It's been nearly six weeks since the Supreme Court's Patient Protection and Affordable Care Act (ACA) ruling, and some physician-based organizations have had time to digest the intricacies of the resulting information that was released.
As a refresher, the new law will require most Americans to carry health insurance or pay a penalty beginning in 2014. The law also guarantees that health insurance will be available to those who are already ill or need expensive care, ultimately helping many poor and middle-class people afford coverage. All totalled, it is believed that hospitals can expect an influx of approximately 32 million newly insured patients. So the issue that has developed is, "How are physicians reacting to these changes?" To answer this question, the following are opinions delivered by the Presidents of three, large, physician-minded associations.
John R. Tongue, MD
American Academy of Orthopaedic Surgeons
Although the American Association of Orthopaedic Surgeons (AAOS) opposed much of PPACA, we recognize that there are provisions in the law that aim to help providers deliver high-value healthcare services, including the development and implementation of Accountable Care Organizations and other quality improvement efforts, and assistance for pediatric specialists serving underserved communities. In addition, there are valuable patient protection provisions within the law, such as enabling young adults to remain on their parents’ insurance policies, outlawing coverage denials based on pre-existing conditions, enforcing medical loss ratio requirements, and doing away with maximum coverage limits on insurance policies.
However, PPACA also contains some provisions that could greatly hinder providers’ ability to deliver patient care, thereby threatening patients’ access to the healthcare services they need. The AAOS, along with its more than 18,000 members, stands ready to work with Congress to address these detrimental provisions in the law, such as continuing efforts to repeal the Independent Payment Advisory Board (IPAB) and other administrative burdens that infringe upon providers’ ability to deliver safe and effective patient care.
Jeremy A. Lazarus, MD
American Medical Association
While the law is not perfect, the AMA, the nation's largest physician organization, supported it because it makes necessary improvements to our health care system. We are pleased the law expands coverage to millions of uninsured who live sicker and die younger than those with insurance. It allows physicians to see patients earlier before care is more expensive, provides funding for research on drugs and treatments, increases Medicare and Medicaid payments for primary care physicians and includes Medicare bonus payments for general surgeons in underserved areas.
The AMA is working during implementation of the law to make changes like eliminating the Independent Payment Advisory Board. Lawmakers also must address two problems that predate the law, the broken Medicare physician payment formula and the flawed medical liability system.
Glen Stream, MD, MBI
American Academy of Family Physicians
The Patient Protection and Affordable Care Act has been a divisive issue not only in our country but also amongst our own membership. Clearly, it is far from perfect legislation. But now that the Supreme Court finally has issued its long-awaited ruling, we can move forward with needed health system reforms.
The Academy will continue to work to implement the best pieces of the ACA, advocate for change in provisions of the law that are flawed and address the law's two key deficiencies -- meaningful medical liability reform and a replacement for the sustainable growth rate (SGR) formula.
The ACA, even with its flaws, provides a pathway to reach the AAFP's vision of health care for all, a policy goal the Academy has been pursuing for more than two decades. By extending health coverage to roughly 30 million more people, the law will improve the health of the nation by ensuring access to basic primary care, including preventive services and chronic disease management.
The court's decision helps our patients by preserving provisions of the ACA that:
- eliminate annual and lifetime coverage limits;
- eliminate cost sharing for preventive services;
- prevent payers from denying coverage based on pre-existing conditions; and
- allow young adults to stay on their parents' insurance up to age 26.
For primary care physicians, the court's decision preserved provisions of the ACA that:
- create Medicare primary care payment incentives; and
- boost Medicaid payments for primary care services to Medicare levels.
For our workforce, the decision means investment in primary care education and training will continue through:
- funding for teaching health centers;
- scholarship and loan repayment programs in the National Health Service Corps;
- support for the health professions grants for family medicine; and
- establishment of the Health Care Workforce Commission.
The ruling also means that projects intended to align payment to support medical home transformation will continue.
There is plenty to like, and dislike, about the ACA. The bottom line is that our Academy will work to maximize the provisions of the law that benefit family physicians and our patients while also addressing issues where the law is lacking or deficient.
So how about the rest of the country's physicians? In a survey conducted by Kantar Health and Sermo, Inc. following the Supreme Court’s decision to uphold the Affordable Care Act:
- 71% of U.S. physicians want major changes to the law
- 57% percent of the 1,500 respondents said they would like to see the law repealed altogether
- 14% would keep the law but undertake major bipartisan revisions
- 26% favor keeping the law and “fine tuning” it over time.
With the jury still out on the ACA, only time will tell if the ACA will deliver improvments and changes that the US health system needs.