You are previewing Health Care Reform Simplified: What Professionals in Medicine, Government, Insurance, and Business Need to Know.
O'Reilly logo
Health Care Reform Simplified: What Professionals in Medicine, Government, Insurance, and Business Need to Know

Book Description

Health Care Reform Simplified: What Professionals in Medicine, Government, Insurance, and Business Need to Know describes the Patient Protection and Affordable Care Act of 2010. Now that the U.S. Supreme Court has upheld the individual mandate and other key parts of the law—what must busy healthcare professionals, insurance industry professionals, business and HR managers, and policymakers do?

First, read this book. It translates the law's complex language into terms that are easy to understand, explaining what the new law does, when its provisions take effect, and how to implement it. This brand-new second edition also updates all the provisions and explains the myriad ways the ACA is already being put into practice.

Health Care Reform Simplified, Second Edition, outlines the financial impact of the law and how it affects businesses, insurers, hospitals and doctors, and state and local governments. Most important, this book gives consumers and employers critical information for making informed choices about new options for private and public health insurance coverage. It also describes how the law interacts with Medicare and Medicaid. Finally, it looks at the potential roadblocks—political, judicial, and economic—that may yet derail some of the provisions. But with more than half of the Act's provisions in force already, and the Supreme Court's landmark decision upholding the law, there is no time to lose in understanding how the legislation affects you whether you are a consumer or deliverer of health care in the U.S. This book:

  • Explains health reform in easy-to-understand terms

  • Shows how the law is playing out in the real world

  • Explains the ways the law or parts of it yet may be repealed by the 2012 election and the implications for readers

  • Provides HR professionals and managers options for covering employees while explaining costs and benefits

  • Details the impact on medical professionals and insurers and steps they must take now to comply with the law

  • Shows policymakers the way forward now that legal challenges have abated

This edition, completely updated to incorporate the newest regulations and the practices that have been put into place in various states, will prove an indispensable guide for those implementing the law, as well as those receiving health care, in the coming years.

What you'll learn

  • The provisions of the health care law, updated to take into account new regulatory guidelines, as well as models and processes developed at the state level.

  • Options for families and individuals, and how to decide whether to keep existing insurance, switch to a different plan, or get new coverage at an exchange or co-op

  • New government subsidies and tax breaks for health care, and who qualifies for them

  • What government agencies, insurers, and healthcare providers must do to comply with the law

  • Options for businesses, and how employers can decide whether to keep existing plans, purchase plans through exchanges, or provide vouchers to employees

  • The impact of health care reform on hospitals, doctors, insurers, and patient care

  • The potential for a new Congress with a new President to repeal provisions of the law

Who this book is for

Health Care Reform Simplified: What Professionals in Medicine, Government, Insurance, and Business Need to Know is an excellent resource for managers who make decisions about insurance coverage for employees, healthcare professionals and those working in the insurance industry who must understand and comply with the law's provisions, and policymakers who must implement the law at the state and local level. Individuals wondering about such things as the "individual mandate" will also find the book a useful overview of the changes that have occurred and those yet to come.

Table of Contents

  1. Titlepage
  2. Dedication
  3. Contents
  4. About the Author
  5. About the Technical Reviewer
  6. Acknowledgments
  7. Introduction
  8. Chapter 1: Overview
    1. Quick History of Health Care Insurance
    2. Political Primer on Health Care Reform
    3. Health Care Enters the 2008 Presidential Campaign
    4. Health Care Reform Summary, Schedule
    5. Timeline for Health Care Reform Provisions
    6. Coming Next
  9. Chapter 2: Early Changes
    1. Temporary Exchanges for People with High-Risk Conditions
    2. Expanded Plan Options in 2011 for High-Risk Exchanges
    3. New Insurance Guarantees for Children with Health Issues
    4. Young Adults Get Extension to Age 26 on Parents’ Policies
    5. Insurance-Rate Reviews Start, Some States Toughen Oversight
    6. Insurers Banned from Cutting and Capping Coverage
    7. Slowly Filling Medicare’s Prescription Drug “Donut Hole”
    8. Changes Continued Throughout 2011
    9. Coming Next
  10. Chapter 3: New Choices
    1. Some Policies May Be “Grandfathered” Under New Law
    2. Insurance Exchanges Are Critical to Health Care Reform
    3. Opposition to Insurance Exchanges
    4. Individual Mandate Requirements and Penalties
    5. Premiums No Longer Tied to Pre-Existing Medical Conditions
    6. Rights to Appeal, Choose Doctor, and Preventive Care
    7. Government Drops Long-Term Care Provision
    8. Coming Next
  11. Chapter 4: Business Trends
    1. Law Attempts to Give Small Businesses Relief from Big Insurance Costs
    2. Grandfathering, or Keeping Your Existing Plan, Requires Complex Calculations
    3. Larger Employers Required to Report Insurance Value on W-2 Forms
    4. Requirement for Coverage and Penalties for Not Doing So
    5. Small Businesses May Shop at Insurance Exchanges
    6. Early Retiree Reinsurance Program Stops Accepting Applicants
    7. New Law Creates Incentives for Employee Wellness Programs
    8. Coming Next
  12. Chapter 5: Insurance Shift
    1. Insurers’ Medical Loss Ratio Creates Rebates for Policyholders
    2. Guaranteed Coverage for Everybody, Despite Everything
    3. New Law Requires Insurers to Limit Variations in Rates
    4. New Law Sets Minimum Coverage, Preventive Care Coverage
    5. Addition of Birth Control to Preventive Care Creates Controversy
    6. Health Care Reform Cracks the Door for Insurance Co-Ops
    7. New Law Sparks Growth of Accountable Care Organizations
    8. Coming Next
  13. Chapter 6: New Medicine
    1. Attempting to Stop a Deadly Toll Taken by Medical Errors
    2. Health Care Law Tries to Lower Hospital Readmission Rates
    3. Fostering Better Coordination of Care, Communication
    4. “Medical Home” Shifts Focus from Procedures to Patients
    5. Accountable Care Organizations Quickly Gain Ground
    6. Doctor Shortages Predicted Along with Surge of Patients
    7. The Evidence for Evidence-Based Practice
    8. New Law Creates and Renovates Community Health Centers
    9. “Safety Net” Hospitals at Crossroads with Health Care Reform
    10. Coming Next
  14. Chapter 7: Old Growth
    1. Medicare Attempts to Improve Quality, Control Costs
    2. Six Types of Medicare Advantage Plans Defined
    3. Coming Next
  15. Chapter 8: Backlash
    1. Court Ruling Creates New Choices for States
    2. Other New Standards Apply to State Medicaid Programs
    3. New Support Encouraging Baby Boomers to “Age in Place”
    4. New Options for Chronic Conditions, Mental Health
    5. Medicaid Fee Increases for Primary Care Doctors Set for 2013, 2014
    6. Coming Next
  16. Chapter 9: Info Overload
    1. Only 1 in 8 Americans Proficient in Health Literacy
    2. Simplified Summary of Benefits and Coverage Required
    3. Health Care Reform Brings New Sources of Information
    4. Law Requires Disclosure of Financial Ties with Doctors
    5. Health Care Law Requires Nutritional Labeling
    6. Coming Next
  17. Chapter 10: Who Pays?
    1. Medicare Tax Increase to Raise $210 Billion
    2. “Cadillac” Insurance Tax Starts to Gear Up in 2018
    3. Private Insurers to Pay Billions Annually in New Fees
    4. Drug Companies Start Paying New Fees in 2011
    5. New Tax for Medical Devices Begins in 2013
    6. Medicare Savings Estimate of Doubtful Accuracy
    7. Health Care Reform Puts a “Sin Tax” on Tanning Services
    8. Other Health Care Reform Revenue Sources
    9. Coming Next
  18. Chapter 11: War on Reform
    1. Partisan Divide over Health Care Reform
    2. Republicans Hope to Repeal and Replace Affordable Care Act
    3. Conclusion: Health Care Reform Takes Nation to Tipping Point
  19. Bibliography
  20. Index