The Affordable Care Act Moves Forward: What’s Up for 2013

Over two years after becoming law, the Affordable Care Act (ACA) continues to improve health care and lower costs for millions of Americans, including those who rely on Medicare. The recent election was key to the future of the landmark legislation, which will expand access to health care coverage and work to improve quality of care. While many of the law's key provisions, including the individual mandate and requirement that insurance companies cover individuals with pre-existing conditions, do not take full effect until 2014, other reforms and improvements are slated to take effect in 2013.

Post-election, the most immediate issue facing states is the November 16, 2012 deadline to decide whether they will set up their own health exchanges – marketplaces where regulated insurance plans will be offered for residents who need to purchase coverage. States have the option to implement their own exchanges, set up a "partnership" exchange in conjunction with the federal government, or let the federal government set up and run the state's exchange alone. So far, 13 states and the District of Columbia have moved to begin setting up their states' exchanges.  Between 20 and 30 states are expected to seek their own exchanges or partner with the federal government, while the remaining states will opt to let the federal government run their exchanges.[1] Subsidies will be provided to individuals and families to help with the costs of purchasing coverage through the exchanges, and will be based on a sliding scale up to 400% of the federal poverty limit. The exchanges are expected to be ready in January 2014.

Other ACA reforms and initiatives that start, or take effect, in 2013, include:

Improving Funding for Preventive Care: Effective January 1, 2013, new funding will be provided by the law to state Medicaid programs that choose to cover preventive services graded "A" and "B" by the U.S. Preventive Services Task Force. The financial incentives will encourage states to cover services that aim to keep patients healthy by monitoring and preventing chronic conditions. States who cover those services will receive a 1% increase in the Federal Medical Assistance Program (FMAP). [2]

Increasing Medicaid Reimbursement to Primary Care Providers: Beginning January 1, the ACA requires states to increase Medicaid payments to primary care providers to equal 100% of Medicare reimbursement rates for two years. The federal government pays for the difference in costs. [3] The increased funding means improved access for Medicaid beneficiaries as well as bolstering primary care, which lowers costs long-term for states.

Expanded Authority for Payment Reform Demonstrations: In 2013, demonstrations that test new models of health care delivery and financing will be implemented.  These models will encourage providers to work together to improve health outcomes and care coordination for patients while aiming to lower costs for payers.

Additional CHIP Funding: Effective October 1, 2013, states will receive two more years of funding to continue covering children who are ineligible for Medicaid. The additional funding ensures millions of children will continue to have access to low-cost health coverage.

These provisions, as well as those set to take effect in 2014, are a step forward in finally addressing the real fiscal issue around our country's health care – that of rising overall health care costs.  The Affordable Care Act provisions will also improve health care access and quality for millions of American families.

For information on how the ACA improves Medicare, click here.