Making Sense of the Affordable Care Act

One of President Obama’s early priorities was to guarantee that all citizens had access to healthcare insurance while curbing health care costs. Despite strong opposition, in March 2010 Obama signed the Patient Protection and Affordable Care Act (“ACA”) – commonly known as “ObamaCare”. Although the ACA was challenged in both Congress and the Courts, the United States Supreme Court upheld the constitutionality of the majority of the law – including the requirement that individuals have health insurance or face stiff financial penalties. With a favorable Supreme Court ruling, Obama’s reelection and a Democratic Senate majority – major health care reform is a reality.

 

ACA has many provisions, but I will only address here some of the more significant features. One component is the creation of healthcare exchanges – a market place that provides options for uninsured individuals and small businesses looking to purchase affordable insurance. These exchanges are intended as statewide systems to allow consumers to more easily compare and purchase plans. If a state does not create an exchange, individuals will be able to access an alternative federal exchange. Another feature of the ACA allows states some latitude defining benefits that an insurer must cover. Yet while states have some discretion, certain benefits such as mental health, preventative care, maternity care, and vision and dental care for children are required. Contraception is a particularly controversial benefit. Although the ACA requires that contraception be covered, self- insured religious groups may be exempt. States must decide in the near future whether they will create a state healthcare exchange. In the state of Florida, Governor Rick Scott initially opposed health care exchanges; however, since President Obama’s reelection his opposition has softened.

 

In order to make coverage affordable, small businesses, as well as middle and low income families will receive tax credits to offset coverage costs. Those who can afford coverage, but elect not to purchase it, will be subject to tax penalties. Despite the tax credits, the ACA anticipates that a certain percentage of the population still will not be able to afford coverage and will need to rely upon Medicaid. ACA expands eligibility for low income persons and initially will fully reimburse states for these costs. Gradually, however, this reimbursement percentage decreases and states will shoulder a greater cost portion. In the state of Florida, Governor Rick Scott strongly opposed expansion of Medicaid; however, like his stance on health care exchanges, his position has toned down since the election.

 

Requirements of the ACA are phased in. The first phase began in September 2010, when insurance companies were required to offer coverage for dependents through age 26. Prior to that date, 30 % of dependent children were uninsured – many were too old to be covered under a parent’s policy but not able to afford coverage on their own. Other provisions, such as implementation of healthcare exchanges and rules prohibiting insurers from denying coverage for those with pre-existing conditions, will be phased in over the next few years.

 

Regardless of political differences, most agree that at least in concept, health care coverage for all citizens is good. But adding so many new insured’s over a relatively short time may strain the existing healthcare system. There are a finite number of primary care physicians. Fewer medical school grads are choosing the primary care specialties and older primary care physicians are retiring. Recognizing that more primary care physicians are needed, the ACT promises to increase Medicaid reimbursement rates to that of Medicare, as well as providing additional funding to train more primary care physicians.

 

The DCMA is closely monitoring these changes and the impact that it will have upon the practice of medicine. The DCMA along with the FMA, is here to assist physicians move into the implementation of the Affordable Care Act. DCMA represents physicians. Make sure you, as a practicing physician, are with us.