How is Obamacare implementation going?

Dr. Victor A. Puleo, Jr., CFP®, CICHealth care reform -- now almost universally called Obamacare -- kicks into high gear in October, when millions of consumers begin shopping for health insurance on new state and federal exchanges.

But the law has been reshaping the health care landscape for several years now. What grade does Obamacare deserve to date?

"B-minus," says Victor Puleo, associate professor of insurance and risk management at the University of Central Arkansas in Conway.

Puleo admits the grade may be a "little harsh." In fact, he sings the praises of many of reform's biggest accomplishments. In the following interview, Puleo explains what has gone right -- and wrong -- with health insurance reform.

Grade the Obamacare rollout up to this point. Where is it succeeding? Where has it fallen short?

I would give Obamacare a B-minus on its rollout to this point. And that's probably being a little harsh.

There are quite a few success stories for consumers with the implementation of health care reform. To date:

  • Lifetime limits on benefits have been eliminated.
  • All group and individual plans had to begin covering dependents to age 26.
  • Pre-existing conditions for children under 19 have been eliminated.
  • First-dollar coverage for specific preventative health care services have been mandated.
  • Fully insured plans are subject to medical loss ratio requirements providing health insurance premium rebates to both employers and employees, and those covered by individual plans.

Beginning in 2014, we will see the removal of all annual limits on essential health benefits, guarantee issue and elimination of pre-existing condition limitations for adults, a maximum 90-day waiting period on all plans, and premium tax credits for individuals and families with household incomes between 100 (percent and) 400 percent of the federal poverty level ( FPL) to purchase individual coverage through online insurance marketplaces/exchanges.

That's quite a few successes for such a controversial law.

However, there are at least a couple of places where Obamacare has fallen short. The one-year postponement in the shared responsibility penalties (employer mandate) is most definitely a shortfall, as is the delay until 2015 in annual limits on out-of-pocket maximums for some employer-sponsored health insurance plans.

The Obama administration's flexibility in implementing the law and postponing these two parts of health care reform alone has created unexpected challenges for consumers -- and for some employers, new opportunities to rethink health insurance strategies for 2015.

2014 is the year that Obamacare finally gets into full swing. What do you think will be the biggest challenges facing consumers, employers and insurers over the next 12 months?

Consumers with incomes up to 400 percent of the federal poverty level that currently do not have affordable health insurance offered through an employer will be eligible for premium tax credits to purchase health insurance on the health insurance marketplaces/exchanges.

Additionally, consumers with low-end household income -- 100 percent (to) 250 percent of FPL -- may be eligible for reduced cost sharing (deductibles, coinsurance and copayments) if they obtain coverage through the health insurance marketplaces/exchanges. Health insurance plans sold both on the exchanges and off the exchanges will not be able to turn people down or charge them more because of a pre-existing medical condition.


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