MCMS Physician Winter 2017 - 12

mon t m e d s o c .c om

Repeal of the ACA -
A Sure Thing Or Is It?
BY JAY ROTHKOPF, MD, EDITOR

The Affordable Care Act is Dead
That is, if the politicians are to be believed. For the past
several years, the public has been subject to endless debate over
the benefits and shortcomings of President Obama's signature
law. Now, with a change in administration, repeal has been
promised on "Day One."
So what comes next? Alternatives, both state and federal,
surely exist, but what are they? Who will they cover? How
will they work? Broadly speaking, the Affordable Care Act
at the time of its passing had two goals: decrease the number
of uninsured Americans, and lower the cost of care for all.
Statistically speaking, the first has been accomplished, but
many feel the second has not. While it is not my intention to
comment on the politics of healthcare, for the purposes of this
article, a brief discussion of how the ACA was "supposed" to
work is both necessary and warranted.

A Little Background
The heart of the law is the so-called "individual mandate,"
or the requirement that all eligible Americans either purchase
health insurance, or pay a pre-determined, income-adjusted
penalty that would increase over time. The purpose of this
was to encourage young, healthy patients to sign up for plans,
allowing them to not only gain coverage, but expand the "risk
pool." Theoretically, this would increase the amount of money
insurance companies would then have to care for the sick, who
always cost more. By tacking on a penalty, the law ensured that
every American would have "skin in the game." Unless granted
an exemption, all citizens would have to participate in the
system. With these new requirements came new protections.
Chief among them were an end to the denial of coverage for
pre-existing conditions, no more lifetime caps on benefits or
charging women more for healthcare (to name a few). A similar
mandate was also required for employers, based on company
size.

The law's second goal, to lower costs, has been far less
successful. Initially, insurers were asked to participate in
"exchanges," which could either be set up by the state or run
by the federal government. Given the anticipated short-term
losses from such a massive transition, the law established "risk
corridors," vehicles through which insurers would receive
taxpayer-funded subsidies to 'blunt the pain' from having the
sickest patients sign up first. While the industry did what it
was told, the numbers did not improve, leaving many carriers
to withdraw from the markets. Medicaid, expanded in some
states but not in others, has been left to pick up a lot of the
slack. For those purchasing individual insurance, costs have
skyrocketed, while employers have struggled to hold down
rates of their own group plans.

Replacing ACA: How Does That Look
So what can the government do to help? What does
'replace' look like? Given that discussions are focused on
ending not only mandates, but national coverage standards for
health plans as well, how will we improve coverage for less?
Ideas surrounding this topic are myriad, but the top five
currently being floated include:
1) Refundable tax credits for Americans who
purchase individual insurance. Similar to the ACA's
mandate, this alternative would have key differences. The
biggest would be a lack of income limits for receiving
government subsidies. Under this rule, individuals and
families would also be exempt from having to purchase
insurance through an exchange, would have more choice,
and would be free to purchase 'mini-med plans,' which are
less expensive but carry limited benefits. While a tempting
option for the young and healthy, this could be problematic
for older, sicker patients, who still run the risk of being
priced out of the market. It also may not solve the problem
of how to cover catastrophic costs.

M C M S P H Y S I C I A N 12 W I N T E R 2 0 1 7


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Table of Contents for the Digital Edition of MCMS Physician Winter 2017

MCMS Physician Winter 2017 - 1
MCMS Physician Winter 2017 - 2
MCMS Physician Winter 2017 - 3
MCMS Physician Winter 2017 - 4
MCMS Physician Winter 2017 - 5
MCMS Physician Winter 2017 - 6
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