Patients Concerned About Care After Supreme Court Decision

July 13, 2012

From what insurance I'll take to questions about Medicare, my patients are starting to ask about the impact of the ACA on their care.

Unless you have been hiding under a rock for the past two weeks and not paying attention to any of the recent news, there is no doubt you have heard a great deal about the impact of the Supreme Court's recent decision in favor of upholding the constitutionality of the Affordable Care Act (ACA). In my practice, my patients have not asked me directly what I think or how I feel about the recent decision. They are very aware of my very conservative approach to the treatment of their medical problems and I am sure most have assumed that they can guess what my opinion regarding the recent decision is.

Without injecting political bias into the content of this week's posting, I will relay some of the concerns of my patients regarding the recent 5 to 4 decision. As each of my working class patients have come and gone for the past two weeks, most have exhibited their dismay regarding the vote. The general consensus of my patients has been that the ACA decision will have a tremendous impact on their costs of healthcare. By now, we all understand that the ACA will be funded by large tax increases on the working population. My patients are very concerned that the increased costs being passed on to them in the form of taxes will decrease their take-home income. They are also very concerned regarding the increasing costs of their healthcare insurance premiums and out-of-pocket copayments.

The population of my patients that are the most concerned and worried about the approval of the ACA are my retired patients receiving Medicare benefits. This population of patients has worked for a great deal of their lives and they have paid into the system in the way of taxes and now they fear the cherished Medicare benefits they have worked so hard for will be in jeopardy. At the top of their concern would be the fact that our legislators plan to funnel approximately $500 billion from the Medicare system into the fund to provide relief for premiums of ACA beneficiaries. They are very concerned that their care will ultimately be rationed due to the fact that there will just not be enough physicians to care for the increased number of newly insured persons entering the healthcare system.

The next question I am most often asked is whether or not I will accept new patients that will have insurance plans provided by the ACA benefit. My consistent answer to my patients is that I plan to continue to offer services and care to my existing patients as I have for almost nine years. I do not plan to remove any patients from my existing panel of patients - period.

However, the logistical problem that our legislators have failed to grasp is that the large majority of physicians are already working as hard as we can to provide care to our existing patients. How are we to continue to provide the same high level of care to our existing patients and openly welcome new patients into our existing practice. Further, if the Medicare reimbursements to physicians are decreased, how are we to continue operating our practice and maintain vitality for the staff that I employ? This will result in physicians being reluctant to accept new Medicare patients. It will also result in physicians being reluctant to accept Medicaid patients whose care will be reimbursed at a fraction of what Medicare and commercial insurances are presently providing.

I fully understand that our healthcare system is in need of modification. The payment system under which we operate is flawed and does not adequately provide payment based on the quality of care. However, the tremendous scope of change that we will be forced to embrace as a result of the ACA will not improve patient care or the outcomes. I am thankful that I am not a legislator during times such as this. However, when change is being forced upon us, I can certainly say that it would have been very nice if our lawmakers would have solicited the input and contributions of those of us in the workforce prior to the enactment of such legislation.

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