After hearing about the Supreme Court’s decision to uphold President Obama’s Affordable Care Act, we were interested to learn what the historical decision means for healthcare professionals from a legal sense. We spoke with Atlantic Health Solutions’ in-house legal counsel Jeff Greenberg, to hear his predictions for what’s to come.
What does the Supreme Court's decision to uphold the ACA mean for patients and their quality of care?
There will be a lot more patients in the health care system, as more will be covered with some type of health insurance. Some people have said that the quality of health care provided will suffer, because there will be so many more people with access to care and no increase in providers. Patients will likely see longer wait times and a difference in how quickly they can get appointments. It has been predicted that with more patients gaining access to care, patients could see the same scheduling issues typical of Canadian health care. Also, as lower reimbursement is expected, physicians might be led to be less motivated due to lack of revenue, leading to lower quality care. Fortunately, others say that providers have planned for this influx of volume, so the quality should remain the same.
What does the decision mean for Physicians from a stability and care standpoint?
For physicians, this decision is a double-edged sword. While they will see greater patient volume, at the end of the day, physicians’ reimbursement is going to be lowered even more. Because someone is going to end up paying for these patients’ care, they will be forced to examine other options such as being pushed into the ACO model and bundled payments. Unfortunately, these options do not benefit specialists as much as primary care health care providers. Many hope that while they will be getting paid less, they might make up for it with volume; the question will be if they can truly make a profit off of patients with government supplied insurance. Physician’s main priority is to provide care to those in need, so many will accept lower paying insurance work, especially if their schedule needs to be filled, but many high quality providers will not be required to accept these patients, and if their schedule is full with high-revenue patients, there might not be room for others.
What can we expect to see happen in regards to hospitals purchasing IDTFs?
A lot more physicians may go work for hospitals as surviving as an outpatient facility is not necessarily easy or secure. Hospitals are also required to take all patients and they always have, so until now they have missed collecting from patients without means. Now they will collect from the government entities and be able to feed revenue to their hospital-owned providers. This is good for those physicians comfortable with being an extension of the hospital, and fewer will see the benefits of being an IDTF (independent diagnostic testing facility) as oppose to being purchased to some.
What are the implications for patients who opt not to purchase insurance and continue to be uninsured?
If patients don’t purchase insurance, they can continue to be uninsured. Patients that cannot afford care and prefer to remain uninsured will not be penalized, however if you can afford insurance and decide to remain uninsured, you will pay a penalty each year. As for employers who are now required to provide insurance plans to their employees, many are determining whether purchasing the insurance or simply accepting the penalty is more affordable. Many believe that the penalty will be less expensive. Businesses with less than 50 employees are not required to provide insurance and are presently unaffected by the Affordable Care Act.
So, is this the end of cash-pay?
This is absolutely not the end of self-pay and cash-pay patients will still be demand concierge services and other cash-pay procedures. It is predicted that even after the decision to uphold the ACA, 20 million Americans will remain uninsured and will continue to utilize cash pay options. It is also important to remember that the mandate is still subject to being repealed.
How do you think this will affect our nation's healthcare system long term?
Long term, it is too early to tell. If Romney gets elected, he will likely try to overturn the decision immediately and some states will still opt out of Medicaid Expansion, which could cause huge issues. The conversation about Medicaid Expansion for states is still going on and the end result is still not clear. However, if everything remains as it is I would speculate cost and payment challenges, physicians being forced to work for hospitals/ACO’s, a larger patient population and some limited access to providers, with quality care and price transparency attempted to be driven.