Ten Ways Obamacare Could Impact Patients, Emergency Departments, and the Physician Workforce
By Todd Taylor, MD, FACEP, and Kevin Klauer, DO, EJD, FACEP
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on March 6, 2014
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- The Congressional Budget Office (CBO) estimates that 2.5 million people will leave the workforce over the next 10 years due to the Affordable Care Act (ACA). They will reduce their work hours or quit altogether.
- Insurers have been advised that they do not need to cancel policies in 2014.
- As of Dec. 28, 2013, just 11 percent of people signing up didn’t have insurance previously.
- ACA now requires more comprehensive coverage whether people need it or not (eg, a 60 year old now must carry maternity and pediatric coverage). Fortunately, it also covers mental health, which people may need when they see their new premiums.
- Most of the low-deductible plans (especially in the silver variety) have sizable co-pays, coinsurance, special fees, and the maximum allowable out-of-pocket costs ($6,350 for an individual).
- EDs (and most other providers) will find they now must get the majority of their payment directly from patients. So, even though patients are insured, EDs still have to track down payment from individuals—particularly before they’ve met their deductibles.
- Most people who do not qualify for a government subsidy will now pay more for health insurance on average.
- ACA makes health insurance available to everyone with taxpayer-funded subsidies, but due to high first-dollar coverage, the vulnerable group remains functionally uninsured.
- Patients who cannot find in-network care due to a lack of availability will likely come to the ED.
- On-call physicians will likely send patients back to the ED when they show up for follow-up and are not in-network or cannot pay their deductible.
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