One of President Donald Trump’s big rally cries during his campaign was that he was going to get rid of Obamacare, and the new president seems to be getting his wish. On March 6, House Republicans released legislation to repeal and replace the Affordable Care Act (ACA) with its American Health Care Act (AHCA).
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The new bill looks to change how healthcare is financed for people who do not have insurance through their employer, and would eliminate the mandate requiring all Americans to carry health insurance.
“Primary care physicians may suffer the most as people covered through these ‘bare bones,’ high-deductible plans or who are left uninsured devalue paying for ‘healthy’ or preventive care and instead feel they must wait until they get very sick or injured to spend their hard-earned dollars on health care,” says Timothy Hoff, a professor of healthcare policy at the D’Amore-McKim School of Business, at Northeastern University in Boston. “As Medicaid expansion also grinds to a halt through the ACA repeal bill, doctors working in inner-city and rural areas particularly will be faced with having to say goodbye to existing patients with whom they have established relationships.”
Jim Stone, president of The Medicus Firm, a national physician search firm based in Dallas, Texas, notes it’s difficult to pinpoint what the AHCA’s impact will be on physicians, as there are still many questions and key pieces of information that remain unclear.
“One of the most important uncertainties is how the AHCA legislation would impact the quantity of people who are covered with healthcare insurance,” he says. “Not only is this important from the patients’ perspective obviously, but this in turn could impact physicians in terms of their patient load and patient mix, as well as impacting their reimbursements.
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“Many healthcare analysts and experts have determined that the AHCA would decrease the amount of Americans covered by health insurance,” he continues. “If that is the case, that could also cause a shift in patient loads from primary care back to emergency rooms.
Barbara B. Tobias, MD, medical director of the Health Collaborative, a Cincinnati, Ohio-based nonprofit focused on improving healthcare, says physicians in Greater Cincinnati understand that the community prospers when everyone is healthy, and access to healthcare is a critical piece of that. That’s why there’s a need to carefully evaluate what the right incentives are so that there aren’t additional barriers to health for physicians, hospitals and the diverse population they serve, she says.
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“Levers like flexible savings accounts, higher premium rates for older adults and high deductibles often discourage people from seeking the right kind of care to keep them healthy and out of emergency rooms later,” she says. “Provisions like this found within the Republican ACA replacement plan, coupled with the proposal to restructure the Medicaid program, creates uncertainty for physicians in ensuring there are no disruptions in care for all who walk through our doors.”
Millions may lose coverage
Many of the nation’s leading hospital and doctor groups are lining up against the new bill, saying they fear millions of Americans will lose coverage.
Hoff says for physicians in an inner-city or rural area, the new rules could cause meaningful numbers of patients to stop coming in because they cannot afford to pay or because they have lost their insurance.
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Simon Lorenz co-founder of Klara, a New York-based healthcare communications platform, notes physicians should take this time to do a practice audit and focus on easy marketing campaigns like digital appointment reminders to boost visibility.
“This repeal may affect their bottom line, especially outside of major cities with high-traffic. Depending on the demographic of your patients, some may dropout due to lack of coverage or misunderstanding/fear regarding the new plan,” he says. “They should plan ahead to boost new patient acquisition and encourage existing patients to return.”
Changes in Medicaid
The American Medical Association are one of numerous medical groups that are weary over the GOP bill, in part because of its aim to eliminate the funding for Medicaid expansion.
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Wayne Lipton, founder and CEO of Concierge Choice Physicians, a concierge group with more than 200 affiliate physicians in 23 states, notes that for doctors who care for large Medicaid patient populations, millions would no longer be covered under the new legislation.
“Those with high-risk illnesses will potentially have to pay more if they have interruptions in their insurance, and thus, may end up uninsured,” he says “Many doctors will be facing more bad debt. For most practices, the issues will be far less than for hospitals, who will be facing much more losses because of unreimbursed healthcare. Emergency rooms may again become packed with the uninsured, impacting those emergency departments, their budgets and the physicians who work there.”