The Affordable Care Act is a complex piece of legislation with multiple goals:
- Universal access to health care regardless of pre-existing conditions
- Reduction of costs of health insurance by averaging costs between healthy and unhealthy individuals
- Reduction in actual outlays for medical services by
- Reducing use of expensive emergency room services
- Screening and earlier identification and treatment or prevention of major illnesses
The “repeal” effort to date addresses none of these goals, and in fact backtracks on them.
In addition, there is a continuing expansion of “cost sharing,” a euphemism for the shifting of costs from employers to employees for those workers who have access to group health insurance.
Physicians saw increased office traffic in 2016, but this is not likely to continue in the future. Alicia Ault, writing for Medscape, comments,
Use and intensity of services and prices are the two biggest components of American health spending growth, the economists said. Overall use and intensity of healthcare goods and services continued to grow in 2016 as more people gained healthcare coverage through Medicare, Medicaid, or private insurance, and as disposable personal income rose. (1)
As the amount of money consumers have to spend for healthcare increases, their use of health services will decrease. Economists with the Centers for Medicare and Medicaid Services (CMS, the agency that administers the Federal Marketplace as well as children’s programs) are expecting a reduction in use of physician services just in response to increased cost sharing, even without changes or repeal of the ACA.
Historical data show that greater cost sharing leads to less use of healthcare, Sean Keehan, a CMS economist, told Medscape Medical News. “People think twice about seeing the doctor if it’s going to be much more than it was before,” said Keehan, who is also lead author on the article in Health Affairs.(1)
Other factors will drive down use of health services over the next several years:
- Inflation which will reduce what consumers have available to spend
- Relatively stagnant wage growth, meaning that wages will not keep up with inflation
The CMS estimates are optimistic, excluding any impacts of ACA repeal. A sharp increase in the number of people who cannot afford health insurance would be a game changer, and, frankly, could force some primary care physicians to close their practices. The areas likely to see the greatest impact are poor and rural communities.
What you need to consider:
- For most people, money is going to be a problem. Do you need to improve or acquire skills to allow you to get a higher paying job?
- Relocation to an area with better local public health services?
- How will you deal with older relative who may find themselves in trouble?
- Alicia Ault, Physician Services to Decline With More Cost-Sharing, CMS Says. Medscape. Feb 15, 2017.