Health professionals are notoriously difficult to survey. Even when successful, their responses can often be disappointing and misleading.
The Affordable Care Act makes healthcare more accessible by expanding access to non-affluent Americans for affordable insurance plans, and by altering how doctors are paid in Medicare. These changes should increase demand while simultaneously decreasing long-term healthcare costs over time.
What are the ACA’s main goals?
The Affordable Care Act’s major goals include mandating employers to cover employees, creating state-based insurance exchanges to assist individuals and small businesses purchase coverage, expanding Medicaid eligibility to those below 133% of poverty line and prohibiting lifetime and annual monetary caps on coverage. In addition, it mandates insurance plans provide certain essential health benefits such as prescription drugs and maternity care coverage.
Additionally, the Affordable Care Act allows children to remain on their parents’ policies until age 26 and prevents insurers from denying coverage or increasing premiums for individuals with preexisting conditions. Furthermore, it mandates all insurance plans provide preventive care without out-of-pocket costs as well as setting medical loss ratio rules to hold private insurers accountable for spending at least 80% to 85% of premium dollars on actual healthcare needs.
As more patients enroll, ACA expansion will place new demands on the system and necessitate additional investments in staff, equipment and training; it could even create pressures which lead to attrition among health care workers and worsen shortages of physicians.
What are the unintended consequences?
No one should be fooled into thinking that an overhaul of our health care system would go smoothly, and unfortunately the Affordable Care Act (ACA) has many unintended consequences which may have negative ramifications on current practices in healthcare delivery.
Addition of 34 million patients will place further strain on an already overburdened system and may create new access barriers in certain communities. As increased demand and bureaucracy reduce the time medical professionals devote directly to patient care, attrition rates may rise, contributing to workforce shortages.
The Affordable Care Act also includes changes to how Medicare reimburses physicians. This shift will see payments shift away from rewarding volume toward rewarding cost efficiency; doctors will feel this change starting in 2018 when their Medicare payments change; this could cause severe disruptions to physician-patient relationships, with some opting to limit their panels or use subscription-based models as ways of maintaining these important relationships while still ensuring financial viability.
What are the challenges?
Even with its many successes, the Affordable Care Act still presents challenges to American healthcare. One such obstacle is millions of Americans lacking access to affordable yet high-quality health coverage.
Another challenge lies in the increasing cost of healthcare, driven by factors such as medical advances, new technology and consumer demand. All these elements will continue to drive healthcare costs up.
Another challenge facing health care stakeholders is the shortage of health care professionals, due to attrition due to burnout and health care’s labor-intensive nature. To address this shortage, health care stakeholders need to implement strategies to attract and retain health care workers such as pay raises, profit sharing plans and career advancement opportunities for both private and public sector health care stakeholders.
What are the solutions?
Health professionals can support reforms that address various market barriers. These include asymmetric information that enables doctors to exploit consumers through misleading direct-to-consumer advertising and create demand unwarranted by clinical need.
Physicians and hospitals could both benefit from Medicare’s new proposal to recognize cost efficiency. Under this proposal, payment to physicians and hospitals will gradually increase depending on their performance in improving patients’ health outcomes and total costs of their care, providing an incentive to reduce costs while offsetting financial penalties from insurers or other payors.
States can continue advancing their coverage and affordability efforts, such as public options, while the federal government can offer further help through increased Advance Premium Tax Credit subsidies. Congress could use this as an opportunity to show it is willing to repair and strengthen the ACA instead of simply repealing and replacing it.
