So can Hospitals get their bills paid now?

One of the areas that many individuals, organizations and political parties fail to recognize is that for years, Emergency Departments have not got their bills paid and the hospitals have had to bear the brunt of unpaid bills and patients fear getting sick or making that trip to Emergency or the doctor. Will the Affordable Care Act solve this dilemma and will the opening of the new Health Insurance Exchanges (not to be confused with the Healthcare Information Exchange) be a turning point for many to be able to get preventative and emergency care covered? This was the hope. While the bill is not perfect and I know that many in the country, who don’t know the details of the ACA think it was a bad idea, I felt it was at least a start to thinking about healthcare in a different way. Many times, I have mentioned in my writing that we needed to think differently and I believe this is the first step towards that. While entitlements are not the answer, something obviously needed to get done to solve our health problems in the United States.

On a recent trip to Hong Kong, I got to understand how far behind we were in terms of change. In talking to a friend of mine who was a doctor there, they thought that the U.S. had an interoperable electronic health record capability for decades and that when they implemented theirs in the early part of the 21st century, that they were following us. It came to her as quite a surprise that we were actually following them.

I would buy stock in for profit healthcare providers if I were you…this might be the start to better financial results for them.

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Stairway to….Ohio’s Health Insurance Exchange

Was watching the Kennedy Center Honors last night. Led Zep was being honored. I realised that I’m old (Heart sang Stairway to Heaven) when bands from when I was in high school were honoring a band when they were in grade school. We’re all going to get old and fast. Probably why I have been asked by my colleagues and friends about the changes in healthcare insurance and the new exchanges that will be coming in to force soon. Many are worried about the changes. Somebody mentioned to me that that they don’t believe that pre-conditions will be overlooked from now on. There are a lot of ambiguities in the way the exchanges will operate. I feel that it comes with any major paradigm shift in thinking.

Change is not the most welcome thing individuals welcome, least of all something that affects their health care. Essentially, the exchanges are new organizations that will be set up to create an organized market for people to purchase health insurance. They are supposed to offer a choice of different health plans, as well as certifying plans that participate in the exchange and provide information to help consumers better understand their health insurance options.

From 2014 onwards, these exchanges will primarily serve individuals looking to buy insurance on their own and small businesses with up to 100 employees, though states can opt to include larger employers in the years to come. States are expected to establish Exchanges or can ask the Federal Government to do it for them and they can be a government agency or a non-profit organization. In addition, states can create more than one exchange, as long as only one serves each geographic area, and can collaborate to build regional exchanges. As it has been reported in the media, on November 16th, 2012, the Governor of Ohio told federal officials that Ohio would have a federally-managed health insurance exchange. The caveat is that the state would keep control over its insurance industry. Governor Kasich additionally indicated that Ohio would maintain control over eligibility for Medicaid.

Before the announcement, the Department of Insurance, working with other agencies solicited assistance for the first year of exchange planning and implementation. Qualified health plans purchased through an exchange in Ohio are prohibited from covering abortions, except in cases of rape, incest, or to avert death of the pregnant woman.

Essential Health Benefits (EHB): The Affordable Care Act (ACA) requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Ohio has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Community Insurance Company (Anthem Blue Cross Blue Shield)- Blue Access PPO. The funding for the exchange started in September of 2010 when the Ohio Department of Insurance received a federal exchange planning grant of one million dollars.

The Federal Government will be responsible for running the health insurance exchange in Ohio beginning in 2014. Ohio must submit a blue print of plan management functions if it wants to take over responsibility the exchange to the Department of Health and Human Services by the 15th of February, 2013. Additionally, much of the above information is available through the Kaiser Foundation website. A great source of information for everyone.