With the HealthCare.gov site going down in flames at launch, it may have seemed that the entire Affordable Care Act was on the rocks. Admittedly, the spectacular failure of the site has been terrible for the morale of everyone who had a reason to touch the system, and the fact that it's still far from perfect isn't exactly an upper.
That being said, it's easy to forget that HealthCare.gov is just a website (albeit a very important one). In looking at how the ACA is shaping up, it's important to bear in mind that one way or another, consumers will get enrolled in exchange plans and bring those plans into the health system.
So, this is a good time to stop and take a look at what we know (or think we know) about the effect of the ACA on healthcare providers, as they'll be the ones who have to piece together how these plans work. And so, from our research to date, I'd say we know the following things to far:
1. GROWING DEDUCTIBLES
Most healthcare exchange plans will have very large deductibles. If consumers choose the cheapest bronze plan, the deductible will fall somewhere in the $2,500 to $5,000 range, plus co-pays on services in the 40% range.This isn't great news for providers.
2. NEW INDIVIDUAL PLANS
More insurers are offering individual plans, with about one-third of insurers which are on the exchanges offering individual plans for the first time.
3. POLICY CANCELLATIONS
Despite White House promises to the contrary, millions of policies are being canceled by insurers—almost a million in California alone—because they don't meet ACA requirements.
4. REIMBURSEMENT SIZES
Reimbursement under ACA plans will be higher than Medicaid but lower than under standard commercial plans.
5. WITH ONE EXCEPTION ...
In emergency departments, however, reimbursements are likely to improve under ACA plans
With such a mix of pluses and minuses, it's hard to tell whether the ACA will offer a net gain to providers, but my vote is that when things shake out, more people will get more care and more providers will get paid. If so, it's not a bad bargain after all.
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