The Affordable Care Act (ACA) or Obamacare has been a hotly and partisan contested program since its introduction and now with the upcoming Republican Congress, House of Representatives and President who have discussed eliminating the ACA, there are many questions about what will happen. Basically, what will happen to the ACA once President Obama leaves office?
Already, President-Elect Trump seems to have pulled back from his ACA repeal stance. Certain elements of the ACA will remain such as the shift to Value-based provider reimbursement. This allows payers to pay less to providers (improve profit/savings) as “lack of value” results less than 100% provider reimbursement. This sounds good in a naïve kind of way; however, the patient’s satisfaction controls 25% of the reimbursement to their provider whose business has a very narrow margin. Imagine telling your car dealer that you thought the car and the salesman were average so you only should pay 87.5% of the final sales price of the car.
Another problem with the ACA is that the insurance is not affordable. Premiums are skyrocketing (this was predictable from the start) and deductibles are in the thousands of dollars. 62% of Americans have less than $1,000 in savings which means that either people avoid care or the provider network has to pay to provide care to the patient.
Additionally, ACA success was predicated on young healthy people enrolling and never using their insurance. However, more than half of Americans state that they can’t afford to pay over $100 per month for health insurance. Millennials were more apt to state this then other groups. Of interest is that 90% of households have a car and monthly car insurance premiums can easily exceed this amount.
Preventive health initiatives and patient engagement and ownership by the individual in their health is crucial to any effort to improve the population’s health while decreasing the cost of health care.