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Affordable Care Act Q & As

It’s still too soon after implementation to have many questions raised by the Affordable Care Act answered definitively, and of course, debates in courts across the nation will likely change things. But, some of the details about how it’s impacting quality patient care are beginning to come into focus even as they raise more questions.


Q: Do ACA plans provide adequate quality patient care?

A: Like many of the questions, this one has multiple answers. On one hand, millions of Americans now have access to healthcare when previously they did not. And not just those with low incomes, people with pre-existing conditions are now able to obtain health insurance coverage when previously they were either denied or priced out of it. Obviously, for these groups, the quality of their healthcare has improved.

On the other hand, there is concern over lower reimbursement rates and increased paperwork and their effects on quality patient care.

“These underpayments are ultimately shifted to patients in the form of shorter visits, less doctor face time, quick hospital discharges, and compromised care,” according to a November, 2012 white paper in The Heritage Foundation’s Backgrounder.The paper details the differences in care for children and adults seeking a variety of services with and without Medicaid; the facts are concerning.

Q: Is it hard to get an appointment with Obamacare?

A: Although there are anecdotal reports of patients being unable to get appointments with doctors in a timely fashion or at all, a Commonwealth Fund survey found that by June 1, some 60 % of newly insured Americans reported they had seen a doctor, gone to a hospital or filled a prescription using their new coverage.  Sixty-two percent of them said they wouldn’t have been able to obtain that service without their new coverage.                                                 `

Q: Are healthcare providers refusing to see patients who have coverage through the Affordable Healthcare Act?

A: Physicians have always been able to choose which insurances they will accept and which they won’t, and some are exercising that right when it comes to coverage bought on the exchange.

Many of the new enrollees have enrolled in their state’s Medicaid program under the expansion provided for in the ACA. However, according to a Merritt Hawkins survey of 15 major metropolitan areas, the number of physicians who accept Medicaid dropped to 45.7% in 2013, down nearly 10 percentage points from 2009 when 55.4% accepted Medicaid patients. A contributing factor is lower reimbursements for services with further cuts looming.

Q: Do I have to wait until next year to enroll if I missed this year’s deadline?

A: Enrollment for 2014 coverage did close March 31, 2014 but there are exceptions that qualify people with certain circumstances for a special enrollment period.  Among those that may qualify are people who have lost their healthcare coverage for reasons other than voluntary discontinuation; young adults who age out of their parent’s policy or who graduate and lose the school policy they had purchased; getting married or having a child; and those with a significant loss of income. People who think they may qualify must apply within 60 days of the qualifying event to be eligible for a special enrollment period, coverage and subsidies through the Affordable Care Act.

In states that have expanded Medicaid, Medicaid enrollment is open year-round.

Q: Will coverage rates go up next year?

A: Only time will tell for certain, but two schools of thought contradict each other. The Atlantic reported in a July 16 article that “More insurance companies have indicated they will participate in the exchanges in 2015, offering affordable plans; that suggests they will do just fine in this marketplace,” resulting in competition that will keep prices down.

Join us next time when we’ll discuss the impact of the Affordable Care Act on physicians and their practices.

If you have questions or concerns regarding quality patient care, click here to contact General Medicine, The Post Hospitalist Company.



Tom Prose