What is the Patient Protection and Affordable Care Act?

What is the Patient Protection and Affordable Care Act? In reality, it is many things for many people. It contains some health insurance guarantees for uninsured individuals, some penalties for people who don’t obtain health insurance as mandated, some taxes assessed upon wealthy individuals upon their investment income and the sale of their homes, some compliance mandates for nursing homes, some reductions in payments for Medicare providers, i.e., hospitals, physicians and others, and some support for new health care systems called Accountable Care Organizations. How will it affect you? It depends. Who are you?

Are you a wealthy individual? If so, you will be taxed upon your “net investment income” as defined by the act as a surtax. The irony is that the individuals paying this tax will derive no direct benefit from the insurance exchanges or other provisions of the Act. There is also a tax upon the sale of real property exceeding certain levels. These taxes necessitate consultation with your tax consultant to see what’s in and what’s out.

Are you indigent as the welfare code defines, or merely functionally indigent but not yet qualified? The Affordable Care Act is still in its infancy in terms of regulatory implementation and the structure of the federal subsidies for low income families via exchanges.

Are you simply uninsured without availability through an employer sponsored health care plan, Medicare or Medicaid? You have the option of obtaining insurance or paying a penalty, a tax, which the Supreme Court June 28, 2012. Many individuals might elect to pay the tax rather than obtain most costly insurance. A side effect of the Supreme Court decision characterizing the penalty as a tax would be to limit the government’s ability to raise the tax beyond what is reasonable.

Are you a physician or a hospital or a nursing home? Your reimbursement from government sources is likely to decline. Understanding how the newer systems will integrate with your practice or system is vital to survival. It is estimated that reimbursement will decline by 15% and that a number of organizations will be consolidated. Planning is essential in this environment.

Are you a nursing home? By March of this year, you are obligated to have effected a compliance program as dictated by the PPACA. And these are the readily evident problems arising. More are on the horizon as the regulators begin issuing the regulations implementing the Act.