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Affordable Care Act puzzle parts

Affordable Care Act maze

There are lots of different parts of the healthcare reform puzzle that are being worked on.

The Affordable Care Act is not as simple as an evening news sound bite or even an in-depth article in your local newspaper. While there are hot button issues like birth control and the individual mandate that gets lots of attention, there are far larger issues being worked on behind the scenes. The PPACA spelled out how healthcare reform should look like, it has been up to the Department of Health and Human Services (HHS) working with insurance companies and hospitals to draw up the rules and guidance for implementation of the law.

Just Do It!

An oft-repeated question I hear is, “Why is it taking so long to implement all the elements of the ACA?” First, we have to remember that each state is in charge of regulating its own insurance industry. An insurance company that operates in all 50 states has 50 sets of different rules to conform to. Both the insurance companies and states need time to reveiw, align and implement the new regulations. Sometimes this necessitates new legislation on the part of the state in order for the insurance company to properly comply with the federal rules.

Most of the iceberg is below the surface

There are also other provisions of the ACA that everyone must collaborate on to implement. Here are just a few of the lesser known elements that are being worked on for implementation in 2014.

  • Early Retiree Reinsurance Program encourages plan sponsors to continue to offer health insurance to early retirees. Even though HHS will fund the program, they need to work with insurance companies to create the paperwork flow and support.
  • Administrative Simplification provisions of the Affordable Care Act (ACA) adopt new standards and “operating rules” for how electronic transactions are conducted between HIPAA “covered entities”.
  • Transitional Reinsurance Program Assessment: health insurance issuers and third party administrators will pay an assessment to fund state non-profit reinsurance entities for the purpose of establishing a high-risk pool for the individual market.
  • Wellness: The new law promotes wellness programs through premium incentives and state programs that reward people for participating in these programs, as well as small business grants that encourage employers to offer these programs in the workplace.
  • Consumer Oriented and Operated Plans (CO-OP) are the quasi public option that was written into the ACA. HHS has given out several loans to different states to get the CO-OP’s started. California is in the process of passing legislation that would allow CO-OP’s to operate in the state.

Spirit of cooperation

As you can see, there are many elements of the ACA that don’t get much attention but are key to the success of healthcare reform. All parties concerned realized that if you shift one part of the healthcare puzzle, you’ll need to make adjustments someplace else. From the correspondence I receive, everyone is working to have the reforms in place and working by 2014.