This could be the make-or-break year for President Barack Obama's Patient Protection and Affordable Care Act, as hospitals, physicians, insurers, consumers and elected officials wonder whether it will meet its coverage expansion and cost-control goals or fall short of expectations.
This month marks the start of comprehensive health coverage for millions of uninsured, underinsured and insecurely insured Americans, either through subsidized private insurance or expanded Medicaid. Hospitals and physicians are gearing up to serve the newly insured while also facing major regulatory and payment reduction challenges. Insurers will scrutinize the claims experience in their new Obamacare plans to decide this spring where to set premiums for 2015 and try to cope with cuts in Medicare Advantage payments under the ACA. And members of Congress are watching carefully to see how the law plays out for their constituents before the November congressional elections, when Republicans hope to capture control of the Senate and scuttle the healthcare reform law. But for now, GOP leaders are trying to tone down the anti-reform rhetoric and focus on problems in the law's rollout.
Meanwhile, physicians hope 2014 will bring the repeal and replacement of Medicare's widely hated sustainable growth-rate physician payment formula, while hospitals want that legislation to include provisions extending a variety of hospital payment programs.