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AFFORDABLE CARE ACT :
Exit , Stage Right
The Affordable Care Act ’ s days appear to be numbered – what will health care look like in a new administration ?
The rollback of the Affordable Care Act ( ACA ) is underway . Within hours of taking the oath of office on January 20 , President Donald Trump signed an executive order that undermines enforcement of Former President Barack Obama ’ s signature legislation . Just a week earlier , the GOP-led Senate and House voted to start the process of repealing the ACA using the reconciliation process ( see SIDEBAR on page 39 ). It ’ s safe to say the ACA is being shown the door .
If the ACA is successfully repealed , what will take its place ? There seems to be little agreement on that matter , as well as on how a new health-care system will affect insurers , physicians , and patients . Will the next version of American health care indeed be a total replacement of the ACA , or just a reshaping to accommodate more conservative views ? Could the United States – the only one of the 34 counties included in the Organisation for Economic Co-operation and Development ( OECD ) without universal access to health care – finally find a way to provide “ insurance for everybody ,” one of President Trump ’ s stated goals ? And , perhaps most importantly , will the replacement come swiftly enough to prevent the panic and chaos that might erupt when the current system is revoked ( or falls apart because of uncertainty , defunding or lack of enforcement )?
Here , ASH Clinical News attempts to gain greater clarity on a markedly unclear and complex process , and to understand how these potential changes could affect hematologists and their patients .
ACA and Hematology
The passage of the ACA has been credited with bringing health insurance to an estimated 20 million previously uninsured Americans , dropping the country ’ s uninsured rate from 16 percent to 9 percent . 1 Still , in an era of hyperpartisanship , the ACA has faced a difficult implementation , and half the country has rejected it , citing its failure to stop insurance companies from limiting access to health care and raising premiums and deductibles . From multiple perspectives , though , the ACA has benefitted patients with blood disorders through Medicaid expansion and insurance exchanges . These diagnoses frequently carry high price tags and require intensive follow-up ; the ACA helped by prohibiting insurance companies from limiting coverage or denying coverage based on pre-existing medical conditions and by eliminating lifetime caps on payment .
Anecdotally , Joseph Alvarnas , MD , chair of ASH ’ s Committee on Practice and director of Value-Based Analytics at City of Hope National Medical Center in
Duarte , California , has witnessed how the ACA has improved the delivery of services to hematology patients . “ When I speak to my colleagues , both from City of Hope and at Kaiser Permanente or Kaiser partner facilities , we talk about how expanded coverage has improved care – people are getting diagnosed earlier , referral patterns are more timely , and delivery of care is more consistent .”
Because the ACA is so new , though , there are few data to unequivocally support these assertions . He noted that , “ given the nature of how portions of the ACA were implemented , it ’ s hard to see complete and universal improvements in care access and subsequent care delivery for patients with blood disorders .”
A few of the legislation ’ s promises have fallen flat . The out-of-pocket maximum limits provision , for instance , promised to cap the amount of money an individual would pay for covered services in a year ; however , “ loopholes ” in the provision have compromised its effectiveness . First , these limits apply only to “ essential health benefits ” ( the 10 categories of coverage all insurance policies must include ) and do not include many of the costs incurred by patients with hematologic disorders , including monthly premiums , balance billing amounts for non-network providers , and the money spent on some medications .
38 ASH Clinical News February 2017