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Election ushers in health care shift



With the re-election of President Obama, the major provisions of the Affordable Care Act are now more certain to occur.

Soon to come are higher Medicaid reimbursements for doctors, higher Medicare taxes and changes to the tax code to make it harder to deduct medical expenses.

And next year at this time, many consumers will be shopping at new online marketplaces for their health insurance.

The landmark federal health legislation passed in 2010, and several of its provisions are already in effect.

Today many young adults stay on their parents’ health plans until they turn 26. Seniors get help with the “doughnut hole,” which causes a costly gap in Medicare drug coverage. And insurance companies pay refunds to customers if the companies don’t reach spending minimums.

But, in many ways, the Affordable Care Act was backloaded, with many of its programs, taxes and fees postponed to the future.

Now, with the blessing of the Supreme Court earlier this year and with last week’s election results, the future is here.

Coming soon are the following changes:

  • Beginning Jan. 1, primary care doctors who treat Medicaid patients will receive the same reimbursements they get for treating Medicare patients.

In the past, Medicaid paid less than Medicare, and physicians were reluctant to participate in the program.

The change is meant to increase the number of doctors who see Medicaid patients. It applies to family practitioners, internists and pediatricians and covers 2013 and 2014, according to the Kaiser Family Foundation.

Medicaid is funded by the federal government and states and covers the poor and disabled.

Medicare is a federal program, mostly for those 65 and older.

  • Beginning Jan. 1, it will be harder to take the itemized deduction for medical expenses on your tax returns. The law increases the threshold from 7.5 percent of adjusted gross income to 10 percent of adjusted gross income.

Jan. 1 is also the start date for higher Medicare taxes on individuals who make more than $200,000 and couples who make more than $250,000.

Both changes are meant to help fund the expanded access in the law.

  • About a year from now, in October 2013, even bigger changes will be apparent. (This assumes no post-election compromises between the Congress and White House.)

Next fall marks the start of enrollment in the new online insurance marketplaces. Coverage begins Jan. 1, 2014.

Individuals and small businesses will shop for health insurance at these exchanges. Private insurance companies will offer plans there. Subsidies will be available for those eligible.

States have until later this week to decide if they want to set up their own exchanges or participate in one operated by the U.S. Department of Health and Human Services.

Gov. Bob McDonnell said last week that Virginia would not have its own state exchange. Eight other states have made the same decision.

Even so, the federal government promises no delay.

“No matter if a state chooses to run their own exchange, work in partnership with the federal government or have a federal exchange, consumers in all 50 states will have access to these new marketplaces come January 2014,” said Fabien Levy, press secretary for the Department of Health and Human Services.

  • The online markets will be important because of another of the law’s provisions, one that requires almost everyone to have health insurance or pay a tax penalty. Called the individual mandate, this provision starts Jan. 1, 2014.
  • McDonnell also said last week that Virginia will not participate in another of the law’s provisions, the expansion of Medicaid.

The Affordable Care Act provides for new insurance coverage through Medicaid for up to 17 million uninsured people.

Those who earn less than 133 percent of the federal poverty guidelines will be eligible. This translates to $14,856 for an individual and $30,657 for a family of four. The change begins in 2014.

States will receive 100 percent of the cost of the expansion from the federal government for the first three years and at least 90 percent in subsequent years. Even so, McDonnell is not convinced.

The Associated Press reported last week that he told a post-election press conference, “I don’t believe the federal government can possibly deliver its commitment to fully fund the program, and I don’t want to be part of contributing trillions of dollars to the national debt.”

Jim Hall: 540/374-5433