Health Care Reform: The ACA, Your Practice, and You - Part 3 March 17, 2014 Covered California, Health Care Reform ACA, Affordable Care Act, Andrew Calman, Covered California, Obamacare 0 Click here to view the previous post in this 3-part series on Health Care Reform/Affordable Care Act. From the physician’s perspective, these patients will not be very different from existing HMO and PPO patients covered by these same private plans. Offices will need to check eligibility and obtain referrals and authorizations, just as with current patients. Some of these patients have never had insurance before and may need to be educated about co-payments and deductibles. Some plans may use their existing provider networks, while others may have “narrow networks” that exclude some providers. Payment rates may or may not be the same as with current patients under existing plans. It is essential that physicians inquire directly with their contracted health plans to determine their network status and payment rates. California’s Knox-Keene regulations should ensure that physicians are paid by health plans for eligible patients; CMA is working hard to make sure that even if patients do not pay their insurance premiums on time, their doctors will still be reimbursed for services. The ACA has its most profound impact upon those who currently do not have insurance. However, the ACA has also allowed more than 3 million young adults to be covered by their parents’ health insurance, is closing the “doughnut hole” for Medicare prescription drug coverage, and has provided rebate checks for 8.5 million Americans whose insurance companies spent less than 80% of revenue on health care. There are also subsidies for small businesses (including medical practices) that offer health insurance for their employees. For more details on the ACA, including how the ACA is funded and potential long-term issues, see Dr. Calman’s previous article in San Francisco Medicine, October 2012. For all the clamor about the world-changing or world-ending impact of Obamacare, we expect that after a few months of growing pains, Covered California will become just another part of the health insurance landscape that most of us encounter every day, joining employer-sponsored HMOs, PPOs, Medicare, Medi-Cal, and the occasional self-pay patients we see in our practice. Efficient practices will see a positive impact on their finances. Covered California patients will have insurance cards, co-pays, authorizations, and referrals just like everybody else. Many will have health problems that have long been neglected, which we can use our skills and knowledge to alleviate. The battles over contraceptive coverage and other issues will be resolved in the courts of last resort. The “cost curve” will be monitored and debated, with great difficulty firmly linking these reforms to cost changes (as is already the case—health care cost increases are down recently, but nobody is really quite sure why yet). The heavy opposition to the ACA is really nothing new—Presidents Roosevelt, Johnson, Nixon, Clinton, and G.W. Bush all faced severe attacks when they rolled out new programs, from Social Security to Medicare and Medicaid and senior prescription drug benefits. All such programs had difficult births and have needed continual refinement, but few have argued for their complete repeal. We do know it is a good thing for as many Americans as possible to have health insurance and access to care. And after some years, just as it is now unthinkable that most elderly Americans in 1966 had no health insurance, it may require effort to imagine an era when American citizens were routinely denied insurance because of preexisting conditions, had their insurance canceled because they or their children got sick, or went bankrupt from six-digit medical bills. By then, one can only hope that the Washington pundits will have moved on to another real or imagined crisis. Click here for more information about Covered California and available FAQs for physicians and patients. Comments are closed.
