The Affordable Care Act is widely considered to be the most significant regulatory reform of US healthcare since Medicaid and Medicare were created.
Millions more Americans gained access to health insurance coverage through this law, while subsidizing premiums for those who couldn’t afford them. Unfortunately, however, it also severely limited physician-owned hospitals (POHs), owned and operated by physicians.
1. The Patient Protection and Affordable Care Act
President Obama signed the Patient Protection and Affordable Care Act into law in March 2010, providing patients with various rights and protections as well as subsidies to make health insurance more accessible for millions of Americans.
The Affordable Care Act (ACA) introduced some major modifications to how health care is paid for and delivered. This included decreasing payments to hospitals under Medicare while offering value-based payment systems for hospital services.
The ACA’s restrictions on physician-owned hospitals and their owners prevent them from employing the most profitable strategies for growth, such as increasing ownership stakes, expanding facilities, building new facilities and making better use of existing assets. They may choose to alter asset utilization – such as converting patient beds into operating rooms – in order to maximize profit from existing assets.
2. The Affordable Care Act’s Medicaid Expansion
Medicaid expansion has been a major contributor to job creation in states. As more and more uninsured people gain health coverage, there is an increasing need for doctors, nurses and other healthcare professionals who can provide these new patients with necessary medical services.
Under the Affordable Care Act’s Medicaid Expansion, states were required to expand their traditional Medicaid programs to cover an additional population of low-income adults. These individuals would receive an enhanced federal matching rate (FMAP), which varies by state.
At first, some states were reluctant to embrace Medicaid expansion because they worried that an influx of newly eligible citizens would strain their programs. But the ACA’s financing structure created an incentive for states to join and also ensured that any additional federal funds provided were not a burden on taxpayers.
Despite these obstacles, Medicaid expansion has been an integral component of the Affordable Care Act (ACA), improving access to care, decreasing out-of-pocket healthcare costs and saving federal taxpayers billions in health care spending. Furthermore, this expansion helped protect low-income Americans from economic decline and eliminated disparities in access to health care.
3. The Affordable Care Act’s Subsidies
In addition to expanding coverage, the Affordable Care Act also reduced Medicare payments to hospitals by more than 20 percent. These reductions are a result of ACA policies that reward or penalize certain behaviors within hospitals such as value-based payment models, hospital readmissions and other cost reduction initiatives.
These programs were initially welcomed as a means to reduce healthcare costs, yet they exacerbated an existing trend where physicians were shifting their practice management and marketing functions into hospitals. Furthermore, they undermined physician confidence that they would be paid for their services during a time when many doctors weren’t accepting new insurance plans offered through the Affordable Care Act (ACA).
The Affordable Care Act’s subsidies, or tax credits, were designed to reduce premiums and out-of-pocket expenses for many consumers with incomes below 400 percent of the poverty level (as defined by the federal government), enabling them to afford high quality health coverage at a fraction of the cost. Republicans’ proposals to cap subsidies would have eliminated those benefits entirely, potentially leading to millions of Americans going uninsured and driving up individual market premiums by millions.
4. The Affordable Care Act’s Regulations
According to a coalition of state medical associations, the Affordable Care Act (ACA) placed a moratorium on physician-run hospitals. This has impeded patient access to quality healthcare and driven up costs for Medicare beneficiaries, according to this coalition.
The Texas Medical Association is advocating that Congress lift the moratorium on Private Hospital Rooms and restore hospital capacity.
Among other provisions, the Affordable Care Act’s regulations eliminated lifetime limits on benefits for all health plans and limited insurers to annual limits or maximum payouts. These initiatives aim to enhance consumer safeguards and boost healthcare quality.
Due to ACA restrictions on physician-owned hospitals, they have sought new ways to maximize profits from their existing assets. This could include expanding services that don’t need additional space (like outpatient surgeries), converting patient beds into higher-earning operating or procedure rooms, or increasing hours of operation. While these practices can reduce competition and boost hospital profits, they don’t increase the number of hospitals in America.
