![]() ![]() What changes will physicians begin to feel?ĭoctors who treat more Medicare patients will feel these changes the most. Doctors who achieve the best outcomes with the lowest total insurer and patient spending – including spending for services such as hospitalization and drugs – will be paid more favorably than other physicians. It will gradually shift incentives and payments away from rewarding volume of services to rewarding value. How will Medicare payment change for physicians? Its primary beneficiaries are non-affluent Americans who previously made too much money to qualify for Medicaid, but didn't earn enough to afford health insurance coverage. It gives non-affluent Americans a means of affording health insurance, and it sets into motion changes in how physicians and hospitals are paid by Medicare. The ACA was created for two primary purposes. What is the purpose of the Affordable Care Act? We sat down with Arnold Milstein, MD, MPH, who has been at the forefront of federal health policy changes over the past 15 years, to understand how physicians at Stanford will be affected in the years to come. But now that the Supreme Court has upheld the constitutionality of the health care reform law, what does it mean for the physicians and hospitals charged with delivering medical care under this new payment system? The Affordable Care Act has given them exactly that. We need to find ways to blend health, housing, transportation, social services and other items to reduce the need for costly medical services, he writes.There is nothing the news media like more than an ugly bipartisan debate. The ACA should focus more on the “upstream” determinants of health – beyond just medical services.Premium support would enforce a long-term budget for Medicare by allowing greater control of the beneficiaries themselves, as opposed to imposing payment and price controls it would also accelerate innovation in the design and pricing of Medicare services. Replace the Independent Payment Advisory Board with a premium support system for Medicare.Equalizing the subsidy structure for exchange plans and the tax treatment of employer-sponsored benefits, more employees would go on the exchanges which gives them greater choice and portability. The exchanges need to be the primary vehicle for health insurance – not Medicaid expansion.The Administration has made a serious mistake in dragging its feet and acting overly restrictively with states who could launch their own bold and far-reaching experiments, as it has itself in encouraging conservative states to expand Medicaid under the ACA. States should apply for waivers under Section 1332, which takes effect in 2017 and gives states flexibility to meet the law’s goals while retaining its basic protections. Increase federalism in the healthcare system.One suggestion is a modification of the Cadillac tax that makes any excess plan costs above a cap be considered taxable income to the employee, as opposed to an excise tax. While better than nothing, it doesn’t confront the underlying problem of health insurance being tax deductible, which is regressive and inefficient. Congress must continue income-related subsidies while making coverage affordable to both households and taxpayers, which is “no easy task” because it could drive up costs of the ACA considerably. Subsidies still leave plans too expensive.Six key areas in the ACA are flawed - and need to be fixed if healthcare reform is to meet its promise and not have rampant cost problems: Furthermore, the Congressional Budget Office (CBO) has estimated that over the next decade, as the population increases, coverage will expand only modestly and the proportion of the uninsured will cease to decline. Secretary of Health and Human Services Sylvia Burwell sharply adjusted down projections of new exchange enrollees in 2016 to 1.3 million. Much of the progress made under the ACA expanding healthcare coverage to the uninsured has been thanks to increased enrollment in Medicaid - not the exchanges - a harbinger of even less progress to come. Obama’s essay marks the first time a modern sitting president has had a piece published in the journal. Given the lackluster healthcare exchange enrollment numbers, unaffordable coverage, and increasing overall healthcare costs, President Obama is wrong to think the Affordable Care Act (ACA) needs just a few tweaks – its most fundamental aspects need to be rethought. ![]()
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