Access to care

Edition: September 2012 - Vol 20 Number 09
Article#: 4063
Author: Repertoire

The good news stemming from the Supreme Court’s decision to uphold the Affordable Care Act is that as many as 32 million people who had up until now lacked health insurance will now carry it. But the big question is this: If those 32 million people avail themselves of more medical services than they otherwise would have, will there be enough healthcare professionals – particularly, primary care professionals – to care for them?

The Affordable Care Act does indeed offer hope to primary care physicians, primarily through programs that reward providers for delivering high-quality care, such as the Comprehensive Primary Care Initiative and accountable care organizations, says Robert Doherty, senior vice president of governmental affairs and public policy, the American College of Physicians, writing in the organization’s magazine, the Annals of Internal Medicine. (Efforts by Repertoire to interview Doherty were unsuccessful.) He is also upbeat about provisions in the law that prohibit insurers from denying or limiting coverage, and that encourage research on the effectiveness of different treatments.

But the Court’s decision – as well as the Affordable Care Act itself – present continuing challenges to providers, says Doherty. “[P]hysicians are concerned that the [Affordable Care Act] did not eliminate the Medicare Sustainable Growth Rate formula, which has resulted in scheduled cuts in physician payments every year since 2002, even though the cuts are typically overridden by Congress,” he writes. “Many are concerned about the administrative burden of reporting for so many programs, from Medicare e-prescribing to ‘meaningful use’ criteria for electronic health records, to the Medicare Physicians Quality Reporting System, and the penalties they will incur if they do not satisfy the performance metrics.”

Doherty is also concerned that the Supreme Court’s decision about Medicaid could undermine the effectiveness of the Affordable Care Act. The Court ruled that the federal government could not – as the law provided it could – withhold funding for Medicaid to those states that elected not to extend Medicaid coverage to all persons with incomes up to 133 percent of the federal poverty level. “[I]n states that decline to enroll their poor in Medicaid, a law designed to cover nearly everyone could end up extending coverage to everyone except the poor – an unfortunate detour on the road to universal coverage,” Doherty writes.

Community health centers

One sector of the industry that is playing an increasingly important role in caring for uninsured people are community health centers. These centers – which service patients on a sliding fee scale basis – serve more than 20 million patients in 8,000 locations, according to the National Association of Community Health Centers. Their mission will remain largely uninterrupted, thanks to the Supreme Court decision, says NACHC President Tom Van Coverden.

The Court’s decision “means that in the years ahead, millions of newly insured people, and communities identified as medical shortage areas, will gain access to doctors, nurses and other health care professionals, and the quality, cost-effective primary and preventive services our health centers provide,” said Van Coverden in a statement.

However, as did Doherty, Van Coverden expressed disappointment in the Court’s decision regarding expanded Medicaid coverage. “This potentially leaves some of the 16 million eligible low-income people with no affordable coverage alternative, and it possibly denies many of these hard-working Americans the security of having insurance for their health care needs, no matter how complex or serious they may be.”

The Medicaid question

Indeed, questions surrounding Medicaid’s future are many. One month after the Supreme Court’s decision, the Congressional Budget Office predicted that that portion of the decision forbidding the federal government from coercing the states to expand their Medicaid rolls could result in 6 million fewer people being covered by Medicaid and the Children’s Health Insurance Program (CHIP) by 2022. But since an additional 3 million people are likely to receive subsidies through the newly formed health insurance exchanges, a total of 3 million more people are expected to be uninsured than when the Affordable Care Act was formulated.

“The real issue to be faced now is what will happen in the states, given the fact that they do not have to implement the Medicaid expansion,” says Michael Paquin, president, MDP Group, Thousand Oaks, Calif. “The law never did anything to address the financial shortfall in the Medicaid program. Now states will approach it in different ways.

“This is an area that will need to play out. Even in a presidential election year, when people talk a good story but usually do not act, governors will have no choice but to act here, and not necessarily along party lines, as finances will trump politics.”

“The next question that remains is whether the states opt out for the Medicaid expansion,” says Rita Potter, director of managed care, The Nebraska Medical Center. “The Nebraska Medical Center is number one in the state for carrying for volume of Medicaid patients. At the moment, Nebraska is one of the states whose governor is wanting to opt out and not expand coverage. We continue to watch how the rest of the country will address this issue state by state.”