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Affordable Care Act Facts

  • Estimated 32 million new enrollees
  • Accountable Care Organizations (ACOs) – services all in-house with fiscal and performance targets.  Federal financial incentives if goals met.
  • Coverage cannot be denied for pre-existing conditions.
  • Employers with > 50 full-time employees must provide health insurance.
  • Wellness model – no copays for annual health appraisals and immunizations.
  • Organizations will be incentivized or penialized based on patient outcomes.
  • Institutions will not receive any reimbursements for preventative readmissions or any acquired disease/condition during hospital stay (e.g., nosocomial pneumonia).
  • Parents may keep children on plans until the age of 26.
  • Consumers can expect higher wait times for preventative and speciality care services.
  • More stringent utilization review practices for high cost procedures such as MRIs, CTs, non-life threatening surgeries.
  • Health care exchanges offer private insurance policies to consumers if they are not covered by employers.
  • Resources:  Kaiser Family Foundation, www.medicare.gov
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