October has only just begun, but fears about healthcare reform are multiplying like swooning teens at a vampire flick. The Patient Protection and Affordable Care Act is freighted with anxiety-inducing provisions that are eliciting angst in all quarters. No one, it seems, is spared: not providers, not health plan executives, not employers, and not the public.
At a public meeting in Baltimore Tuesday, officials from the Centers for Medicare & Medicaid Services and the Federal Trade Commission tried to quell the concerns of health insurance executives and healthcare providers over accountable care organizations. Doctors and hospitals worry that by forming partnerships to deliver coordinated quality care to a select group of patients for set fees, they could potentially violate antitrust and anti-fraud laws. Federal officials tried to reassure them:
"From an antitrust perspective, we want to explore whether we can develop safe harbors so doctors, hospitals, and other medical professionals know when they can collaborate and when they cannot," FTC Chairman Jon Leibowitz said in opening remarks at Tuesday's FTC/CMS Workshop on ACOs.
Providers aren't alone in their apprehension. Health plan executives fear that ACOs will only push costs higher. And since no single, agreed upon ACO payment structure yet exists, they may be right.
Here's another provision of the reform law that's sending chills down the spines of employers. It's the so-called medical loss ratio (MLR). Insurers with large group coverage plans are required to spend at least 85% of premiums on medical costs, and at least 80% of premiums for individual and small group plans starting in 2011. If insurers fall short, they will be required to give customers a rebate for the difference starting in 2012.
McDonald's—like some other employers with large numbers of low-wage employees—offers a "limited-benefit" or "mini-med" health plan. Last week McDonald's made headlines for saying that it might cut health insurance to its 30,000 employees. According to the Wall Street Journal, a McDonald's memo to federal regulators said "it would be economically prohibitive for our carrier to continue offering" the mini-med plan unless it got an exemption.
Health and Human Services, stuck between a rock (enforcing the medical loss ratio provision) and a hard place (seeing tens of thousands lose their health insurance, however meager) granted the exemption.
Political agendas aside, the most bone-chilling aspects of the healthcare reform law are the ones that can't be easily pinned down, understood, and applied. Like the lurking possibility of antitrust violations and the MLR, they are ill-defined specters threatening to drain coffers and make zombies out of leaders.