Skip to main content

2013: How health care will affect you

By Aaron E. Carroll, Special to CNN
updated 8:56 AM EST, Fri December 28, 2012
In 2013, expect a lot of preparations for the Affordable Care Act to kick into effect the following year, says Aaron Carroll.
In 2013, expect a lot of preparations for the Affordable Care Act to kick into effect the following year, says Aaron Carroll.
STORY HIGHLIGHTS
  • Aaron Carroll: Next year will be in preparation for 2014 when Affordable Care Act kicks in
  • Carroll: Most states will probably commit to participating in the Medicaid expansion
  • He says forming health insurance exchanges will take a lot of work to get ready
  • Carroll: Expect the costs of health care to continue getting a lot of attention

Editor's note: Dr. Aaron E. Carroll is an associate professor of pediatrics at the Indiana University School of Medicine and the director of the university's Center for Health Policy and Professionalism Research. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.

(CNN) -- There's a lot that will happen in 2013 with respect to health care, but the truth of the matter is that most of it will be in preparation for 2014. That's the year the Affordable Care Act really kicks into effect. Here are my guesses for what to watch in 2013:

1. The Medicaid expansion

Much of this year's election was fought over whether Medicaid should be cut. Now the big decision is how much Medicaid will be expanded. About half of the uninsured who hope for coverage under the Affordable Care Act will do so under Medicaid, an estimated 16 million to 17 million people. But June's Supreme Court ruling made the expansion optional, and states get to decide if they will participate. At last count, 17 states have said yes, and nine have said no. The rest will need to commit in 2013. My guess is that most will. The Obama administration has decided to play hardball, and leaving that money on the table will be met with screams by the uninsured and providers alike.

2. Medicaid provider payments

Aaron Carroll
Aaron Carroll
Become a fan of CNNOpinion
Stay up to date on the latest opinion, analysis and conversations through social media. Join us at Facebook/CNNOpinion and follow us @CNNOpinion on Twitter. We welcome your ideas and comments.



These are going up. Way up. Part of the Affordable Care Act makes Medicaid payments to physicians look more like Medicare payments. There is such a difference that many physicians will see fees for primary care services go up by 73%. Physicians will be thrilled. Those who think Medicaid costs too much already will not.

3. The health insurance exchanges

In 2014, the other half of the uninsured will need to go to the health insurance exchanges to get their insurance. These are tightly regulated marketplaces where individuals will be able to get community-rated insurance and can't be turned down even if they have chronic conditions. People who make between 133% and 400% of the federal poverty line will get subsidies in the form of tax credits to help defer the cost.

Seniors warn Congress: Hands off
Hobby Lobby takes on Obamacare
Obamacare: What's next?

But many states are choosing not to form local exchanges, leaving it to the federal government. For those states that opt for exchanges, there's a ton of work to do next year to get them ready to go. The federal government will be responsible for all the states that are opting out, and it has even more work to do. Expect a lot of news on their development. October 1, 2013, is the date they're all supposed to go live.

4. Medicare taxes

Taxes are going up. Right now, employees pay a tax of 1.45% for Medicare (employers pay an equal amount). Starting next year, for couples making more than $250,000 that tax will go up by 0.9% on income above the threshold. Additionally, investment income will also be taxed at 3.8% for people above the threshold. This is the first time that unearned income will be subject to a Medicare tax.

5. Medicare reform

This got a lot of attention in the election, and in the first few rounds of fiscal cliff negotiations. Talk of raising the eligibility age is dead for now, and discussions of turning Medicare into a voucher program are in the dustbin of history as well. I don't think that any huge changes will happen on this front, short of those already put in place by the Affordable Care Act and quietly re-embraced by Republicans post-election. The Obama administration has proposed some new cuts, but almost none of those will affect 2013.

6. Insurance transparency

A small but important benefit of the Affordable Care Act will start in 2013. From now on, insurance companies are mandated to describe all plans in easy-to-understand English in a standardized format. Here's a sample (PDF). This will make things easier for many people, although insurance policies will still be hard to understand.

7. Health care spending

Although many believe that health care costs will rise more slowly in 2013, at about 3.8%, we will still be spending $2.9 trillion. That's a lot of money. As we continue to fight over the budget deficit and the debt, expect the costs of health care to continue getting a lot of attention.

That should account for most of the excitement next year. Whether I'm right or wrong, we'll be covering it here on CNN.com.

Follow us on Twitter @CNNOpinion.

Join us on Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Aaron E. Carroll.

ADVERTISEMENT
Part of complete coverage on
updated 12:42 PM EDT, Wed April 16, 2014
Rick McGahey says Rep. Paul Ryan is signaling his presidential ambitions by appealing to hard core Republican values
updated 11:39 AM EDT, Wed April 16, 2014
Paul Saffo says current Google Glasses are doomed to become eBay collectibles, but they are only the leading edge of a surge in wearable tech that will change our lives
updated 2:49 PM EDT, Tue April 15, 2014
Kathleen Blee says the KKK and white power or neo-Nazi groups give haters the purpose and urgency to use violence.
updated 7:56 AM EDT, Wed April 16, 2014
Sen. Sheldon Whitehouse and Rep. Henry Waxman say read deep, and you'll see the federal Keystone pipeline report spells out the pipeline is bad news
updated 7:53 AM EDT, Wed April 16, 2014
Frida Ghitis says President Obama needs to stop making empty threats against Russia and consider other options
updated 5:29 PM EDT, Tue April 15, 2014
Peter Bergen and David Sterman say the Kansas Jewish Center killings are part of a string of lethal violence in the U.S. that outstrips al Qaeda-influenced attacks. Why don't we pay more attention?
updated 12:41 PM EDT, Tue April 15, 2014
Danny Cevallos says families of the passengers on Malaysian Airlines Flight 370 need legal counsel
updated 11:23 AM EDT, Mon April 14, 2014
David Frum says Russia is on a rampage of mischief while Western leaders and Western alliances charged with keeping the peace hem and haw
updated 7:56 AM EDT, Mon April 14, 2014
Most adults make the mistakes of hitting the snooze button and of checking emails first thing in the morning, writes Mel Robbins
updated 1:54 PM EDT, Mon April 14, 2014
David Wheeler says as middle-class careers continue to disappear, we need a monthly cash payment to everyone
updated 7:55 AM EDT, Mon April 14, 2014
Democrats need to show more political spine when it comes to the issue of taxes.
updated 11:55 AM EDT, Mon April 14, 2014
Donna Brazile recalls the 50th Anniversary of the Civil Rights Act as four presidents honored the heroes of the movement and Lyndon Johnson, who signed the law
updated 9:17 AM EDT, Mon April 14, 2014
Elmer Smith remembers Chuck Stone, the legendary journalist from Philadelphia who was known as a thorn in the side of police and an advocate for the little guy
updated 2:56 PM EDT, Sun April 13, 2014
Al Franken says Comcast, the nation's largest cable provider, wants to acquire Time Warner Cable, the nation's second-largest cable provider. Should we be concerned?
updated 11:22 AM EDT, Fri April 11, 2014
Philip Cook and Kristin Goss says the Pennsylvania stabbing attack, which caused grave injury -- but not death, carries a lesson on guns for policymakers
updated 3:06 PM EDT, Fri April 11, 2014
Wikipedia lists 105 football movies, but all too many of them are forgettable, writes Mike Downey
updated 10:32 AM EDT, Fri April 11, 2014
John Sutter and hundreds of iReporters set out to run marathons after the bombings -- and learned a lot about the culture of running
updated 12:49 PM EDT, Fri April 11, 2014
Timothy Stanley says it was cowardly to withdraw the offer of an honorary degree to Ayaan Hirsi Ali. The university should have done its homework on her narrow views and not made the offer
updated 10:16 AM EDT, Fri April 11, 2014
Al Awlaki
Almost three years after his death in a 2011 CIA drone strike in Yemen, Anwar al-Awlaki continues to inspire violent jihadist extremists in the U.S, writes Peter Bergen
updated 9:21 PM EDT, Fri April 11, 2014
David Bianculli says Colbert is a smart, funny interviewer, but ditching his blowhard persona to take over the mainstream late-night role may cost him fans
updated 1:31 PM EDT, Thu April 10, 2014
Rep. Paul Ryan says the Republican budget places its trust in the people, not in Washington
updated 5:28 PM EDT, Thu April 10, 2014
Aaron David Miller says Obama isn't to blame for Kerry's lack of progress in resolving Mideast talks
updated 11:22 AM EDT, Mon April 14, 2014
David Weinberger says beyond focusing on the horrors of the attack a year ago, it's worth remembering the lessons it taught about strength, the dangers of idle speculation and Boston's solidarity
updated 12:32 PM EDT, Thu April 10, 2014
Katherine Newman says the motive for the school stabbing attack in Pennsylvania is not yet known, but research on such rampages turns up similarities in suspects and circumstances
updated 7:03 AM EDT, Fri April 11, 2014
Simon Tisdall: Has John Kerry's recent track record left Russia's wily leader ever more convinced of U.S. weakness?
updated 12:40 PM EDT, Thu April 10, 2014
Mel Robbins says Nate Scimio deserves credit for acting bravely in a frightening attack and shouldn't be criticized for posting a selfie afterward
updated 2:39 PM EDT, Wed April 9, 2014
Wendy Townsend says the Rattlesnake Roundup -- where thousands of pounds of snakes are killed and tormented -- is barbaric
updated 9:45 AM EDT, Thu April 10, 2014
Dr. Mary Mulcahy says doctors who tell their patients the truth risk getting bad ratings from them
updated 9:28 AM EDT, Wed April 9, 2014
Peggy Drexler says the married Rep. McAllister, caught on video making out with a staffer, won't get a pass from voters who elected him as a Christian conservative with family values
updated 7:43 AM EDT, Wed April 9, 2014
David Frum says the president has failed to react strongly to crises in Iran, Syria, Ukraine and Venezuela, encouraging others to act out
updated 4:57 PM EDT, Wed April 9, 2014
Eric Liu says Paul Ryan gets it very wrong: The U.S.'s problem is not a culture of poverty, it is a culture of wealth that is destroying the American value linking work and reward
updated 7:51 AM EDT, Wed April 9, 2014
Frida Ghitis writes: "We are still seeing the world mostly through men's eyes. We are still hearing it explained to us mostly by men."
updated 10:08 AM EDT, Thu April 10, 2014
Chester Wisniewski says the Heartbleed bug shows how we're all tangled together, relying on each other for Internet security
updated 3:26 PM EDT, Wed April 9, 2014
Danny Cevallos says an Ohio school that suspended a little kid for pointing his finger at another kid and pretending to shoot shows the growth in "zero tolerance" policies at school run amok
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT