Residency Insight -- A PRESENT Podiatry eZine

Ryan Fitzgerald, DPM
PRESENT RI Associate Editor
Hess Orthopedics &
Sports Medicine,
Harrisonburg, Virginia

The Patient Protection and Affordable Care Act

Over the last several months, Healthcare reform has become an increasingly hot topic, with both sides of the aisle accusing the other of misinformation and paltry sensationalism. However, as of March 23, 2010 and the signing of the president’s name on the bill, the healthcare reform act, also known as the Patient Protection and Affordable Care Act, has become law. There are many points of view regarding healthcare reform in general, and more specifically with this bill, which is now a law. Both its supporters and its critics loudly proclaim their points of view with equal vehemence and fervor.

As physicians, we find ourselves in an unusual position –we are both healthcare consumers as well as providers—and therefore, we will have to learn to deal with this new system, both as patients AND as doctors. There is much confusion over what will happen in the new system, both with reimbursement levels, as well as costs of coverage. Among issues that were not addressed in the current Patient Protection and Affordable Care Act is any significant element of tort reform to limit frivolous lawsuits, nor does the current act address the Title XIX concerns regarding the definition of “physician” for the purposes of Medicaid. Also excluded from the final bill was a provision to allow for the establishment of new student loan repayment opportunities. Regardless of your point of view on the topic of reform, members from both sides of the issue now find themselves in new, uncharted territory, leaving everyone with the same question: What happens now?

Listed below, are some of the more immediate changes that will go into effect over the next several years:

More Americans will be covered: A big chunk of the millions of American citizens who are currently uninsured will get coverage help in 2014. That's when state Medicaid programs will expand to cover people living between 133 and 400 percent of the federal poverty level. Subsidies will also kick in to provide affordable plans in new insurance marketplaces. Individuals and businesses can shop around to buy insurance on these "exchanges."

Many will be required to buy coverage: The bill requires most Americans to have insurance by 2014 or pay a penalty. Some people would be exempted from the insurance requirement, because of financial hardship or religious beliefs, or if they are American Indians, for example.

Children remain on their parents plans until age 26: Starting this year, dependent children could remain on their parents' health insurance plans until they turn 26.

Lifetime caps are gone: All existing insurance plans will be barred from imposing lifetime caps on coverage, and restrictions will be placed on annual limits on coverage as of this year. And insurers can no longer cancel a person's health insurance retroactively for things other than outright fraud.

Getting Rid Of Pre-Existing Condition Exclusion: Six months after the bill's passage, insurers will no longer be able to refuse children insurance because of pre-existing illness. By 2014, the same rule will apply to adults. In the meantime, people with pre-existing conditions will soon have the chance to enroll in special insurance pools and receive subsidized premiums.

Medicare Changes, the donut hole is gone: Senior citizens would get more help paying for drugs. The approximately 4 million Medicare beneficiaries who hit the so-called doughnut hole in the program's drug plan will get a $250 rebate this year. Next year, their cost of brand-name drugs in the coverage gap will go down by 50 percent.

More Coverage for preventative care: Preventive care, such as some types of cancer screening, will be free of copayments or deductibles starting this year. Medicare Advantage: A program that uses private firms to deliver Medicare benefits — will see sharp spending cuts starting in 2011.

Taxing 'Cadillac' Plans: For high-cost insurance plans, the health bill would tax insurers 40 percent on the amount of premiums above the thresholds. These plans are defined as costing more than $10,200 for an individual or $27,500 for a family (not including stand-alone vision or dental benefits). The tax would not be imposed until 2018. The goal is to generate revenue to pay for covering the uninsured and to make the most expensive plans—which some argue encourage overuse of medical care—less attractive.

Government Oversight of Insurers: Insurers will be required to report how much they spend on medical care versus administrative costs, a step that later will be followed by tighter government review of premium increases. And insurers will now have to sell policies to all comers at rates based on community averages, writes the New Yorker's James Surowiecki.

I am certain that each of you have an opinion regarding these recent developments in healthcare, and I would encourage you to share your point of view with your colleagues around the country through the eTalk thread currently discussing this topic.

We at PRESENT love hearing from you, and look forward to learning from you. I encourage you to post your interesting cases in the eTalk section of PRESENT podiatry to promote our collective knowledge. We look forward to hearing from you!