healthcare

Key ACA Provisions: Where Do We Stand?

By Kerry McKean Kelly On Feb 25, 2014

Some of the major provisions of the Affordable Care Act have experienced delays or amendments since the law was enacted in 2010. Here’s a status update:

  • Insurance mandates: The individual mandate requiring individuals to carry health insurance coverage or face a penalty took effect Jan. 1. However, the employer mandate requiring employers with more than 51 full-time workers to offer minimum health insurance coverage to their employees or face a penalty was delayed one year beyond its original start date of Jan. 1, 2014. And in February, an additional delay to 2016 was announced for companies with 50 to 99 employees. For companies with at least 100 employees, the new change required them to offer minimum coverage to only 70 percent of their workers in 2015, down from a previous target of 95 percent.
  • Health Insurance Marketplace: New Jersey officials chose not to develop a state-run health insurance exchange and instead opted to be part of the federal Health Insurance Marketplace. The federal site went live Oct. 1, 2013 – the first day of federal fiscal year 2014 – but was saddled with extensive operational glitches. According to the US Department of Health and Human Services, about 55,000 New Jersey residents have signed up for insurance through the ACA’s online marketplace through Feb. 1. Although an interim number, those 55,000 enrollees are far short of the 800,000 ACA-eligible uninsured in the state as estimated by the Rutgers Center for State Health Policy.
  • Medicaid expansion: New Jersey is among the states that opted to expand its Medicaid program to all low-income residents making up to 133 percent of the federal poverty level beginning Jan. 1. Under the expansion, federal funds will cover 100 percent of New Jersey’s expanded Medicaid services for the first three years and then will be reduced to 90 percent federal funding. The Governor’s office projected a state savings of approximately $227 million through this expansion. The Administration said about 100,000 people would be covered by the expansion; other estimates from Rutgers University suggested the expansion could reach as many as 225,000 uninsured residents.
  • Payment reform: Hospitals and other healthcare providers face significant cuts in Medicare and Medicaid reimbursement, including cuts intended to incentivize providers such as reduced payments for hospitals with high rates of patient readmissions and reductions in “disproportionate share hospital” payments for hospitals that serve a significant share of patients on Medicaid and Medicare. All told, New Jersey healthcare providers are facing about $1.3 billion over 10 years under the ACA. In the 2014 federal budget, the scheduled Medicaid DSH cuts for 2014 were eliminated and the scheduled 2015 DSH reductions were delayed one year, in recognition that providers continue to bear the burden of caring for uninsured and underinsured individuals. However, other ACA cuts continue to put the squeeze on healthcare providers.