Since its enactment, the Affordable Care Act has been rife with opposition on both sides of the aisle, and it has undeniably created sweeping changes to the landscape of American healthcare. If the latest data can be believed, the law seems to have made healthcare more accessible for millions of Americans, and it also has created huge rate hikes which are expected to continue increasing in the coming years, even if no additional legislation is introduced.
This dissatisfaction with the Patient Protection and Affordable Care Act (PPACA, or ACA for short) was a reason why a cornerstone of President-Elect Trump’s presidential stump speech was the promise to repeal the act. But, whether or not repealing the act is functionally possible, or which portions of the act have become indelible, is up for debate.
Although we cannot know for sure what Trump’s administration will do at this time; we surmise that the parts of the Affordable Care Act that are unilaterally good for America will not be dismantled due to a variety of issues that have permanently etched the impact of PPACA on our healthcare system and functional business landscape. Let’s look at some of the Affordable Care Act’s provisions and discuss why they will survive in 2017 no matter what future legislation or lobbying efforts attempt to unwind one of the most important pieces of federal legislation in recent history.
Easing the Transition towards Electronic Healthcare
The Affordable Care Act was a major push towards electronic healthcare. The act acknowledges the growing antiquity of paper-based record methods: “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 or eliminate paperwork and administrative burdens, cut costs, reduce medical errors and most importantly, focus on improving the quality of care.”
It’s doubtful that a new administration will be able to halt progress towards further adoption of electronic healthcare system in clinical settings. Virtually every clinic has an electronic health record (EHR) system and practice management software already in place, and are reaping the many benefits of a nearly paper free work environment. Although doctors, nurses and office administrators often complain about the inefficiencies of information screens, few would trade this back in to wrestle with paper charting and filing. The only question that remains is the speed at which we move towards deeper integration of electronic healthcare technology from medical devices through the network and out to the myriad of touchpoints involved with a patient’s care – the lab technicians posting results, the clearing houses making payments, the medical staff making analysis and the patients reviewing everything from appointments to post-op on their smart phones. Most legislation includes provisions for electronic healthcare, perhaps most important is the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, that seeks to be the biggest step in moving away from fee-for-service payment models and transitioning towards value-based care. Electronic healthcare is a vital part of the value-based architecture and will continue to spearhead the transition.
Mandates on Value-Based Healthcare
The ACA was the first big step into incentivizing value-based healthcare, which is an ideology espousing payment for services based on the outcome or treatment and not frequency of treatment. Included in the Affordable Care Act is legislation mandating a patient-first, value-based healthcare system that put the priorities of the consumer first. For example, the way the Centers for Medicare and Medicaid Services (CMS) adjusts payments based on value through incentive programs like the Physician Quality Reporting System, is due to provisions within the ACA.
Will a new administration repeal the mandates towards value-based healthcare? No, value-based healthcare is here to stay. The value-based ideology of the Affordable Care has bipartisan appeal and is more efficient and cost-saving for everyone due to the way it improves healthcare while lowering costs. Recent data supports this: payment arrangements like capitation have been proven to be more financially viable for providers than the traditional fee-for-service system, and value-based healthcare has opened up new ways of treatment.
Rural healthcare is a great example. The ACA states: “Today, 68% of medically underserved 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.” More payments means more money for providers and insurance companies, and recent legislation like the Medicare Access and CHIP Reauthorization Act (MACRA), which are ideologically rooted in the ACA, include provisions to combat rural healthcare problems. Telehealth is one of the solutions that comes to mind. Value-based healthcare is already engraining itself into our healthcare system and will likely not change with a new administration attempting to set the clock back over a decade.
Increasing Access to Preventive Care
A key component of the ACA is making sure insurance plans include free access to preventive care. The law mandates that new plans “must cover preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance”, as well as providing free care for seniors. The law also “…expand the number of Americans receiving preventive care… provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost.”
Preventive care coverage is here to stay because payers are financially motivated to provide preventative care versus reactionary care. Preventative care is cheaper for payers and patients. Providing a mammogram at no cost to catch cancer in the early stages, is much cheaper than a relentless barrage of chemotherapy treatments. Preventative care improves patient outcomes and makes patients happier, also fulfilling the value-based mandates in legislation. Screening patients for healthcare indicators in their 40s and 50s allows for lower cost, early intervention treatment plans than expensive operations later on, and the patient enjoys many more years of thriving adulthood instead of retiring early due to an inability to continue as a viable work asset.
Final Thoughts on Healthcare in 2017
It’s safe to say that the Affordable Care Act cannot be repealed outright, at least not entirely with regards to the many positives it has embedded in the business of our healthcare ideologies. It will be amended in line with policies that coincide more closely with the President and his party’s way of thinking of the government’s role in providing healthcare for its citizens. Before becoming overly passionate about what this administration may bring to the forefront of healthcare legislation, we have to remember 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. Many of the provisions in the Affordable Care Act were almost place holders for already existing and independently accepted competitive market drivers that have forced more innovation in the business side of healthcare. Only time will tell the actual effect of forthcoming repeals or additions for PPACA, but we can rest assured the wisdom of healthcare’s business market drivers will remain undaunted by winds of temporal change.