Though the Affordable Care Act has seen its fair share of controversy, the law has had a huge impact on American healthcare. We’ve seen the law make healthcare more accessible for millions of Americans, and also create huge rate hikes which are expected to continue increasing in the coming years.
The huge rate hikes, as well as the other downsides of the Affordable Care Act, is a reason why President-Elect Trump has promised to repeal the act. Whether or not repealing the act is functionally possible, or which portions of the act have become indelible, is up for debate.
Because of the bipartisan appeal and the way many aspects of healthcare are already engrained in the architecture of healthcare, I believe that parts of the Affordable Care Act will not be dismantled. Here I take the list of Affordable Care Act’s provided by the Department of Health and Human Services (HHS) and discuss why they will survive in 2017.
- Appealing Insurance Company Decisions. The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process
Why It Will Continue: An important Consumer Protection provision that will stay because internal market forces incentivize the ability for an external review process. Health insurance companies compete for business, and by providing better levels of service for enrollees, they are able to out-compete their competition. By providing a plan that includes a review process, it’s easier for insurance companies to gain enrolees, versus other companies that don’t have such a process. The provision simply makes a process like this official.
- Paying Physicians Based on Value Not Volume. A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care.
Why It Will Continue: This provision ties in with the value-based paradigm shift we are seeing. From the continual updates to quality reporting systems, to MACRA (Medicare Access and CHIP Reauthorization Act), we are seeing an avalanche of processes and legislation towards value-based outcomes. The provision is another step in the goal of shifting away from volumetric-based payment systems.
- Providing Free Preventive Care. All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance. Effective for health plan years beginning on or after September 23, 2010. Learn more about preventive care benefits. See the full list of covered preventive services.
Why It Will Continue: This bullet point encompasses many different provisions about free preventive care, from state Medicaid preventive care laws, to laws specifically about seniors. These provisions will likely stay because payers are financially motivated to provide preventive care versus reactionary care. That is, it is more profitable for insurance companies to provide preventive services rather than continually react to crises in healthcare. Screening for cancer with mammograms is more inexpensive than rounds of chemotherapy treatment.
- Encouraging Integrated Health Systems. The new law provides incentives for physicians to join together to form “Accountable Care Organizations.” These groups allow doctors to better coordinate patient care and improve the quality, help prevent disease and illness and reduce unnecessary hospital admissions. If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save.
Why It Will Continue: Accountable Care Organizations provide competitive advantages for both patients and physicians. They offer better accessibility, care and coordination, and higher quality care at lower costs. Physicians will continue to join ACOs, regardless of the provision, it just makes them more likely to.
- Reducing Paperwork and Administrative Costs. Health care remains one of the few industries that relies on paper records. The new law will institute a series of changes to standardize billing and requires health plans to begin adopting and implementing rules for the secure, confidential, electronic exchange of health information. Using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and most importantly, improve the quality of care. First regulation effective October 1, 2012.
Why It Will Continue: The move towards electronic health records (EHRs) has already begun—nearly every clinic utilizes one now. The initiative to further develop the electronic healthcare is driven by both recent legislation and the healthcare industry.
- Increasing Payments for Rural Health Care Providers. Today, 68% of medically undeserved communities across the nation are in rural areas. These communities often have trouble attracting and retaining medical professionals. The law provides increased payment to rural health care providers to help them continue to serve their communities.
Why It Will Stay: Incentivizing payments for rural health care providers opens up opportunities to explore new avenues of healthcare technology—telehealth comes to mind. Rural health was a talking point on the recent MACRA legislation, and we will see continued effort to combat rural health problems.
- Putting Information for Consumers Online. The law provides for where consumers can compare health insurance coverage options and pick the coverage that works for them.
Why It Will Continue: A new administration was likely not change this, as it already happens through government websites.
Final Thoughts on Healthcare in 2017
Because provisions in the Affordable Care Act are deeply embedded into our healthcare system, the act cannot be repealed entirely. It can, however, be amended. We are already seeing pushes to repeal Medicaid expansion in favor of block grants on the state level. Keep in mind that many of the provisions in the ACA – like preventing the denial of coverage based on preexisting conditions – have bipartisan appeal and are in general, good for America. A lot of what’s in the Affordable Care Act are independently driven by market drivers in the industry, and will continue to persist regardless of legislation. Only time will tell in this tumultuous healthcare climate, but we can be sure that everyone is looking towards a value-based outcome industry.