Prior to the primary election, I was sitting at the Welcome Inn in Larned listening to Dr. Marshall stump for a Congressional seat. He talked about the Affordable Care Act (Obamacare) and, in very general terms, said that it has got to be replaced because of failed promises and the impact it was having on doctors and their practices.
Most of us dont know that the ACA was a massive restructuring of the healthcare industry (probably more so than any other industry in the USA) including: a multitude of new taxes in order to pay for the restructuring (the Supreme Court upheld it as a tax law); new diagnostic and treatment codes (an increase from 14,000 to 69,000 codes); established a monitoring and reimbursement process for how much insurance companies can charge for insurance and limited how much can go toward overhead and profit; Medicare/Medicaid reimbursement is being changed from the fee-for-service modelin which providers are paid for each treatment, test and office visit to one that compensates providers on quality of care with performance measurement standards and reporting requirements (it required the creation of new organizations called accountable care organizations); the creation of a whole new level of bureaucracy called health insurance exchanges/marketplaces; established new penalties for non-compliance which inflated the number of federal employees needed to monitor and assess and enforce penalties.
Regarding the impact on doctors, the ACA provided very little support, especially for those in private practice, who were faced with the new coding requirements and a huge number of new reporting requirements and paperwork. Some doctors now spend 25% of their time filling out forms and rechecking codes. The Federal Government estimates that 87% of solo practices will suffer up to $300 million in penalties for non-compliance or for not filling out the forms correctly. In addition, due to the changes in Medicare/Medicaid regulations, the number of doctors who limit or refuse to see Medicare/Medicaid patients has increased from 8.6%/26.7% in 2012 to 25%/38% in 2014. Even more regulations went into effect Jan. 1, 2017. As one consultant warned, the ACA will be the unraveling of private, independent practice. Statistics are bearing this out. A survey by the Physicians Foundation shows that the percentage of doctors working in practices owned by a hospital or integrated delivery system increased from 24% in 2004 to 53% in 2014 while the number of doctors in independent practice decreased from 62% in 2008 to 35% in 2014. Together with new requirements for Electronic Medical Records under the American Recovery and Reinvestment Act, these regulations are driving small medical practices out of business.
When Congress was considering the ACA, were told that no one knew what was in the details of the law. Lets pass it and find out if it works. Little did most of us know that the ACA did more than simply make insurance premiums affordable and take away preexisting conditions. It was a massive restructuring of the healthcare system in the USA because bureaucrats believed they knew more about healthcare delivery than frontline doctors. Unwinding it will be a formidable challenge for Republicans.
Good luck to Dr. Marshall as he assumes his new duties in Congress. Good luck to Congress and the new President as they replace the ACA with something better.