Skip to main content

2013: How health care will affect you

By Aaron E. Carroll, Special to CNN
December 28, 2012 -- Updated 1356 GMT (2156 HKT)
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
December 13, 2014 -- Updated 2108 GMT (0508 HKT)
The NFL's new Player Conduct Policy was a missed chance to get serious about domestic violence, says Mel Robbins.
December 16, 2014 -- Updated 1740 GMT (0140 HKT)
The slaughter of more than 130 children by the Pakistani Taliban may prove as pivotal to Pakistan's security policy as the 9/11 attacks were for the U.S., says Peter Bergen.
December 17, 2014 -- Updated 1600 GMT (0000 HKT)
The Internet is an online extension of our own neighborhoods. It's time for us to take their protection just as seriously, says Arun Vishwanath.
December 16, 2014 -- Updated 2154 GMT (0554 HKT)
Gayle Lemmon says we must speak out for the right of children to education -- and peace
December 17, 2014 -- Updated 1023 GMT (1823 HKT)
Russia's economic woes just seem to be getting worse. How will President Vladimir Putin respond? Frida Ghitis gives her take.
December 17, 2014 -- Updated 0639 GMT (1439 HKT)
Australia has generally seen itself as detached from the threat of terrorism. The hostage incident this week may change that, writes Max Barry.
December 12, 2014 -- Updated 2020 GMT (0420 HKT)
Thomas Maier says the trove of letters the Kennedy family has tried to guard from public view gives insight into the Kennedy legacy and the history of era.
December 15, 2014 -- Updated 1456 GMT (2256 HKT)
Will Congress reform the CIA? It's probably best not to expect much from Washington. This is not the 1970s, and the chances for substantive reform are not good.
December 15, 2014 -- Updated 2101 GMT (0501 HKT)
From superstorms to droughts, not a week goes by without a major disruption somewhere in the U.S. But with the right planning, natural disasters don't have to be devastating.
December 15, 2014 -- Updated 1453 GMT (2253 HKT)
Would you rather be sexy or smart? Carol Costello says she hates this dumb question.
December 14, 2014 -- Updated 2253 GMT (0653 HKT)
A story about Pope Francis allegedly saying animals can go to heaven went viral late last week. The problem is that it wasn't true. Heidi Schlumpf looks at the discussion.
December 14, 2014 -- Updated 1550 GMT (2350 HKT)
Democratic leaders should wake up to the reality that the party's path to electoral power runs through the streets, where part of the party's base has been marching for months, says Errol Louis
December 13, 2014 -- Updated 2123 GMT (0523 HKT)
David Gergen: John Brennan deserves a national salute for his efforts to put the report about the CIA in perspective
December 12, 2014 -- Updated 1426 GMT (2226 HKT)
Anwar Sanders says that in some ways, cops and protesters are on the same side
December 11, 2014 -- Updated 1439 GMT (2239 HKT)
A view by Samir Naji, a Yemeni who was accused of serving in Osama bin Laden's security detail and imprisoned for nearly 13 years without charge in Guantanamo Bay
December 14, 2014 -- Updated 1738 GMT (0138 HKT)
S.E. Cupp asks: How much reality do you really want in your escapist TV fare?
December 11, 2014 -- Updated 1828 GMT (0228 HKT)
Rip Rapson says the city's 'Grand Bargain' saved pensions and a world class art collection by pulling varied stakeholders together, setting civic priorities and thinking outside the box
December 13, 2014 -- Updated 2310 GMT (0710 HKT)
Glenn Schwartz says the airing of the company's embarrassing emails might wake us up to the usefulness of talking in-person instead of electronically
December 12, 2014 -- Updated 2233 GMT (0633 HKT)
The computer glitch that disrupted air traffic over the U.K. on Friday was a nuisance, but not dangerous, says Les Abend
December 12, 2014 -- Updated 1740 GMT (0140 HKT)
Newt Gingrich says the CBO didn't provide an accurate picture of Obamacare's impact, so why rehire its boss?
December 13, 2014 -- Updated 0040 GMT (0840 HKT)
Russian aggression has made it clear Ukraine must rethink its security plans, says Olexander Motsyk, Ukrainian ambassador to the U.S.
December 12, 2014 -- Updated 0046 GMT (0846 HKT)
The Senate committee report on torture has highlighted partisan divisions on CIA methods, says Will Marshall. Republicans and Democrats are to blame.
December 11, 2014 -- Updated 1833 GMT (0233 HKT)
It would be dishonest to say that 2014 has been a good year for women. But that hasn't stopped some standing out, says Frida Ghitis.
ADVERTISEMENT