As ObamaCare enters its fifth year, there are still major components of the law to be worked out for the first time.
Both the individual mandate and the employer mandate – which are considered vital pillars of the president’s landmark healthcare law – will confront new challenges in 2015. Doctors and hospitals will also face new penalties for failing to comply with federal rules such as those requiring the use of e-records.
The stakes are high in 2015. The administration will be hoping that ObamaCare regains ground after a muddy patch over the last few weeks that included controversies around the administration’s famously blunt former adviser Jonathan Gruber, an inflated enrollment tally and a new legal threat to the law’s subsidies.
Employer mandate goes into effect
After years of delays, businesses with at least 100 employees will be forced to offer insurance for the first time in 2015.
Business groups have lobbied hard against the controversial rule, which they have called a major headache that will force layoffs and less hours for workers.
The GOP-led House has voted numerous times to delay – and ultimately repeal – the employer mandate. The Senate’s incoming Republican leadership has also floated the same approach as part of its battle plan in 2015.
Fines levied for individual mandate
Most Americans have been required to have health insurance since January 2014, but the financial penalties for those who ignored the mandate will only go into effect during tax season this spring.
Each person without insurance will pay $95 or 1 percent of their income, whichever is higher.
The mandate is a crucial part of ObamaCare, meant to push people of all ages and health conditions to seek coverage – and balance the influx of older and sicker people who were expected to flood the marketplaces with younger, healthier counterparts.
Implementing the new fines next year will require full attention from the Internal Revenue Service. It will likely be a major challenge for the already cash-strapped agency that is dealing with sharp budget cuts and new responsibilities such as the employer mandate.
Primary care doctors face pay cut
Family doctors who treat Medicaid patients will see steep drops in payments from the federal government that could make it tougher for millions of low-income people to find care.
Reimbursements from Medicaid will shrink an average of 43 percent starting in January, when the federal government’s temporary raise for primary care doctors is set to expire.
The federal government had raised its reimbursement rates to entice more doctors to accept Medicaid patients under ObamaCare. Patients with Medicaid have been historically known to cost healthcare providers far more than they are repaid for the treatment, causing some doctors to turn away patients.
Medicaid has added 10 million people to its rolls under ObamaCare, reaching a total of 63 million enrollees this year. While Congress decided not to make the hikes permanent, at least 15 states will keep at least a portion of the new payment rates to help Medicaid patients.
Medicare doctors fined for not using e-records
More than 270,000 doctors and 200 hospitals nationwide will see funding cuts from Medicare next year for failing to meet new government requirements for electronic medical records.
The Obama administration has sought to encourage “meaningful use” of e-records and e-prescribing systems to make healthcare providers more efficient and cut down on communication errors that can harm patients.
But the effort has come under fire from some providers who say patients are harmed by the cuts to their reimbursement rates. The cuts will increase to 3 percent within three years.
Electronic medical records have been increasingly adopted by healthcare providers across the country, though the steep investment costs – about $165,000 for an average five-person practice in the first year – continue to be a burden.
CHIP funding set to expire
A 27-year program that has helped millions of children gain insurance is set to end next year without new steps from Congress.
Under ObamaCare, the Children’s Health Insurance Program, or CHIP, is reauthorized until 2019 but only funded through September of next year.
The program provides coverage to about 8 million children annually and has been praised by lawmakers of both parties.
Still, members of Congress have failed to take steps to fund the program despite urgent pleas from governors who say they need to know immediately whether the program will end.
While some of the children currently enrolled could now find other options under ObamaCare, the program’s coverage tends to be more generous with deductibles and copays, as well as wider doctor networks, than cheaper plans on the exchanges.