Affordable Care Act (ACA)

Learning more about how the ACA, also known as Obamacare, impacts physicians

The Patient Protection and Affordable Care Act, commonly referred to as either the Affordable Care Act (ACA) and Obamacare, has widely been regarded as one of the biggest attempts at overhauling our healthcare system in decades. In this article, we try to highlight some of the major objectives of the ACA and how it specifically affects independent providers.

Overview of ACA

The ACA’s primary focus is increasing access to affordable insurance plans which allow for unprecedented amounts of coverage. This goal is achieved through several different means of change. The first is the individual mandate, or the requirement of every U.S. citizen and legal resident to have health insurance to avoid paying fines. In order to reduce costs of and barriers to buying insurance, the ACA further necessitates guaranteed coverage and disallows insurance companies from denying insurance based on medical history, present conditions, or other factors such as gender, age or race.

Along with increasing the number of Americans with health coverage, Obamacare also attempts to expand the scope of coverage health insurance plans provide. Under the ACA, insurance plans are placed in one of five benefit categories (platinum, gold, silver, bronze, or catastrophic) depending on the types of services they cover. All plans, however, are required to cover ten essential health benefits, ranging from mental health services to preventative health.

Lastly, Obamacare attempts to offset high costs of insurance with subsidies for individuals and families with low to middle socioeconomic status. These subsidies reduce costs of often high premiums for patients up to 400% of the poverty line.

How the ACA Applies To Independent Providers

One of the biggest implications of the ACA, especially for family practice physicians and internists, is the requirement of the coverage of preventative care and other wellness services. This incentivizes patients to visit their primary care physicians more often and have more regular check-ups and physicals, in an effort to invest in long-term care.

Another major component of the ACA is Medicaid expansion, which increases patient eligibility for the program. For providers, this means many of their previously uninsured patients may now receive coverage under Medicaid.

Obamacare also put an emphasis on increasing the adoption of electronic health records (EHR) systems. The mandate not only required clinics and hospitals to switch over to using EHR systems (or upgrade them) but also incentivized ‘meaningful use.’ Meaningful use is the usage of EHR systems to reduce health disparities and improve care coordination and therefore, care quality. Making documentation more efficient and improving patient engagement through these integrated systems will not only increase communication between providers but also between patients and providers, giving patients more ownership over their own health care.

What now?

With the election of President Trump, there has been much conversation about what is going to happen to the ACA. So here’s what we know so far:

President Trump’s administration has pushed back on the ACA. Within the first few days of his Presidency, he signed an executive order which does not repeal the law but does make some of the stipulations put forth by the ACA less stringent. For instance, the executive order makes it easier for uninsured citizens to avoid receiving fines, providing less incentive for them to then get insured.

On Monday, March 6th, 2017, President Trump and his administration officially released their plan to replace Obamacare–the American Health Care Act (AHCA). If passed, this plan would cease federal funding to state Medicaid programs in 2020, repeal the individual mandate, and replace current income-based subsidies with age-based subsidies among other things. Overall, the plan’s intent is to move the power of making health decisions more towards individuals and families. Major critique of this repeal and replace bill claims that it is more beneficial for the younger, wealthier sections of the population and unfavorable for middle and lower class citizens. Learn more about the details of the AHCA here.

This is an ongoing and contentious conversation. We will continue to add to this article as events unfold, so please check back here for more updates about how changes in the ACA can affect both you and your patients.