What 2014 brings for Obamacare

3:26 AM brings, Obamacare No Comments

| By Jay MacDonald, Bankrate.com

Health insurance will become more affordable for many and mandatory for most this year.

The long-awaited affordability features of the Affordable Care Act are finally ready for prime time in 2014, along with the Obamacare requirement that virtually all Americans must have health insurance or face a penalty.

Major provisions of President Barack Obama's health reform law, from its subsidies for lower-income applicants to its expansion of Medicaid, finally take center stage.

"Many Americans will start to learn what tax credits and cost-sharing subsidies they're eligible for and the vast benefits of the law," predicts Dania Palanker, senior counsel for the National Women's Law Center in Washington, D.C. "Not only will they have insurance, they'll have insurance they can afford to use."

And yes, like an episode of "Downton Abbey," there are certain to be surprises along the way.

"The other side of getting health insurance at an affordable price with a pre-existing condition is, the young will pay a higher price for their good health and age," says Michael Morrisey, a professor of health economics at the University of Alabama at Birmingham. "When that sticker shock hits, it's probably going to be a big topic for the first half of 2014."

Here are the top six Obamacare plot twists sure to make headlines in 2014:

The spotlight finally shifts to the star of the Affordable Care Act: affordable health care.

If your income qualifies you for assistance, the law can help bring down the cost of your family's health coverage in two key ways:

By providing an advance tax credit to lower your monthly insurance premiums. By offering out-of-pocket subsidies to help you pay your insurance deductibles, copayments and coinsurance.

The premium tax credits are available at incomes between 100 percent and 400 percent of the federal poverty level, or roughly $11,500-$46,000 for individuals or $23,500-$94,000 for a family of four. You must purchase coverage through your state Obamacare exchange to qualify.

"These tax credit subsidies are provided on a sliding scale, meaning that those people who need help the most get the largest help," says Ron Pollack, executive director of the health care consumer group Families USA.

To qualify for the out-of-pocket subsidies, your household income must be below $59,000 for a family of four or $29,000 for individuals, and you must enroll in a silver (mid-level) health plan through your state's health exchange. The online exchange also can tell if you qualify for free or low-cost coverage under Medicaid.

Under health reform's "individual mandate," most Americans who don't have health coverage by March 31 will be assessed a penalty against their federal income tax for 2014.

The uninsured will be penalized the greater of 1 percent of their annual household income or the oft-cited $95 per person (and $47.50 per child under 18), to a family cap of $285.

Those per-person penalties jump to the greater of 2 percent of income or $325 in 2015, and the greater of 2.5 percent of income or $695 by 2016.

Morrisey says the uninsured middle class is more likely to feel the sting of the individual mandate than lower income groups.

"At $95 a year, the penalty is no big deal," he says. "But at 2.5 percent of income in 2016, if you're making $60,000 a year, the penalty is more than $100 a month. That's money that could be going toward insurance."

Douglas Hough, associate director of the Bloomberg School of Public Health at Johns Hopkins University, says the mandate's aim of herding everyone into the insurance pool is long overdue.

"It truly is revolutionary," he says.

Americans with pre-existing health conditions and women of all ages will have something momentous to toast for the New Year: equal treatment from health insurers.

Health insurance companies can no longer deny you coverage, charge you more, cancel your policy or exclude benefits because you have a life-threatening or chronic health condition. The provision applies to all but "grandfathered" plans that were in effect prior to the Affordable Care Act.

In addition, Obamacare prohibits insurance companies from charging women higher health insurance rates than men or denying them coverage because of health conditions such as pregnancy or cancer.

Don't cry for the insurers, says Morrisey. After all, they'll soon have millions of new policyholders to help absorb the added expense.

"Young, healthy people will pay a higher price to help insure the older and sicker," he says.

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Obamacare vs. your employer's plan

12:30 PM employers, Obamacare No Comments

| By Susan Ladika, Bankrate.com

Even if you have health insurance through work, you might still want to explore the Obamacare exchanges.

If you already have health insurance through your job, you're probably wondering whether Obamacare will give you some new options. Will you be able to comparison-shop for a plan on the new online exchanges that might be better than your employer health insurance? The answer is a big, resounding "maybe."

Like almost everything else having to do with health care reform, there are plenty of nuances and caveats. Trying to decipher them and choose the best health insurance plan for your situation "makes homeowners insurance seem really simple," says Brian Haile, senior vice president for health policy at the tax services company Jackson Hewitt.

The exchanges are online health insurance marketplaces set up under the Affordable Care Act. In 34 states, the marketplaces operate through the federal government's HealthCare.gov website, while 16 states and the District of Columbia are running their own exchanges.

Even if your employer already offers health insurance, there's nothing to prevent you from shopping on your state's exchange. However, if you decide to leave your work-based plan and purchase coverage on the exchange, you "may not qualify for some of the benefits that the uninsured have," notes E. Denise Smith, a professor of health care management at Gardner-Webb University in Boiling Springs, N.C.

Here's the big hiccup: Unless your employer's coverage for an individual is considered unaffordable under the law (that is, if your share of the premiums costs more than 9.5 percent of your household income) or inadequate (picking up less than 60 percent of the cost of covered benefits), you aren't eligible for a government subsidy to help pay for your insurance. Subsidies are one of the things that can make plans on the new state exchanges appealing.

Subsidies in the form of tax credits are available even if you earn up to 400 percent of the federal poverty level, currently about $46,000 for an individual and $94,000 for a family of four. The subsidies vary based on income and the size of your family.

And that brings us back to the central question: If you have employer health insurance, should you check out the Obamacare exchanges anyway? There are differing opinions.

"It would generally not benefit an employee to leave their employer-sponsored plan," Smith concludes, adding that your employer would be under no obligation to help pay for an exchange plan.

Haile says you may not be able to do better than your work-based coverage. "Look at how robust your employer plan is" and the benefits it provides, such as whether it includes dental and vision care, which are not part of the essential health benefits that must be offered with plans sold in the Obamacare exchanges, he says.

Still, if your employer-sponsored health insurance seems to eat up a big chunk of your budget, you might want to explore your options on the state exchange, Haile says.

Again, one of the key criteria of whether you'd qualify for subsidized insurance through your state's exchange is if your share of the premium for an individual health plan where you work would amount to more than 9.5 percent of your household income. Whether you take more expensive family coverage doesn't matter; the benchmark is what an individual policy would cost.

The rule means that someone earning $40,000 a year and paying $3,775 for individual coverage would not be eligible for a subsidy, says Brian Poger, CEO of Benefitter, a software company that's helping employers navigate their way through health care reform. That same worker paying even more for family coverage would still not be eligible because, again, the premium for an individual is less than $3,800 (or 9.5 percent of $40,000).

The 9.5 percent-of-income threshold is one that few workers would meet, according to one recent study. The ADP Research Institute found that only 8.6 percent of employees are required to pay premium contributions that would meet the Affordable Care Act's definition of "unaffordable."

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States roll out varied Obamacare plans

12:00 PM Obamacare, plans, States, varied No Comments

| By Michelle V. Rafter, MSN Money

Nearly half of which have States decided, to their own health care Exchange set up, will have a State-run option while residents in other States.

Rocky King spent almost two years getting ready for Oct. 1.

King is executive Director of CoverOregon, which will provide coverage State, online Exchange, health care for individuals, families and businesses with fewer than 50 employees. In the past two years, he has overseen the Exchange computer infrastructure, personnel and training-community partners.

"It was incredible", says King. "We have staff who did 40 to 50 of this training in the past two months, and they are tired."

It is the latest and one of the largest stages of health care reform, health insurance through a network of State and federal marketplaces to an estimated five Americans younger than 65, who currently do not have the coverage extend.

Under the new system if you are not insured or just shopping for better insurance, depends on the type of coverage available in large part where you live.

A total of 23 States run their own exchanges or to offer a partnership with the Federal Government to State hybrid Exchange. The remaining 27 States opted out running their own programs, so residents of those States that will have possibility of registration by the State-run Exchange.

While some Republicans still fight for Obamacare defund, this scenario is considered unlikely. Instead, open registration for individuals and families in a State to start nationwide Exchange as planned and executed by March 30 for cover from 2014.

Registration for small businesses will open on Oct. 1 and will remain indefinitely, no matter where the business is located. By 2015, to provide businesses with more than 50 employees to insurance companies have or will have to pay a fee of $2,000 per employee (excluding the first 30 employees).

Own Exchange States like Oregon, Washington and New York have millions of dollars in federal funds on infrastructure run the marketplaces as well as campaigns to raise awareness, to publish it.

Introduced this week for example, in the State of Washington, chance, a fictional young girl and star of a campaign $13 million inhabitants there wanted to familiarize with its insurance online Exchange, Healthplanfinder. Washington turned more than 1,000 insurance brokers, are trained and licensed people to evaluate plans to help.

Residents of New York can buy new stock insurance through existing and new providers to the State. A new entrant is a cooperative, which plan will provide coverage plus a catastrophic, high deductible like other four levels of support, health insurance of Republic of New York. That co-op claims that their premiums among the lowest offered, ranging from an average $423,64 per month for a "Platinum" plan a single adults up to $173,54 per month for the catastrophic coverage.

Oregon CoverOregon total will offer 102 plans through 11, although most people for a much smaller number of plans into consideration. Under a standard plan, "Silver" would a family of four with an annual income of $32.499, $35.324 $81 to $118 in monthly premiums, with $10 health coverage for doctor visits and $5 pay for health coverage for generic drugs. Families with low incomes receive subsidized insurance and qualify may also for Medicaid, tax credits or other financial support.

No one expects an immediate rush of applications. King estimates that 217,000 people in CoverOregons to register commercial insurance during the first year and an another 200,000 in Medicaid. "Each State we have expected low registration in October", King says. "they go and browse and shop and find out what they are eligible for funding."

In many States, the decision was whether to create politically charged exchanges of State. In Idaho, the State operates an own Exchange despite the widespread opposition to the program. "People in Idaho don't, trust the State Government but they trust Washington, D.C., still less" Eagle, Idaho, bar owner stated in a report of Kaiser Health News/United States today.

Florida rejected extension million funds for health care because of political opposition to Obamacare. The State passed a law to create a health insurance exchange in 2008, but it has not met not open requirements for business and currently Federal Republic. State residents must want to login so the Federal Exchange to work.

Here is a list of which States have their own Exchange and be instructed the Federal Republic Exchange according to Kaiser Family Foundation:

California
Colorado
Connecticut
Hawaii
Idaho
Kentucky
Maryland
Massachusetts
Minnesota
New Mexico
New York
Nevada
Oregon
Rhode Iceland
Vermont
Washington
Washington, D.C.

Arkansas
Delaware
Illinois
Iowa
Michigan
New Hampshire
West Virginia

Alabama
Alaska
Arizona
Florida
Georgia
Indiana
Louisiana
Kansas
Maine
Mississippi
Missouri
Montana
Nebraska
New Jersey
North Carolina
North Dakota
Ohio
Oklahoma
Pennsylvania
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Wisconsin
Wyoming

To find out what options are available, read the official website, HealthCare.gov.

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Debate rages over Obamacare, medical costs

11:00 AM costs, Debate, medical, Obamacare, rages No Comments

| By Michelle V. Rafter, MSN Money

Newly public data has shed light on wild disparities in the cost of common medical procedures and treatments, which in itself could put pressure on doctors, hospitals and other providers.

When Dr. Jeffrey Rice needed to schedule outpatient foot surgery for his son three years ago, he called the recommended facility to find out what it would cost. The estimate was so high -- $15,000 to $25,000 -- that Rice asked the surgeon for a second option. The cost for the same one-hour procedure at an outpatient surgery center in a slightly more convenient location: $1,500.

Rice's experience isn't an anomaly. Costs for identical medical procedures can vary by thousands of dollars from clinic to clinic, city to city and state to state, according to federal data and other sources.

With the next phase of the Affordable Care Act kicking in Oct. 1, when individuals can begin enrolling in state-run health exchanges, debate rages over whether health care reform will do anything to rectify such pricing disparities or help lower costs.

The 2010 law, widely known as Obamacare, is meant to address the availability and cost of health insurance, not necessarily the cost of specific services. Still, supporters believe that because it paves the way for universal health care coverage, the resulting larger pool of insured patients should lower costs in the long run. Supporters also believe the high-deductible health plans that health exchanges and a growing number of employers are offering will make consumers more cost-conscious and put downward pressure on health care prices.

Detractors say the number of uninsured who will get coverage under Obamacare is not large enough to affect the cost of health care and that expanded coverage of preventive care and other services will contribute to higher prices.

"Anybody who says they know how it's going to affect costs is smarter than me, or they're guessing," says Dr. Peter Ubel, a medical doctor, author and a professor of business public policy and medicine at Duke University. "This is the kind of stuff that will unfold over the next few years."

The uncertainties over what could happen haven't slowed a movement to make health care costs more transparent, and some argue that holding doctors, hospitals and other providers more accountable for what they charge will on its own help drive down costs.

Today, what hospitals or doctors charge isn't determined by quality of care but by market power, says Rice, who is chief executive at Healthcare Blue Book, a medical care cost-comparison website. "If you're an academic medical center with a good brand name you'll be paid more than an imaging center. If you're a hospital chain you might be paid more than an individual hospital," he says.

Last May, the federal government's Center for Medicare and Medicaid Services helped shine a light on costs by publishing for the first time Medicare charges for the 100 most frequently billed discharges at 3,000 U.S. hospitals. For example, bills for treatment of chest pain at 10 Bay Area hospitals in 2011 ranged from an average $21,044 at Chinese Hospital in San Francisco to $53,408 at Seton Medical Center in Daly City. The average Medicare reimbursement for the treatment ranged from $4,575 to $7,795.

Since May, websites such as NerdWallet and OpsCost have created user-friendly services that make it easy to browse the government data. One Oklahoma mom used OpsCost to contest a bill for her daughter's emergency room visit that included a $260 charge for acetaminophen, the pain reliever better known by the brand name Tylenol, says OpsCost co-founder George Kalogeropoulos. A Tampa man whose family doesn't have insurance used it to find a hospital for his wife to deliver their baby.

"It's also been very surprising how many hospital CFOs and billing experts have been asking us for data about their competitors, other hospitals near them," Kalogeropoulos says. "Generally speaking, there is a lot of unease in those circles as prices have been set in a fairly irrational and arbitrary way for so long, and these folks know that a storm is brewing with the push for transparency."

Other tools have popped up to help people pick low-cost health care providers. Healthcare Blue Book supplies pricing information found in the health care section of Angie's List, a subscription-based consumer review website. Healthcare Blue Book also licenses its database, which is compiled from commercial and private insurance data, to insurance carriers to share with their corporate clients' employees who can use it to choose providers.

But prices can vary widely even within an insurer's network of approved providers, Rice says. "Patients have to shop the network, that's the biggest message that I can get out," he says. "Otherwise, you don't find out until after, and pay several thousand dollars too much."

In another sign of transparency, some hospitals are starting to advertise their fees. In August, the Surgery Center of Oklahoma posted prices for common procedures, including $1,925 for putting a cast on a broken arm and $6,990 to repair a knee ligament. North Carolina Gov. Pat McCrory recently signed a bill requiring hospitals to disclose prices for 140 common medical procedures.

"More states are starting to put requirements out there for hospitals to post prices," says Ubel, the Duke University professor. "That's going to change the culture of medicine almost as much as anything else. That's not from Obamacare, it's more just everyone realizing they have to look at why they're spending so much money on health care."

One way that Obamacare could eventually help drive down health care costs is if hospitals are motivated by it to join accountable care organizations, or ACOs, groups of service providers who band together to offer coordinated care at lower prices. "Obamacare gives (providers) incentives to do this, and if that has a big effect on how medical practice works, it could lower costs," Ubel says.

According to Kaiser Health News, more than 428 hospitals have joined ACOs, serving an estimated 4 million Medicare recipients and about 14% of the U.S. population.

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4 stocks to profit from Obamacare

9:54 AM Obamacare, profit, stocks No Comments

| By James Brumley, InvestorPlace

Investors can lament Obamacare, or they can capitalize on it by owning stakes in the companies best-positioned to profit from the changes.

Any anti-Obamacare voters expecting a Republican to take over the oval office in 2016 and to repeal all 2000 pages of President Obama's healthcare overhaul might want to adjust those expectations. That snowball has been set into motion for too long -- and has already gathered too much momentum -- to be stopped now.

As they say, though, when life gives you lemons, make lemonade. Investors can lament Obamacare, or they can capitalize on it by owning stakes in the companies best-positioned to profit from the changes. Most of the top prospects can be found on the medical-technology and the medical-data arena.

Just for the record, it's not Obamacare that's creating the real opportunity in the healthcare IT industry. It was 2009?s HITECH Act (part of the American Recovery and Reinvestment Act) -- which clarified how many of the electronic record-keeping requirements could and would be met -- that's actually driving the growth in the electronic healthcare records, or EHR, arena.

What's HITECH? Essentially, it's mandated improvement in the accuracy of medical records specifically by compelling caregivers, hospitals, and pharmacies to begin using digital medical records. It's an acronym for "Health Information Technology for Economic and Clinical Health", if that helps. Of course, the advent of Obamacare -- which will successfully complicate the process of getting or receiving care -- is setting a bullish stage for the healthcare technology industry's players. The top prospects within that arena are (in no particular order):

Though nowhere near the top of the average investor's watchlist, Cerner (CERN) is probably one of the first medical technology names well-versed investors think of. Aside from being one of the biggest with a market cap of $16.65 billion, its revenue and earnings growth have almost been freakishly reliable.

While there's nothing especially unique working in the company's favor, its sheer size means it can muscle its way into new markets.

HMS Holdings (HMSY) is, for all intents and purposes, a government watchdog that will almost certainly play a bigger role in billing management once Obamacare is fully implemented.

HMS drives the bulk of its revenue by earning a percentage of billing mistakes it catches. Medicaid is one of its biggest customers, and Medicare is a major client too. With both programs on pace to become more complicated and open new doors to potential fraud and reimbursement confusion, the opportunity for HMS Holdings will grow significantly.

And to be clear, HMS has only scratched the surface of the opportunity. The Department of Health and Human Services estimates that nearly $65 billion worth of improper Medicare and Medicaid payments were made, and only $4.2 billion of it was actually found and recovered. The industry needs HMS Holdings doing more digging.

Accretive Health (AH) operates in the uglier part of the healthcare billing industry. It's a debt collector -- the nation's biggest. It's not an industry that's going away either. In fact, the need may ramp up once the healthcare industry expands this year and next year.

Additionally, Accretive Health offers a proactive solution that will theoretically keep some patients out of the emergency room in the first place. The company's data-driven computer system identifies patients who likely need preventive care, rather than waiting for serious conditions to arise that send the patient into the emergency room. The system also handles medical billing and medical record-keep tasks, making it a one-stop, efficiency-driving option.

It might not be anything special on the surface, but boring companies have a funny way being cash cows, and in the past three years Accretive Health has grown its top line faster than any other of the companies under the microscope here.

While Quality Systems (QSII) is downright dwarfed by industry top dog Cerner, there's still something compelling about this $1.2 billion company.

At first glance, Quality Systems looks like just another digital healthcare records play. It's got a hand in a little bit of everything, but specializes in nothing. And truth be told, the company hasn't exactly been well-respected lately. The company's services rank fairly low in terms of customer satisfaction, and the management team has been under pressure from activist investment company Clinton Group of late, culminating in some sweeping changes on the company's board.

So where's the upside in that kind of disruption? Because the organization (despite shortcomings and a lack of pizzazz) has an attractive book of business and an existing framework that would be attractive to a suitor interested in tweaking it. And, the buzz is that the new board is open to such a strategic alternative. While buying a stock solely for its buyout potential isn't always a strong idea, when it's a turnaround story too, it sure doesn't hurt.

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