November 1, 2013
The Affordable Care Act (ACA) is intended to improve access to health care, for those who have previously experienced difficulty in obtaining the care that they need. Various access-related problems related to the ACA have been discussed in previous postings to this blog over the past few months (as indicated below).
The ongoing political drama over implementation of the ACA is likely to continue to affect access.
One obvious problem is that access will be restricted so long as the federal Health Exchange (at healthcare.gov) continues to experience operational delays and errors.
While the “glitch fix” efforts are underway, many individuals are being routed to the call centers for a more-manual application procedure. And high-profile communications efforts have been mounted—to assure everyone that coverage will eventually be available for all who want to purchase insurance.
However, access will be cleared up only when the application process is fully operational.
Website delays may also affect access in other ways.
¨ If individuals become alienated by their online experiences, it may be more difficult to lure them back, thus reducing access. This potential impact has yet to be determined.
¨ Postponement of the large-employer mandate (to 2015), combined with technical problems affecting the federal Exchange, may cause large employers to become less willing to participate in the Health Plan, eventually reducing access through employment.
¨ Providers may find themselves trying to cope with delays in the new-patient volume that has been expected, and even a potential problem of overcapacity. The result may be temporary capacity “fixes”— that may later reduce the availability of care.
¨ Insurance companies may find the Exchange operations to be so painful that they may cut back on their insurance policy offerings, thus reducing access to care.
¨ Possible postponement of the individual mandate deadline, and the effective date for new insurance policies to take effect, may also reduce access temporarily—and perhaps even for the longer term.
These and other limitations on access may be “temporary snags”, or may become the “new normal”. How the implementation process plays out will determine the net effect that ACA turmoil will have on access to care during 2014.
Attorneys may find it useful to deal with access issues by considering this (temporary/short term) versus (longer term) framework. Ongoing assessments can continue of current events—and whether problems are likely to be “transient and soon forgotten”, or “long-term with lasting impact”.
Previous installments of “The Access to Care Report” include the following topics:
- Measuring health needs
- Medical records and access
- More patients and access
- Enrollment options
- Young adults
- Unmeasured costs
- Expanded Medicaid
- Variations in Exchanges
- Champions for coverage
- Access to physicians
- Individual mandate
- Security for Exchanges
- Tracking access
- Insurance plan design and access
- Plan accreditation and access
- Consumer shopping behavior
- Political drama and access
More on related ACA and access to care topics may be found in a recent book by the authors that describes implementation of the ACA, and in a new Practice Guide by the authors that addresses funding and access issues in health care.