“We knew right after the election, this is all coming out,” said Blair Childs, an executive at the Premier health alliance, which advises hospitals.
Some of these rules have been under development for nearly a year.
Other key decisions will be determined outside the rulemaking process, as the Obama administration selects participants in several experimental programs, including a new payment method for doctors, hospitals and other providers.
Here are summaries of some of the significant decisions on the health law that the administration is expected to announce shortly:
Medical Device Excise Tax. Last February, the Internal Revenue Service proposed a rule on how to apply this 2.3 percent tax, which kicks in at the start of January. The major unresolved issues concern which devices will be included and how the tax is applied and collected.
Among the questions: Should the tax apply to devices commonly used by veterinarians if the device is also used in human medicine? What about items sold in retail settings but also used in medical procedures such as dental instruments and latex gloves? Does the tax apply to kits — two or more medical tools packaged and sold together — even if the manufacturer of each component had already collected the tax when it was sold to the kit maker?
Brendan Benner, a spokesman for the Medical Device Manufacturers Association, said companies are making marketing and sales decisions based on what they expect will happen, but that presents problems. “When you don’t know what the answer to the question is, it’s hard to make a decision,” he said.
Hospital Payments. Between 2014 and 2019, the government will cut $36 billion out of the money that goes to hospitals that treat large numbers of poor patients. The cuts were included in the health law under the rationale that many currently uninsured patients would be covered either through the expansion of Medicaid or through subsidized insurance.
The administration has to figure out how it will allocate those cuts among hospitals — a task made more complicated by last summer’s Supreme Court ruling that allows states to opt out of expanding Medicaid. On the one hand, hospitals in states that don’t expand Medicaid will continue to serve a crush of uninsured patients, so they will want more federal support. On the other hand, experts note, the government doesn’t want its policy to reward those states for their parsimony by ponying up more money to soften the blow.