Obamacare Expected to Have Little Effect in 2013


It's a new year, and the law known as "Obamacare" will take a few more steps toward full implementation in 2013.

More correctly called the Affordable Care Act, the 3-year-old health care reform law mandates some new changes, but little will be apparent in the Estancia Valley and East Mountains. Steven Hansen, president and CEO of Presbyterian Medical Services, said clinical health care will be largely unaffected in 2013.

"I doubt we'll see any specific changes in any of our facilities this year," Hansen told the Telegraph last week. More obvious changes will be implemented in 2014 when medical coverage becomes more accessible, he said.

Presbyterian operates about 40 clinics statewide, including two in Torrance County: the Family Health Center in Mountainair and the Esperanza Family Medical Center in Estancia.

The term "Obamacare" — originally invoked by Republican politicians to deride the law — has been picked up by the general population and even by President Obama himself.

Hansen noted that Presbyterian clinics accept all patients, regardless of ability to pay, and about 30 percent of people using the clinics today have no insurance. But, as more people get medical coverage, some may choose to go elsewhere, perhaps Albuquerque, for care. Presbyterian has to let people know that it provides high quality care for all patients, Hansen said. If a large number of newly-insured patients should opt to go elsewhere, the result could be a "revenue problem" for Presbyterian, he said.

In 2006, when Massachusetts adopted universal health care coverage under Gov. Mitt Romney, the demand for health services increased while access remained the same. If the same were to occur as the Affordable Care Act is implemented, that could put a strain on the system as well, Hansen said. At present, Torrance County enjoys "a very stable supply of medical providers," he said, "although that's not typical in the country as a whole."

Some of the 2013 Obamacare changes that won't be obvious to everyone include:

An additional tax of 0.9 percent, effective Jan. 1, on annual income above $200,000 from self-employment and wages of single individuals. The threshold amount is $250,000 for a married couple filing jointly (this applies to joint compensation of the two spouses), or $125,000 for a married person filing separately.

An additional Medicare tax of 3.8 percent that will apply to unearned income, specifically the lesser of net investment income or the amount by which adjusted gross income exceeds $200,000 ($250,000 for a married couple filing jointly; $125,000 for a married person filing separately.)

Also beginning Jan. 1, the limit on pre-tax contributions to health care flexible spending accounts has been capped at $2,500 per year.

And, beginning Aug. 1, religious organizations that were given an extra year to implement the contraceptive mandate are no longer exempt. However, certain non-exempt group health plans established and maintained by nonprofit organizations with religious objections to covering contraceptive services may take advantage of a one-year enforcement safe harbor (until the first plan year beginning on or after Aug. 1) by satisfying certain requirements.

The Affordable Care Act was passed by congressional Democrats without a single Republican vote and then signed into law by the president in March 2010. Immediately, the opposition introduced legislation to repeal the bill. A series of lawsuits challenging its constitutionality followed. Last June, the U.S. Supreme Court — to the considerable chagrin of many Republicans — found the law constitutional.

According to a government website, the Affordable Care Act is already making a difference in New Mexico:

As of December 2011, 26,000 young New Mexicans gained insurance coverage as a result of the law.

Since the law was enacted, New Mexico residents on Medicare have saved a total of $23,158,231 on their prescription drugs. In 2010, 20,158 elderly New Mexicans who hit the prescription drug coverage gap known as the "donut hole" received a $250 rebate. In the first nine months of 2012, 11,904 people received a 50 percent discount on their covered brand-name prescription drugs when they hit the donut hole. This discount has resulted in an average savings of $703 per person, and a total savings of $8,368,874 in New Mexico in 2012. By 2020, Obamacare will close the donut hole.

In 2011, 151,948 New Mexicans on Medicare received free preventive services — such as mammograms and colonoscopies — or a free annual wellness visit with their doctor.

Under the new law, 285,000 New Mexicans with private health insurance gained preventive service coverage with no cost-sharing in 2011. For policies renewing after Aug. 1, 2012, women can get coverage — without cost-sharing — of birth control services. Approximately 259,439 women in New Mexico now are guaranteed access to more preventive services without cost-sharing.

For the first time, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. New Mexico has received $4 million under the new law to help fight unreasonable premium increases.

The law bans insurance companies from imposing lifetime dollar limits on health benefits, a provision that frees many patients suffering from cancer and other chronic diseases from worrying about going without treatment. The law also restricts the use of annual limits and bans them completely in 2014.

As of August 2012, 1,256 previously uninsured New Mexicans who were locked out of the coverage system because of a pre-existing condition are now insured.

The state has also received $35,279,483 in grants for research, planning, information technology development, and implementation of Affordable Insurance Exchanges. In addition, Obamacare increases funding available to community health centers. In New Mexico, 15 health centers operate 145 sites, providing health care services for 285,700 people. Health centers in New Mexico have received $72,918,842 under the law to establish new health center sites, expand services, and support capital improvement projects.

For more information, visit www.HealthCare.gov.