The Affordable Care Act's biggest year is, without a doubt, 2014: That's when the federal subsidies to purchase health insurance roll out. It's also when penalties for not buying coverage kick in.
But many of the big changes will start gradually in 2013. They range from increasing payments to Medicaid doctors to upping Medicare taxes to the exchanges' very first open-enrollment period.
1. Health care cost growth will slow to a new low. The United States is expected to spend $2.9 trillion on health care in 2013, according to actuaries at the Center for Medicare and Medicaid Services. That's 3.8 percent more than the $2.8 trillion that CMS estimates we spent in 2012 — and it would be the slowest health care growth rate in decades. It has little to do with the Affordable Care Act, the CMS actuaries explain, and a lot more to do with slow income growth. "Consumers are expected to remain sensitive to rising health costs, particularly given continued low projected income growth," they write. "In this environment, consumers are likely to continue to be judicious in their use of health care services."
2. For some, Medicare taxes will increase. Employers already take out 7.65 percent of workers' wages to support the elderly and disabled. Of that, 1.45 percent goes toward paying Medicare's hospital bills. Obamacare increases the Medicare hospital tax by 0.9 percent, beginning in 2013, for anyone who earns more than $200,000 ($250,000 for joint filers). It also creates a new, 3.8 percent tax on investment income, setting income thresholds at the same $200,000 and $250,000 levels mentioned above. Those two provisions are expected to generate $210.2 billion over the next decade.
3. Your insurance plan will be explained in plain English. Starting in 2013, the Affordable Care Act requires insurance companies to send their subscribers a standardized, four-page summary of benefits and coverage that runs through the health plan in easy-to-understand terms. Think of this as a nutrition label for health insurance.
This requirement actually kicked in a few months ago: Health insurance plans with open enrollment periods after Sept. 23, 2012, were required to offer this information. For anyone buying insurance from a plan with earlier open enrollment, these summaries will show up for the first time in 2013.
4. Primary care providers in Medicaid will get a 73 percent raise. The Congressional Budget Office estimates that Medicaid will gain 7 million new enrollees in 2014, as a result of the health law expanding the program up to 133 percent of the poverty line. The federal government wants to make sure that doctors keep serving that population. That's why the health care law includes a provision that boosts primary care reimbursements in Medicaid to match those of Medicare for 2013 and 2014. On average, that will mean a 73 percent raise for Medicaid doctors, although there's a lot of variation.
5. The Obamacare exchanges will open for business. Jan. 1, 2014, has been cited as the date that states need to be ready for the health reform law. But when you talk to the states actually working to roll out the law, they often talk about Oct. 1, 2013, as a much more significant deadline. That's the day when the health exchanges open for business, when any American can go online, compare plans and, if they want, purchase health insurance. This is true for state-operated health exchanges as well as those being run by the federal government.