Industry:Hospital and Healthcare Added By:Admin Posted On:Aug. 30, 2019
Healthcare rules in the U.S. have changed a great deal over the past few decades, and new laws have reshaped how hospitals operate and how people get coverage. With so many people seeking care, reform has been a constant part of the industry. This article reviews the main healthcare reforms and where their key provisions stand today.
The Consolidated Omnibus Budget Reconciliation Act (COBRA), a 1985 law, lets many private-sector employees keep their employer health coverage for a limited time after leaving a job. The Health Insurance Portability and Accountability Act (HIPAA) added further protections for people moving between jobs and health plans.
Together, these laws gave many workers access to coverage they would otherwise have lost when they left an employer, and they set the stage for the broader reforms that followed.
The Patient Protection and Affordable Care Act (ACA), signed in 2010 under President Barack Obama and often called Obamacare, aimed to help people who could not afford medical care get reasonable health insurance coverage. It brought many previously unaffordable costs within reach and changed how insurers, employers and hospitals approach coverage.
Starting in 2014, the ACA required most people to have health coverage or pay a penalty when filing taxes. The penalty was based on either a flat amount or a percentage of income, whichever was greater, and it rose each year. Low-income households and people who could not find affordable coverage were exempt.
The federal penalty no longer applies. It covered plan years 2018 and earlier, and people without coverage now owe no federal fee, though some states have their own coverage requirements.
Medicaid, the federal and state program for people with low incomes, was expanded under the ACA to cover adults under age 65 with incomes up to 133 percent of the federal poverty level. Because of how income is counted, the limit works out to 138 percent in practice, and it applies only in states that chose to expand Medicaid.
People with incomes above the Medicaid range could qualify for premium subsidies through the health insurance marketplaces. People covered through large employers saw few changes to their coverage.
The ACA also included a 40 percent excise tax on high-cost employer health plans, known as the Cadillac tax. It was meant to discourage very expensive plans and help fund broader coverage, and its start date was delayed more than once.
The tax never took effect. Congress repealed it in 2019, before it was implemented.
Each of these laws has changed how coverage is offered and paid for, from prescription drug programs and Medicare to employer plans. Some provisions, such as the mandate penalty and the Cadillac tax, were later reduced to zero or repealed, while Medicaid expansion and marketplace coverage remain.
For hospitals and healthcare organizations, the lesson is to track these laws closely, because coverage rules shape who can get care, how providers are paid and which costs patients carry themselves.