Will the Affordable Care Act survive?

Looking AheadThe number one question we see ourselves responding to the change in the presidency and the campaign promise regarding the Affordable Care Act. The issue we encounter is that most of the population doesn’t truly understand the scope of the Affordable Care Act and the complexity of the same. Even more important is the fact that it no longer can be an all or nothing scheme and that in our understanding there is no apples to apples comparison as we talk about this legislation. Let’s start with some basics. The Affordable Care Act was designed as a mechanism to provide healthcare insurance to most of the population in the USA. The fallacy of this vision is that healthcare insurance is not the same as healthcare services. Therefore, billions of dollars were used to create a mechanism that instead of increasing the number of facilities and Providers needed it created instead a mechanism to bolster health insurance sales. Insurance companies are no fools and they brought in some low monthly premium plans with high deductible and increase co-pays (do remember that this is but a summary of the situation and that the overall picture is quite complex in details). When you look at the math, healthy individuals ended up with an increase financial obligation with little in return. So, sick individuals, which increase the utilization costs joined and healthy individuals which were to carry the burden preferred to pay the taxes. End result, a financial loss that even the insurances cannot afford to carry for long. In other words, regardless of what the elected government decides to do the healthcare portion of the Affordable Care Act is on life support and probably wouldn’t survive anyway. On the other hand, there are other portions of the Affordable Care Act that affect healthcare professionals and Organizations that we don’t expect to go away. For example:

  • Section 1557 of the Affordable Care Act final rule was published on May 18, 2016.  The act prohibits discrimination in health care activities based on race, color, national origin, age, disability, and sex. The Act doesn’t apply to all healthcare Providers or organizations and offers a definition of Covered Entity that differs from HIPAA. The act also requires the ability to communicate with patients that are classified as non-english proficient in their native language.
  • Section 6401 of the Affordable Care Act provides that a “provider of medical or other items or services or supplier within a particular industry sector or category” shall establish a compliance program as a condition of enrollment in Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP). The basics of this required program may be summarized as the development of Policies and Procedures, training of workforce and activities to ensure compliance.

Based on the above we do expect portions of the Affordable Care Act to survive the new administration yet we believe that the “Obama Plans” are currently in the ICU (Intensive Care Unit) and do not believe they will be around by 2018.