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Health Care Reform Section

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Health Care Reform Quick Terms


Affordable Care Act

Donut Hole

Essential Health Benefits

Grandfathered Health Plans

Health Care Exchange

Medical Loss Ratio (MLR)

Qualified Health Plan

Payment Bundling

Pre-Existing Condition

Preventive Services

SHOP

Value-Based Purchasing


Advantages

Concerns

Individuals

Affordable health care

No pre-existing conditions

No annual or lifetime limits

Low cost preventive care

Higher taxes

Individual mandate penalties

Less choice

Employers


Lower cost alternatives through exchanges

Tax credits available to small employers

Higher taxes

Employer plan mandate penalties

Less choice

Greater regulation

Brokers


Change brings opportunities

New consulting field emerges

Reduced commissions

Reduced competition

Extra work

Less incentives

Carriers

Better alternative than single payer system

Systematic change to simplify & unify administration functions

Erosion of profits

Greater regulation

Less flexibility

Less innovation

Providers

Increase efficiencies

Streamline billing & appeals

Universal payment system

 

Reduced fees

Greater regulation

Less autonomy

Push for consolidation

Greater regulation

Government


Capture votes

Increase government

Increase tax base

Reduce Medicare/Medicaid burden

Tax dollars granted to states

System collapses

Provisions repealed

Loss of votes

Increase in deficit spending

Ancillary

Increased opportunities

Establish new industry

Greater flexibility

Greater regulation


There are roughly seven directly affected individuals or organizations including the federal and state governments.  The chart below outlines a few of the advantages and some possible concerns of each category.  Please send your comments to include what you think may be missing.

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Government Links


Whitehouse.gov


No Employer Mandate for Small Business


Healthcare.gov


Consumer Operated and Oriented Plans (CO-OPs)



Department of Health & Human Services


Grandfathered Plans


Internal Revenue Service


AFA Nondiscrimination Provisions Applicable to Insured Group Health Plans


The Center for Consumer Information and Insurance Oversight


Regulations & Guidence


Fact Sheets



Tools from the Carriers


Oxford Health Plans - UHC


Health Care Lane


The Road to Reform Oxford


Navigating Health Care Reform  2-99


Navigating Health Care Reform  100+


Health Reform Next Steps  2-99


Health Reform Checklist  2-99


Meeting Presentation



PPACA Presentation Opening


PPACA Timeline at a Glance


PPACA Timeline at a Glance


Coverage & Admin Provions at a Glance


Preventive Care at a Glance


Essential Health Benefits at a Glance


Health Care Exchanges at a Glance


Medical Loss Ratio at a Glance


Small Employer Tax Credits at a Glance


Employer Requirements at a Glance


Grandfathered Plans at a Glance


Summary of Benefits and Coverage at a Glance


Advantages & Concerns at a Glance


Empire Blue Cross Changes Page 1


Empire Blue Cross Changes Page 2


Empire Blue Cross Changes Page 3

Disclaimer- Please note that the information in this site does not constitute legal, financial, or accounting advise by Group Coverage, Inc., it’s affiliates, or by William F. Schaake.  In addition it should be noted that Group Coverage, Inc., it’s affiliates, and William F. Schaake, assume no liability for the content contained herein as it is provided for informational purposes only.  We recommend to seek the advise of a qualified attorney, financial planner or tax advisor.  



Timeline Past Present & Future Health Care Exchange Medical Loss Ratio (MLR) Business Tax Credit Essential Health Benefits Coverage & Admin Employer Mandates Grandfathered Plan

Health Care Reform Tools

Preventive Care Summary of Benefits