Five top voices in emergency medicine talk about the pros and cons of the Affordable Care Act

Introduction

With some of its most hotly contested provisions now taking effect, the Affordable Care Act (ACA)—or Obamacare, as both backers and detractors now call it—has been the object of admiration and animosity, of optimism and consternation. Hailed by some as the most significant health-care reform in a half century, it has been roundly scorned by others as an ill-advised debacle.

Participants

Kevin Klauer, DO, EJD, FACEP, medical editor in chief of ACEP NOW and chief medical officer of Emergency Medicine Physicians

Alexander Rosenau, DO, FACEP, president of ACEP and senior vice chair of emergency medicine for the Lehigh Valley Health Network in Allentown, Pa.

Michael Granovsky, MD, FACEP, president of coding for LogixHealth

Todd Taylor, MD, FACEP, Veteran emergency physician, EMTALA and healthcare IT consultant

L. Anthony Cirillo, MD, FACEP, director of health policy and legislative advocacy for Emergency Medicine Physicians

Dr. Klauer: To jump in, what parts of the ACA are good, and what parts may positively impact emergency medicine?

Dr. Taylor: I think the good news is that there are some aspects that have already taken effect: children can stay on their parents’ plan until age 26; the controversial mandate for coverage of contraceptive services; the prohibition of denial for pre-existing conditions for children; prohibition from rescinding coverage; eliminating lifetime limits; regulating annual limits on insurance coverage; and that 80 percent to 85 percent of premium dollars, at least now for large employers, has to be spent on health care services.

The meat of the Act has not yet taken effect. Many of these extend to larger populations in 2014. The biggest is what’s called the minimum-coverage provision, otherwise known as the individual mandate. That requires most U.S. citizens and legal residents to maintain insurance coverage for themselves and their dependents, or they have to pay a 1 percent penalty of their total annual income or—at a minimum—$95.

It expands the pre-existing-condition prohibition to everyone, there are no annual limits on insurance coverage, it ensures coverage for clinical trials, and it adds mental-health and substance-abuse coverage for everyone—although this does not apply to Medicaid or Medicare. It expands prescription coverage. It provides preventative care, which is mostly free. It redefines pregnancy as preventative care, so it must be covered. Of course, that is under the terms of deductibles and coinsurance. And it caps the maximum out-of-pocket expense per individual at $6,350 a year, or $12,700 per family.

“So the jury is out. It’s going to be a long process that requires a lot of education, and the resources will have to be put there. We also have to be very careful not to create self-rationing or effective lack of insurance due to very high barriers of deductibles.”

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