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 11:39 AM EDT, Thu October 30, 2014
Mike Downey says the Giants and the Royals both lived through long title droughts. What teams are waiting for a win?
updated 2:32 PM EDT, Thu October 30, 2014
Mel Robbins says if a man wants to talk to a woman on the street, he should follow 3 basic rules.
updated 5:03 PM EDT, Wed October 29, 2014
Peter Bergen and David Sterman say more terrorism plots are disrupted by families than by NSA surveillance.
updated 5:25 PM EDT, Wed October 29, 2014
Time magazine has clearly kicked up a hornet's nest with its downright insulting cover headlined "Rotten Apples," says Donna Brazile.
updated 4:55 PM EDT, Wed October 29, 2014
Leroy Chiao says the failure of the launch is painful but won't stop the trend toward commercializing space.
updated 7:45 AM EDT, Wed October 29, 2014
Timothy Stanley: Though Jeb Bush has something to offer, another Bush-Clinton race would be a step backward.
updated 8:37 AM EDT, Tue October 28, 2014
Errol Louis says forced to choose between narrow political advantage and the public good, the governors showed they are willing to take the easy way out over Ebola.
updated 2:03 PM EDT, Mon October 27, 2014
Eric Liu says with our family and friends and neighbors, each one of us must decide what kind of civilization we expect in the United States. It's our responsibility to set tone and standards, with our laws and norms
updated 7:45 AM EDT, Mon October 27, 2014
Sally Kohn says the UNC report highlights how some colleges exploit student athletes while offering little in return
updated 3:04 PM EDT, Sun October 26, 2014
Terrorists don't represent Islam, but Muslims must step up efforts to counter some of the bigotry within the world of Islam, says Fareed Zakaria
updated 9:02 AM EDT, Fri October 24, 2014
Scott Yates says extending Daylight Saving Time could save energy, reduce heart attacks and get you more sleep
updated 8:32 PM EDT, Sun October 26, 2014
Reza Aslan says the interplay between beliefs and actions is a lot more complicated than critics of Islam portray
updated 7:19 AM EDT, Mon October 27, 2014
Julian Zelizer says control of the Senate will be decided by a few close contests
updated 8:12 AM EDT, Fri October 24, 2014
The response of some U.S. institutions that should know better to Ebola has been anything but inspiring, writes Idris Ayodeji Bello.
updated 9:12 AM EDT, Tue October 21, 2014
Sigrid Fry-Revere says the National Organ Transplant Act has caused more Americans to die waiting for an organ than died in both World Wars, Korea, Vietnam, Afghanistan and Iraq
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT