Health Care Reform Simplified: What Professionals in Medicine, Government, Insurance, and Business Need to Know

Overview

Health Care Reform Simplified: What Professionals in Medicine, Government, Insurance, and Business Need to Know describes the Patient Protection and Affordable Care Act of 2010. Now that the U.S. Supreme Court has upheld the individual mandate and other key parts of the law—what must busy healthcare professionals, insurance industry professionals, business and HR managers, and policymakers do?

First, read this book. It translates the law’s complex language into terms that are ...

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Health Care Reform Simplified: What Professionals in Medicine, Government, Insurance, and Business Need to Know

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Overview

Health Care Reform Simplified: What Professionals in Medicine, Government, Insurance, and Business Need to Know describes the Patient Protection and Affordable Care Act of 2010. Now that the U.S. Supreme Court has upheld the individual mandate and other key parts of the law—what must busy healthcare professionals, insurance industry professionals, business and HR managers, and policymakers do?

First, read this book. It translates the law’s complex language into terms that are easy to understand, explaining what the new law does, when its provisions take effect, and how to implement it. This brand-new second edition also updates all the provisions and explains the myriad ways the ACA is already being put into practice.

Health Care Reform Simplified, Second Edition, outlines the financial impact of the law and how it affects businesses, insurers, hospitals and doctors, and state and local governments. Most important, this book gives consumers and employers critical information for making informed choices about new options for private and public health insurance coverage. It also describes how the law interacts with Medicare and Medicaid. Finally, it looks at the potential roadblocks—political, judicial, and economic—that may yet derail some of the provisions. But with more than half of the Act's provisions in force already, and the Supreme Court's landmark decision upholding the law, there is no time to lose in understanding how the legislation affects you whether you are a consumer or deliverer of health care in the U.S. This book:

  • Explains health reform in easy-to-understand terms
  • Shows how the law is playing out in the real world
  • Explains the ways the law or parts of it yet may be repealed by the 2012 election and the implications for readers
  • Provides HR professionals and managers options for covering employees while explaining costs and benefits
  • Details the impact on medical professionals and insurers and steps they must take now to comply with the law
  • Shows policymakers the way forward now that legal challenges have abated

This edition, completely updated to incorporate the newest regulations and the practices that have been put into place in various states, will prove an indispensable guide for those implementing the law, as well as those receiving health care, in the coming years.

What you’ll learn

  • The provisions of the health care law, updated to take into account new regulatory guidelines, as well as models and processes developed at the state level.
  • Options for families and individuals, and how to decide whether to keep existing insurance, switch to a different plan, or get new coverage at an exchange or co-op
  • New government subsidies and tax breaks for health care, and who qualifies for them
  • What government agencies, insurers, and healthcare providers must do to comply with the law
  • Options for businesses, and how employers can decide whether to keep existing plans, purchase plans through exchanges, or provide vouchers to employees
  • The impact of health care reform on hospitals, doctors, insurers, and patient care
  • The potential for a new Congress with a new President to repeal provisions of the law


Who this book is for

Health Care Reform Simplified: What Professionals in Medicine, Government, Insurance, and Business Need to Know is an excellent resource for managers who make decisions about insurance coverage for employees, healthcare professionals and those working in the insurance industry who must understand and comply with the law's provisions, and policymakers who must implement the law at the state and local level. Individuals wondering about such things as the "individual mandate" will also find the book a useful overview of the changes that have occurred and those yet to come.

Table of Contents

Introduction (4 pages)

A quick look at the American health care system, the most expensive medical system on earth, and what’s wrong with it.

Chapter 1. History of Health Care in the U.S. (20 pages)

· A quick history of health care insurance.

· America’s breathtaking rise of medical care costs.

· Growth of Medicare and Medicaid.

· Political primer on health care reform.

· Passage of the Patient Protection and Affordable Care Act and continuing political and judicial threats (more in Chapter 11)

· Supreme Court Decision on the ACA (more in Chapter 11)

· Health care reform summary, schedule.

Chapter 2. Early Changes (16 pages)

· Temporary exchanges.

· New insurance guarantees for children.

· Young adults get extension on parents’ policies.

· Insurance rate reviews.

· Bans on cutting and capping coverage.

· Filling Medicare’s donut hole.

· “Sin tax” on tanning services.

· Tax breaks for small businesses.

Chapter 3. New Personal Insurance Options (20 pages)

· Grandfathered policies.

· Insurance exchanges.

· Individual mandate.

· Pre-existing conditions.

· Rights to appeal, choose doctor and preventive care.

· Tax credits.

Chapter 4. Insurance Options for Businesses (20 pages)

· Early tax credits for small businesses.

· Requirements for coverage and penalties.

· Small business insurance exchanges.

· Early retirees.

Chapter 5. Changes in Insurance Market Rules, Regulations (18 pages)

· Medical loss ratios.

· Guaranteed coverage.

· Limits on rate variations.

· Minimum coverage, preventive care.

· Insurance co-ops.

· Accountable Care Organizations.

Chapter 6. Changes to Medical Practices (18 pages)

· Medical errors.

· Hospital readmission rates.

· Medical homes.

· Accountable Care Organizations.

· Doctor shortages.

· Evidence based practice.

· Safety net hospitals.

· Financial disclosure rules for doctors.

Chapter 7. Medicare Outlook (10 pages.)

· Where Medicare stands and how it works.

· Medicare savings estimates.

· Quality controls

· Cost cutting

· Medicare Advantage plans.

· Long-term projections for Medicare.

· Medicare reform proposals.

Chapter 8. Medicaid Outlook (10 pages)

· Where Medicaid stands and how it works.

· Supreme Court ruling.

· Planned Medicaid expansion.

· State-by-state impact.

· Long term care.

· Medicaid waivers for co-pays and other experiments.

Chapter 9. Communicating Changes to the Public (10 pages)

· Misconceptions.

· Health literacy.

· Provisions for bridging communication gaps.

· New sources of information.

· Nutritional labels.

Chapter 10. The Cost and Who Pays (10 pages)

· Medicare tax increase.

· Cadillac insurance tax.

· Private insurance tax.

· Pharmaceutical company tax.

· Medical device tax.

· Other revenue sources.

Chapter 11. Efforts to Repeal Reform (10 pages)

· Supreme Court ruling and individual mandate.

· Continuing lawsuits.

· Republican efforts at repeal and replacement.

· Health care under Ryan budget.

· States oppose and implement reforms at the same time.

· Future of health care reform.

Bibliography

Index

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Product Details

  • ISBN-13: 9781430248965
  • Publisher: Apress
  • Publication date: 9/26/2012
  • Edition description: 2nd ed. 2012
  • Edition number: 2
  • Pages: 196
  • Sales rank: 1,434,283
  • Product dimensions: 5.90 (w) x 9.00 (h) x 0.60 (d)

Meet the Author

Dave Parks has more than 25 years of experience as a journalist and has earned numerous awards for his coverage of some of the most important medical issues of our time. His investigative reporting about health problems found but ignored in veterans of the 1991 Persian Gulf War led to a White House investigation, Congressional hearings and changes in how the military medically screens troops before and after battle. He has written in-depth, groundbreaking stories about cancer survivorship, health disparities, cervical cancer prevention and liver transplantation. He has worked as an editor and writer in the Midwest and Southeast and traveled to some of the deepest reaches of Africa to cover the AIDS pandemic. He is a member of the Association of Health Care Journalists and American Medical Writers Association.
Read More Show Less

Table of Contents

Introduction (4 pages)

A quick look at the American health care system, the most expensive medical system on earth, and what's wrong with it.

Chapter 1. History of Health Care in the U.S. (20 pages)

· A quick history of health care insurance.

· America's breathtaking rise of medical care costs.

· Growth of Medicare and Medicaid.

· Political primer on health care reform.

· Passage of the Patient Protection and Affordable Care Act and continuing political and judicial threats (more in Chapter 11)

· Supreme Court Decision on the ACA (more in Chapter 11)

· Health care reform summary, schedule.

Chapter 2. Early Changes (16 pages)

· Temporary exchanges.

· New insurance guarantees for children.

· Young adults get extension on parents' policies.

· Insurance rate reviews.

· Bans on cutting and capping coverage.

· Filling Medicare's donut hole.

· “Sin tax” on tanning services.

· Tax breaks for small businesses.

Chapter 3. New Personal Insurance Options (20 pages)

· Grandfathered policies.

· Insurance exchanges.

· Individual mandate.

· Pre-existing conditions.

· Rights to appeal, choose doctor and preventive care.

· Tax credits.

Chapter 4. Insurance Options for Businesses (20 pages)

· Early tax credits for small businesses.

· Requirements for coverage and penalties.

· Small business insurance exchanges.

· Early retirees.

Chapter 5. Changes in Insurance Market Rules, Regulations (18 pages)

· Medical loss ratios.

· Guaranteed coverage.

· Limits on rate variations.

· Minimum coverage, preventive care.

· Insurance co-ops.

· Accountable Care Organizations.

Chapter 6. Changes to Medical Practices (18 pages)

· Medical errors.

· Hospital readmission rates.

· Medical homes.

· Accountable Care Organizations.

· Doctor shortages.

· Evidence based practice.

· Safety net hospitals.

· Financial disclosure rules for doctors.

Chapter 7. Medicare Outlook (10 pages.)

· Where Medicare stands and how it works.

· Medicare savings estimates.

· Quality controls

· Cost cutting

· Medicare Advantage plans.

· Long-term projections for Medicare.

· Medicare reform proposals.

Chapter 8. Medicaid Outlook (10 pages)

· Where Medicaid stands and how it works.

· Supreme Court ruling.

· Planned Medicaid expansion.

· State-by-state impact.

· Long term care.

· Medicaid waivers for co-pays and other experiments.

Chapter 9. Communicating Changes to the Public (10 pages)

· Misconceptions.

· Health literacy.

· Provisions for bridging communication gaps.

· New sources of information.

· Nutritional labels.

Chapter 10. The Cost and Who Pays (10 pages)

· Medicare tax increase.

· Cadillac insurance tax.

· Private insurance tax.

· Pharmaceutical company tax.

· Medical device tax.

· Other revenue sources.

Chapter 11. Efforts to Repeal Reform (10 pages)

· Supreme Court ruling and individual mandate.

· Continuing lawsuits.

· Republican efforts at repeal and replacement.

· Health care under Ryan budget.

· States oppose and implement reforms at the same time.

· Future of health care reform.

Bibliography

Index

Read More Show Less

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