Life After The Affordable Care Act: What’s Next?

After the ruling by Judge O’Connor, the proponents of The Affordable Care Act plan to appeal the verdict. They are claiming that repeal will mean the end of coverage for patients who currently have plans, and that the repeal will mean the end of coverage for pre-existing conditions. Both are simply not correct.  What does repeal of ACA really mean for the future of healthcare?

People who have the ACA will continue to have coverage

• There is an injunction which leaves the current coverage in place. No changes will likely happen until the appeal moves through the courts. The final stop will likely end in the Supreme Court. In short, if a patient is currently covered they will not lose coverage.

• Even if the verdict is left in place and Obamacare ends. The patient will likely be covered under Medicaid since the ACA was simply Medicaid for all. The federal subsidies may be discontinued, however, it will fall to the individual state to figure out how to pay for the Medicaid expansion. The cost of the premiums for state run Medicaid will likely be much less than what patients were paying under the ACA. In addition, taxpayers will save money because the states will not have to bear the cost of payment for the federal subsidies which were scheduled to have ended under the tenets of the ACA. 

People will lose coverage for pre-existing conditions

• Pre-existing conditions were covered by Medicaid, Medicare and commercial insurance before the ACA went into effect, and they will continue to be covered. Most pre-existing conditions are common manageable illnesses such as high blood pressure, diabetes and asthma. Running up to the passage of the law, there was and continues to be a conflation of pre-existing conditions and catastrophic illness such as cancer and stroke. It was a tactic designed to gin up fear and it worked. It is being used again. Catastrophic illness will continue to be covered by Medicaid and Medicare if the ACA ends. 

After passage of the ACA two of the main promises never materialized. Healthcare was neither affordable nor accessible, and as a result the goal of universal coverage didn’t happen. The reason:

• Out of pocket healthcare costs for patients continued to increase

• Access to physicians decreased due to both restrictive panels and physician unwillingness to accept restrictive coverage which affected patient care and reimbursements which were not compatible with staying in business

• The exchanges closed and less people signed up with each successive year after the passage. 

Repeal = opportunity

Maybe it is time to admit that the passage of the ACA on Christmas eve with the support of only one party was the wrong way to go about reforming something that affects every American and controls one-sixth of the economy. Whether someone is for single payer/Medicare for all or consumer driven healthcare. The problem of the true costs of healthcare need to be addressed first. We need to have Congress actually listen to practicing physicians and patients who have been on the front line and have suffered. Patients have been priced out of the healthcare system and some cannot afford medication or to even to see a doctor. Physicians have been driven out of private practice and have lost the most important thing that underpins the doctor patient relationship – time and the ability to provide their patient with individualized care. We now have a chance to truly examine and cure what is ailing our healthcare system. It is time to remove the regulations, the middle men (eg., pharmacy benefit managers, group purchasing organizations) and the legislation that makes gouging, lack of transparency, and corporate self interest at the expense of patients legal. The physical and financial health of America depend on it.