Pending repeal of the Affordable Care Act: What you need to know

By Gary S. Kaplan, MD, Chairman and CEO, Virginia Mason Health System

With a pending repeal and replacement of the Affordable Care Act (ACA) by President Trump and the Republican-controlled Congress, there has been a lot of discussion about the potential impact of a repeal on patients, health care providers and insurers.

Much of the discussion has focused on well-known provisions of the ACA, such as the roll-back of Medicaid, the requirement that all citizens and legal residents have health insurance and the guarantee that all people can buy coverage regardless of pre-existing conditions. But there are lesser-known provisions in the law that could end as well if the ACA is repealed. For example:

Coverage for preventive services

The ACA requires almost all health plans to cover the cost of preventive care services without charging patients a co-payment or co-insurance or requiring them to meet a deductible. Preventive services that are completely covered under the ACA include wellness visits for all family members, cancer screenings such as mammograms and colonoscopies, and immunization vaccines for adults and children, including annual flu shots.

Incentives for high-quality, well-coordinated care

The ACA contains several provisions that target longstanding problems in the health care system around cost, quality and patient satisfaction. These include initiatives that reward health care providers for higher quality care, effective care coordination and better clinical outcomes. Results so far are hard to gauge, but overall the incentives are an important step in the right direction.

Lower hospital rates for low-income families

The ACA requires hospitals to charge lower rates to patients who are eligible for their financial assistance programs. It also requires all nonprofit hospitals to publish a written financial assistance policy online that clearly states whether the hospital offers free or discounted care along with a clear statement of the eligibility requirements.

Supporting the health of the community

The ACA requires nonprofit hospitals to conduct a community health needs assessment every three years for the area the hospital serves. The process requires seeking broad community input on factors that influence the community’s health or emergency preparedness. Nonprofit hospitals also have to develop and report their strategy – updated every year – for improving the health of the surrounding community.

Affordable health insurance

The ACA makes health care insurance available to individuals who cannot get affordable coverage any other way. The result is that we have seen tremendous progress in expanding insurance coverage, particularly in states such as ours that chose to expand Medicaid eligibility to individuals with incomes at or below 138 percent of the official poverty level. Here in Washington, more than 600,000 people have enrolled in Apple Health as part of the Medicaid expansion. Statewide, the uninsured rate has dropped significantly, from 14 percent in 2013 to just 5.8 percent today.

The features of the ACA that I’ve mentioned above are just some of the many ways our health care system has been significantly improved by the ACA. While there is certainly room for further improvement in the way health care is financed and delivered, let’s not roll back the progress that has been made.

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