Central Texas Doctors Weigh In On Advantages, Downsides

of Affordable Care Act
by J. Bergamo; KVUE; 9/16/13

2014 will change the face of health care in America. KVUE News looks at the pros and negative aspects through the eyes of those Central Texas physicians who may know the Affordable Health Care Act the best.

Bruce Malone, M. D., is the past president of the Texas Medical Association. James Rohack, M. D., is the director of Scott & White's Center for Healthcare Policy. Ari Brown, M. D., is a pediatrician with 411 Pediatrics, author and spokesperson for the American Academy of Pediatrics. They talk about their opinions on many of the advantages and concerns the plan has to offer.

When it comes to health insurance, "In the United States if you do not have health insurance coverage, you live sicker and you pass away younger," stated Rohack.

In an effort to expand health care coverage to all Americans, Congress passed the Affordable Care Act in 2010. Some parts are already implemented, but the bulk of it becomes a reality in 2014.

"I believe the individual who is uninsured -- especially those who are uninsured due to preexisting problems -- they're the big winners," said Malone.

"The person who has coronary disease, or the father or mother that's got a child with cystic fibrosis and needs to get health care insurance -- they will be able to get that by means of the health insurance marketplace that will become available October 1," said Rohack.

October 1 through March 31 is an open enrollment period. It's the time when the uninsured, or those who choose to break away from their company-provided health plan, can turn to the federal exchange.

"The exchanges are going to be a different institution in medicine," said Malone. "It's going to be a mechanism where you can go online and shop for health insurance."

Customers will choose among four quantities of protection. The Bronze plan means sixty percent of the healthcare expenses will be taken care of. Silver means seventy percent, Gold means 80 pecent and Platinum means ninety percent coverage.

"To an individual who has never had health care insurance before, exactly what does that mean?" said Rohack. "What it means -- if you want the best plan of coverage you are going to spend the largest monthly premium."

While most experts agree whether or not health insurance is provided by an employer or purchased over the exchange, it's likely to be expensive, but depending upon your income amount there may be a few federal subsidies to help you.

"If you need to shell out more than nine-and-a-half percent of your income on a health care premium, you do not have to purchase it," said Rohack. "In other words, you are deemed exempt because it's too expensive to you. If you fall between two percent and nine-and-a-half percent, you'll actually get a tax credit to reduce that regular premium."

As an orthopedic surgeon, Malone has seen and repaired his share of bad breaks. Even so, he says our country's leaders should put on the brakes when considering to the Affordable Care Act.

"I'm worried there are going to be some train wrecks on the way," he said.

Malone says, while the intent of the ACA to provide health insurance to all Americans is a commendable idea, the approach rolled out has many faults -- most notably the price.

"I don't believe the Affordable Care Act does anything at all to reduce cost," said Malone. "In truth, I think it's going to raise cost, and I think that's when the catastrophe is going to happen."

"What my frustration is, is the misinformation that's out there," said Rohack. "October 1 is going to be here very shortly. Right this moment, in Texas, we still don't know what the premiums are going to be made available and who is going to be providing it."

That affects patients as well as physicians like Brown.

"Even me attempting to access the system right now, I had to call individually to the federal government to find out what the issues were for me as a provider," said Brown. "They weren't able to provide some specific answers, but they will, apparently, in October."

Many physicians and medical specialists are already making comparisons to other nations with government-run medical care, whereby physicians have one practice within the system and yet another private -- a cash-only practice for patients who want to be treated without delay. Rohack says that already is available in the U. S. to some degree.

"As this design continues to evolve, then doctors will have to make decisions," he said. "Do I want to continue the insurance model where the insurance provider is paying for me, or do I opt-out? Go to a cash-only enterprise. There's absolutely nothing that prevents a doctor from going to a cash business. We see that popping up all the time. In fact, cosmetic surgery treatment is not covered by insurance."

Malone is certain the Affordable Care Act already demands a significant overhaul.

"There is a new regulation coming out of Washington, D. C. every week relating to medicine. My concern is that medicine is going to become the most regulated profession in the country. I've never heard about cost efficiency caused by highly-regulated market sectors," he said.

 

 

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