2014 5:15 PM EDT2014-04-10 21:15:09 GMT
    More than 13 million Americans are living with some form of cancer. Harsh treatments like chemo and radiation save lives, but they will also change lives. Now, many cancer survivors are learning how to cope with chemo brain.more>>
    More than 13 million Americans are living with some form of cancer. Harsh treatments like chemo and radiation save lives, but they will also change lives. Now, many cancer survivors are learning how to cope with chemo brain.more>>
  • Pedaling For A Cure

    Pedaling For A Cure

    Wednesday, April 9 2014 5:15 PM EDT2014-04-09 21:15:09 GMT
    Five years ago, Leslie Trudeau's world came crashing down. At just 22 years old, her son Taylor lost his battle with leukemia. That's why Trudeau is pedaling for a cure.more>>
    Five years ago, Leslie Trudeau's world came crashing down. At just 22 years old, her son Taylor lost his battle with leukemia. That's why Trudeau is pedaling for a cure.more>>
  • Bringing Hearts Back To Life: New Improved Defibrillator

    Bringing Hearts Back To Life: New Improved Defibrillator

    Tuesday, April 8 2014 5:15 PM EDT2014-04-08 21:15:13 GMT
    CPR and a portable defibrillator helped keep Eric Robinson alive after he went into cardiac arrest. And now a newly FDA approved Biotronik implantable cardiac defibrillator, or ICD, constantly monitors his heart.more>>
    A year ago, while jamming with his son's band, Eric Robinson went into cardiac arrest. CPR and a portable defibrillator helped keep Robinson alive. And now a newly FDA approved Biotronik implantable cardiac defibrillator, or ICD, constantly monitors his heart.more>>
  • Helping High Risk Hearts

    Helping High Risk Hearts

    Monday, April 7 2014 5:15 PM EDT2014-04-07 21:15:09 GMT
    Ironing is not exactly Barbara Roy's favorite activity, but it's something she's glad she can do again. Her doctor diagnosed her with severe aortic stenosis.more>>
    Ironing is not exactly Barbara Roy's favorite activity, but it's something she's glad she can do again. Her doctor diagnosed her with severe aortic stenosis.more>>
*DISCLAIMER*: The information contained in or provided through this site section is intended for general consumer understanding and education only and is not intended to be and is not a substitute for professional advice. Use of this site section and any information contained on or provided through this site section is at your own risk and any information contained on or provided through this site section is provided on an "as is" basis without any representations or warranties.
Powered by WorldNow
Powered by WorldNow
All content © Copyright 2000 - 2014 NewsChannel 5 (WTVF-TV) and WorldNow. All Rights Reserved.
For more information on this site, please read our Privacy Policy and Terms of Service.