An Internist’s Practical Guide to Understanding Health System Reform
This Guide is intended to serve as a practical resource for internists on health system reform legislation, the Patient Protection and Affordable Care Act (ACA), enacted in March 2010. The Guide is organized by the year in which a policy issue is to be implemented, making it easily apparent which new policies may be impacting physicians/patients immediately. Simply click on the policy provision of interest, in any given year, and one will find a summary of that provision of law, in an easy “frequently-asked-questions” format. Additional resources and information on each topic are also included in each summary.
*Updated September 2011.
Table of Contents
I. Introduction
- Summary of Key Health System Reforms Affecting Patients and Key Provisions of Health System Reform Affecting Internists
- How is the Patient Protection and Affordable Care Act (ACA) Funded?
II. 2010 Reforms
- Small Business Tax Credit - 2010
- New Requirements for Health Insurers - 2010
- Coverage for Dependents up to Age 26
- Temporary High-Risk Pools
- Pre-existing Conditions Exclusions Banned for Children
- Restricting Annual or Lifetime Dollar Limits on Coverage
- Prohibiting Coverage Rescissions
- Justifying Premium Increases
- Covering Core Preventive Services
- Option for Early Medicaid Coverage Expansion
- Rebates through Medicare’s Prescription Drug Program
- National Health Care Workforce Commission
- Teaching Health Centers
- Loan and Scholarship Programs under Title VII
- Changes to Primary Care Training Programs - Title VII, Section 747
- Time Spent By Residents in Non-hospital Settings
- State Loan Repayment Tax Exclusion
- Comparative Effectiveness Research
- Center for Medicare & Medicaid Innovation
- Community Health Teams to Support the Patient Centered Medical Home
- Identifying and Correcting Mis-Valued Services Paid Under the Medicare Physician Fee Schedule
- Technical Component Discounts for Advanced Imaging Services
- Medical Liability Reform – Free Clinics and Medical Liability Immunity
III. 2011 Reforms
- Prescription Drug Discounts and Medicare
- Refunds for Excessive Health Insurance Premiums
- National Health Service Corps
- Redistribution of Graduate Medical Education Slots
- Primary Care Extension Programs
- Medicare Bonus Payment for Primary Care Services
- Medicaid Health Homes for Enrollees with Chronic Conditions
- Medicare-Covered Preventive Services
- Medicare Pay-for-Reporting Program
- Community-Based Collaborative Care Networks Grant Program
- Advanced Imaging Service Assumed Equipment Use Rate
- Medical Liability Reform – Demonstration Grants
IV. 2012 Reforms
- Quality Reporting Requirements for Group and Individual Insurers
- Medicare Shared Savings (Accountable Care) Program
- Simplifying Administrative Requirements the Health Care System Imposes on Physicians - 2012
V. 2013 Reforms
- Enhanced Medicaid Reimbursement Rates for Primary Care Services
- National Pilot Program on Payment Bundling
- Prescription Drug Discounts and Medicare - 2013
- Simplifying Administrative Requirements the Health Care System Imposes on Physicians - 2013
VI. 2014 Reforms
- Health Insurance Exchanges
- Health Insurance Tax Credits for Individuals and Families
- Small Business Tax Credits - 2014
- Medicaid Coverage Expansion
- New Requirements for Health Insurers - 2014
- Guaranteed Issue and Renewability
- Premiums Cannot be Based on Enrollee Health Status
- Universal Prohibition on Pre-Existing Condition Exclusions
- Universal Prohibition on Annual Dollar Limits on Coverage
- Eliminate Coverage Waiting Periods
- Essential Benefits Package
- Tax Penalties for Individuals Who Do Not Purchase Coverage
- Employer-Based Wellness Programs
- Income-Based Repayment for Student Loans
- Independent Payment Advisory Board
- Simplifying Administrative Requirements the Health Care System Imposes on Physicians - 2014
VII. 2015 Reforms and Beyond
- Payment Penalties under Medicare’s Pay-for-Reporting Program
- Simplifying Administrative Requirements the Health Care System Imposes on Physicians - 2016
VIII. Conclusion
Policy Highlights
- Strengthening the Public Health Infrastructure (April 2012)
- Reforming Medicare in the Age of Deficit Reduction (April 2012)
- The Role of Performance Assessment in a Reformed Health Care System (November 2011)
Public Policy References
ACP Policy Compendium 2011
A summary of ACP's public policy positions.
Public Policy Virtual Library
The Public Policy Virtual Library (PPVL) is a repository of ACP's current and historic policies.
ACP Services, Inc.
ACP Services is committed to providing additional advocacy efforts on behalf of internists.
