Page 14

Birmingham Bar Association Bulletin Winter 2015

Health Care Reform LaVeeda Morgan Battle, Battle Law Firm, LLC, and Co-Chair, BBA Medical Liaison Committee or be subject to an Employer Shared Responsibility payment. This payment, enforced by the IRS, is triggered if at least one full-time employee purchases individual coverage on an Exchange. The method of determining the number of full time employees includes counting the hours worked by part-time employees as full time equivalents. Employers with less than 50 fulltime employees “For employers, size matters. Effective in 2015, large employers with over 50 fulltime employees (including full time equivalents) must offer affordable health coverage that provides a minimum level of coverage to their full-time employees...” (including full time equivalents) are not subject to the Employer Shared Responsibility provisions. This measure motivates large employers to provide affordable coverage to full-time employees. It fills the health insurance gap created by some large employers electing not to offer health insurance benefits to full-time employees by making it mandatory for large employers to provide health insurance benefits for full time employees. PHYSICIANS FACE NEW PROTOCOLS Physicians face new standards for electronic medical records, payment protocols, and the adoption of a universal language that standardizes diagnosis and possible treatment of certain conditions across various insurers. The essential health care benefit package has now been adopted by each state, and assures physicians a minimum expectation of health care coverage in their patient’s benefits package. Medicaid payments will have parity with Medicare payments in states that adopted the expanded Medicaid program. The Medicaid expansion program provided states with additional federal funding to expand their Medicaid programs to cover adults under 65 with income up to 138% of the federal poverty level. This would have provided federally funded health insurance coverage for 235,000 uninsured working individuals in Alabama living near the federal poverty level. However, since Alabama has not expanded Medicaid, this parity in payments between Medicare and Medicaid will not apply in Alabama. HOSPITALS HAVE STABLE INCOME EXPECTATIONS Most hospitals and insurance companies were able to breathe a sigh of relief following the Supreme Court’s ruling. Shares of big health insurance companies spiked upward as the decision offered certainty for companies and their investors after repeated challenges to the law. Publicly traded hospitals have reported rising volumes of inpatient admissions, surgeries, emergency room visits and, ultimately, earnings and revenue since the law’s main provisions took effect last year. Ultimately, knowing what to expect in continued health care coverage and access to health insurance should support increased coverage for individuals and stability for the health care industry. FUTURE OF HEALTH CARE REFORM In order to achieve the goal of every individual in America having access to health insurance, the federal Exchange was created to cover states choosing not to participate in establishing their own Exchange. For Alabama, where no state Exchange exists, the federal Exchange offers businesses and individuals an apples to apples comparison website for finding health care insurance. The high court held that individuals participating in the federal Exchange must have all the rights and responsibilities provided in the Act for state Exchanges. With this pronouncement in the King case, “Publicly traded hospitals have reported rising volumes of inpatient admissions, surgeries, emergency room visits and, ultimately, earnings and revenue since the law’s main provisions took effect last year.” the Supreme Court declared the fundamental four pillars of health insurance reform safe and sound from the collateral legal attacks addressed in the opinion. G “The essential health care benefit package has now been adopted by each state...” 14 Birmingham Bar Association


Birmingham Bar Association Bulletin Winter 2015
To see the actual publication please follow the link above