By Sam Baker - 12/28/12 11:00 AM EST
2013 will be a big year for President Obama's signature healthcare law.
By next New Year's, almost all of the law's major provisions are scheduled to be fully in effect. And that means 2013 will represent a mad dash to get ready — both in the states and in the Health and Human Services Department.
And though congressional Republicans have largely acknowledged they won’t be able to fully repeal the Affordable Care Act, they’re focusing on intense oversight and hoping for targeted repeal votes on a handful of specific provisions, some of which have garnered bipartisan support.
Here are five important provisions to keep an eye on in 2013:
There's supposed to be an exchange up and running in every state by Jan. 1, 2014, so 2013 is crunch time for implementing the centerpiece of the Affordable Care Act. The healthcare law envisions each state setting up its own exchange, but Republican governors have taken a hard line against implementing any part of "ObamaCare," meaning the federal government will have to handle the task itself in at least 20 states.
Officials from the Health and Human Services Department say they'll be ready, but it's a massive undertaking. First, HHS has to build a data hub to serve all 50 state exchanges, processing applications, determining eligibility and administering tax subsidies available to those who will buy coverage through an exchange. The Obama administration also has to fend off a lawsuit challenging the scope of those subsidies.
If Congress tries to tackle comprehensive tax reform next year, the device tax is sure to at least be mentioned. Beginning in 2013, medical-device manufacturers will begin paying an excise tax designed to raise about $20 billion over the next decade to help pay for the healthcare law's new benefits.
Although some investment analysts say the impact could be relatively modest, the industry insists the tax will hamper innovation and ultimately undermine patient care. There's bipartisan support for repealing the tax — pro-repeal Democrats include Sen. Al Franken (D-Minn.) and Sen.-elect Elizabeth Warren (D-Mass.).
Also beginning on Jan. 1 will be an increase in Medicare taxes. The Medicare trust fund is kept afloat through a dedicated tax, clearly identified on taxpayers' pay stubs. For families who make more than $250,000 per year (or individuals who make more than $200,000), that tax is about to go up — from 1.45 percent to 2.35 percent. Republicans have cited this increase in opposing higher income tax rates for the wealthy, arguing that "ObamaCare" has already raised taxes above the $250,000 threshold Obama has targeted in "fiscal cliff" talks.
Contraception mandate/preventive services
The Affordable Care Act's contraception mandate started off a big political liability for the White House, but it became an outsized point of pride for Obama on the campaign trail. Jan. 1 will be the first time most people will take advantage of the new rules, which require employers and insurance companies to cover a certain set of preventive services without charging a co-pay or deductible.
Although the list of covered services is long, the most attention has been focused on the contraception mandate, and on religious employers' objections to providing a service they believe is immoral. But after all the wrangling, beginning in 2013, women who don't work for churches or houses of worship will start getting contraception without any cost-sharing, while lawsuits over the policy continue to wind their way through the courts.
Pay raise for Medicaid doctors
Beginning Jan. 1, doctors who accept Medicaid patients will get a very major raise. The Affordable Care Act brings Medicaid payments in every state up to the same level that Medicare pays, even as some health policy experts say Medicare already pays too little, Medicaid even less. Primary care doctors will see about a 73 percent pay bump thanks to the higher payments, according to the Kaiser Family Foundation. (That’s a national average — the discrepancies vary widely from state to state.)
Some members of Congress have floated the idea of scaling back the higher Medicaid payments to finance a short-term “doc fix” for Medicare. The idea was deeply unpopular with liberal Democrats, who have said Medicaid is even more important than Medicare in fiscal-cliff talks. But it’s another pot of money in a law that Republicans will keep trying to chip away at, however and whenever they can.