Employers are finally focusing on the real impact of the law. Small employers are looking at strategies to avoid the insurance and coverage mandates. Large employers are looking at ways to mitigate costs and shift health care coverage to third parties or off their books in the case of retirees. The private sector is seeing the cost impact of new mandates, so-called insurance reforms and cost shifting from Medicare. Workers who had good health insurance coverage will begin to learn they will not keep what they had and will pay more for what they get.
Health care providers are seeing what new payment models and poorly defined and poorly understood quality measures truly mean and are questioning the veracity of both. New Accountable Care Organizations are defensive strategies by physicians seeking to preserve if not maximize their future income … just as was the case with HMOs decades ago. Their viability in terms of quality and affordability will be tested over the next few years.
Medicare beneficiaries will soon see the impact of lower payments to Medicare Advantage Plans and longer term the impact of more beneficiaries paying higher income based premiums … it’s not just the “wealthy” anymore.
The fact is Obamacare expands coverage for individuals both in the Medicaid and general populations. The ultimate cost will not be known for several years, but there can be no doubt this is one of the major wealth transfer efforts in many years. Think higher premiums, taxes, fees and other assessments for much of the insured population and the health care industry.
This may be acceptable if the result is more affordable care and higher quality care for all Americans. Unfortunately, the minimal efforts in this regard within Obamacare cannot accomplish such goals. In addition, the increased demand for services through expanded coverage and more “free” benefits will further strain the system and add cost pressure.
Finally, the faulty logic regarding insurance company competition (more is not actually better) is causing a shift in negotiating power from insurers to providers. Under our system of fee setting this means higher costs for physician and hospital services both of which are also being squeezed by Medicare payment cuts.
All these consequences will come together gradually, but they are coming … and then serious reform will begin … once again.
I’ve been in this business long enough to remember the battle over Medicare, I was in the battle over Hillarycare; the real battle to change health care in America has yet to come.