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Is Supreme Court ACA Ruling Best for Physicians, Patients?


I know there will be good that comes out of the Affordable Care Act, but I am concerned that there will be repercussions that we are not prepared for.

Since the ruling on the Affordable Care Act (ACA), I’ve had several conversations about it with family, friends, and patients. Nobody seems to know everything that’s in it. Many know little bits and pieces. Everyone is concerned about the impact it will have on them as individuals and on us as a society.

People are pretty much in agreement that prohibiting denial of coverage due to pre-existing conditions is a good thing. The majority of people I have spoken to are against the mandatory purchase of insurance.

Let me give you an example. Let’s say you are a 28-year-old, non-smoker, no significant history, no family history of early heart disease or diabetes. How often are you going to see a doctor? Once a year for a check-up? Maybe you get the flu, or get a cut and need stitches. So if you had no insurance, you’d pay somewhere between $100 to let’s just say $2,000. If you have to purchase insurance, you’d pay $300 to $500 a month, still have copays, probably have a deductible of over $1,000, so you’d end up spending more.

Yes, I know, God forbid, something tragic happens and you’re not insured, but statistically, you are unlikely to benefit from being forced to buy insurance. Now let’s say, you are uninsured, then you’re diagnosed with high blood pressure. Well, so long as you cannot be denied coverage of a pre-existing condition, you get your insurance then. I have a patient who pays over $1,000 a month for her insurance for her and her husband. She has a $5,000 deductible. She has diabetes, which is pretty well controlled. She is on two meds. So she will never spend more than her deductible. So basically, she is paying for insurance that does not benefit her at all.

The other potentially good thing in the ACA is the closure of the “donut hole” for people with Medicare Part D. As an aside, let me tell you that people who have had Medicare D for years, still don’t understand the donut hole. “Why won’t my Medicare cover my insulin anymore?” It does, just not right now. “Medicare won’t kick in until January.” Yes, it will after so many dollars you spend. I really don’t think it should be my job to explain their benefits to them, but since they blame me for their expenses, I end up having to do so.

Again, I’ll admit, I don’t know all there is to know about the healthcare law. I do know that there will be good that comes of it, but I am concerned that there will be repercussions that we are not prepared for.

Find out more about Melissa Young and our other Practice Notes bloggers.

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