December 5, 2013
National health care reform — officially known as the Patient Protection and Affordable Care Act (ACA) — is the most ambitious piece of health care legislation since the establishment of Medicare and Medicaid in 1965.
The legislation aims to expand access to health care coverage to uninsured Americans through:
- an individual mandate requiring adults to have health insurance or pay a fine;
- an employer mandate requiring firms with 50 or more employees to offer coverage or pay a fine;
- a requirement that each state establish a health insurance exchange or accept a federally established exchange in which individuals and small businesses can buy coverage; and
- an expansion of Medicaid eligibility to cover greater numbers of lower-income people.
Another major goal of the ACA is to implement new health delivery reforms that would bend the health care cost curve down and reduce costs over time.
Supporters believe realigning the delivery system to drive out inefficiencies in the health care system will reduce costs and improve quality of care. The five areas for system reform included in the law are:
1. payment reform
2. primary and preventive care
3. measuring and reporting quality
4. administrative simplification
5. health information technology
But how will these changes affect military and VA beneficiaries?
By law, TRICARE (including TRICARE For Life) beneficiaries and veterans enrolled in the VA health care system are exempt from the direct impacts of the ACA. TRICARE and VA health care meet the minimum essential health care coverage requirements, and in general the ACA does not affect the administration, health care benefits, eligibility, or cost to beneficiaries of these two systems.
However, the sweeping changes made by ACA could still impact TRICARE and VA beneficiaries in the future.
Roughly 32 million uninsured Americans are expected to become insured as a result of the ACA. How will this influx of covered individuals impact access to health care? Especially in the absence of a permanent fix to the annual Medicare/TRICARE physician reimbursement rate cut — now estimated to be at 30 percent — which was critically left out of the ACA. These are questions that MOAA will seek to answer in the coming months.
Reforming an industry that accounts for more than 17 percent of our nation’s economy is bound to have unforeseen consequences. MOAA will track the progress of implementation of the ACA and remain vigilant to ensure that military and VA beneficiaries are not negatively impacted by the changes.