The Affordable Care Act: 5 Changes Healthcare Organizations Must Know

Recently, the U.S Department of Health and Human Services (HHS) has issued final rules applying some crucial consumer protections from the Affordable Care Act (ACA). The intention of lawmakers and government bureaucrats when drafting the Affordable Care Act legislation was to enrich health care benefits. Under the final rule, all individuals and employers will have the ability to buy health insurance coverage no matter what their health status may be.

Insurers will also be stopped from charging discriminatory rates to people and small employers based on reasons like health status or gender. The HHS is now demanding that most health plans include the following requirements by 2014:

1. Reasonable Health Insurance Premiums
Coverage offered to individuals by health insurance companies will only be allowed to vary their premiums based on age, tobacco use, family size, and geography; to base the premium on factors other than those will be illegal.

2. Availability
Almost all health insurers that offer coverage to individuals and employers will have to sell health insurance policies to all consumers; no one can be deprived of health insurance because of a current or past sickness.

3. Renewability
Under the new rules, health insurers will not be able to refuse to renew coverage due to a person becoming sick. Consumers hold the power to choose to renew coverage.

4. Single Risk Pool
Health insurance companies won’t be able to charge higher premiums to higher cost consumers by placing them into separate risk pools. The insurers will need to have a single statewide risk pool for the individual market and one for the small group market.

5. Catastrophic Plans
Consumers will have the right to a catastrophic plan in the individual market. The plan will typically have lower premiums, protection against high out-of-pocket costs, and include recommended preventive services without cost sharing.

When these ACA requirements go into effect in 2014, expect a substantial increase in patient volume. Whether you view healthcare reform as positive or negative, it could prove beneficial to nurse staffing and other forms of healthcare staffing.

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