Patient Protection and Affordable Care Act

(Continued)

Expansion Of Public Programs

Another key component to coverage for more Americans is the expansion of public programs. Medicaid will cover all non-Medicare eligible individuals under 65 with incomes up to 133% of the Federal Poverty Level ($26,000 for a family of 4).

Medicaid has been chronically under-funded so that both physicians and hospitals find that reimbursement rarely meets the cost of providing care. In this case, the federal government will provide states with 100% of the funds necessary to provide these additional services. This will be gradually decreased to 90% in 2020 and thereafter. Primary care physicians in family, internal or pediatric medicine will receive Medicaid payments equivalent to 100% of the Medicare payment beginning January 1, 2013. States will be required to maintain coverage for children enrolled in the Children's Health Insurance Program (CHIP) through 2015. Increased federal funding will be available to states under this program with a 23% increase in 2015.

Medicare, predicted to become insolvent in 2017, will now stand on firmer financial footing for an additional 10 years. Primary care physicians, nursing and allied health training programs will all receive additional funding much needed for our aging population. Removal of deductibles for preventive care such as colonoscopies will encourage earlier detection and treatment of disease.

Is This Health Reform Law Perfect?

No. Does it have significant shortcomings? Yes. Were there compromises? Certainly.

There are already many challenges to the successful implementation of the new law and therefore its beneficial results. First and foremost are the political obstacles; twenty state attorneys general recently filed lawsuits challenging the requirement that individuals must buy health insurance coverage, also known as the “individual mandate.” Mid-term elections and a changed political climate have resulted in further challenges to deny funding. However, the more the public learns of the protections and benefits of this law, the more difficult it will be to return to the time when insurance companies wrote many of the rules.

10 Things You Need to Know About the New Law

32 million more Americans will have access to health insurance.
Preexisting medical exclusions will no longer be allowed. This begins in 2014 for adults.
Medicare services will include free preventive care and closure of the “donut hole”* in the Part D drug program.
Temporary program started in July 2010 for those with pre-existing conditions and those uninsured for more than six months.
New benefits are provided such as coverage for adult children until age 26.
Medical decisions remain in the hands of you and your doctor.
An individual mandate requires most people to have health insurance coverage by 2014.
State run health insurance “exchanges”** will offer a competitive market of coverage options beginning in 2014.
Small business tax credits for employee health insurance coverage is immediately available.
Medicare gains firmer financial footing for an additional ten years with a reduction in the federal deficit of $143 billion.

* The “donut hole” — is the difference of the initial coverage limit and the catastrophic coverage. After a Medicare beneficiary surpasses the prescription drug coverage limit, the beneficiary is financially responsible for the entire cost of prescription drugs until the expense reaches the catastrophic coverage threshold.

** A health insurance exchange is an organized marketplace for the purchase of health insurance.

Will There Be Enough Competition To Lower Health Insurance Premiums?

The “public option” was an attempt to have a competing non-profit insurance offering that would be a strong competitor in the market place; this was not included. There have been significant monopolies in the insurance market that will be hard to overcome.

Perhaps the biggest challenge is whether adequate funding will be available to cover the costs of providing care. Medicaid (MediCal in CA) is a state program that is severely under-funded. Patients who have difficulty finding a doctor subsequently use costly emergency room care to seek treatment, often as a last resort. Doctors have to limit or close their practices due to low reimbursement, and hospitals are forced to reduce services due to lost revenue. The new health care law will use Medicaid to expand coverage significantly. The federal government will assume responsibility for funding all new Medicaid eligible enrollees at higher Medicare levels. Hopefully this will prevent state governments from raiding federal dollars earmarked for these health services.

However, it is clear that physicians and hospitals will face severe financial challenges ahead. Some fear that these groups will be the victims of budgetary cost containment in future years. Quality medical care for all will only be available if the highest priority is given to adequately fund patient care services without which, health care reform will become only an empty promise. To avoid this, it may be necessary to renegotiate inclusion of non-profit only health insurers as most other industrialized nations have done, and to look at the expensive duplication of hospital services in many urban areas where lower volume may threaten higher quality. Furthermore, insistence on a true, competitive marketplace for pharmaceuticals may be needed. Only in these ways will we be able to continue to attract the best and brightest to our medical schools, and to save health-care dollars without sacrificing quality of care.

Finally On A Personal Note

I've been a physician for 27 years. I spent the first 35 years of my life in school and training to ultimately become a doctor. Over these years, it's been a privilege to enter into each of my patient's lives, often at a time of crisis and vulnerability, to provide the care and comfort that return them to health. Health-care is, and continues to be, a noble and unparalleled profession. America is a nation of unbounded dreams and accomplishments. I do believe that we can preserve the best that medicine has to offer while strengthening and making it accessible for all. The Patient Protection and Affordable Care Act is a first step in this direction.

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