The Affordable Care Act of 2010 (also known as Obamacare or the ACA) is the most significant piece of healthcare reform passed in the United States since the creation of Medicare in 1965. By implementing a mandate requiring all employers with 50 or more full-time employees to provide health insurance for their full-time staff, the Affordable Care Act seeks to increase access to healthcare services for US citizens. Understandably, all parties involved are anxious regarding how hospitals will change in the face of such a fundamental re-structuring of the American healthcare delivery system. Will hospital performance actually improve? Will sick people be able to get the care they need (and at an affordable cost)? Perhaps most importantly, will the Affordable Care Act succeed in preventing the collapse of the American healthcare industry in the face of a disproportionately elderly population and an ailing economy?
Since the online marketplace enrollment program launched in October, more than 2 million citizens (as of Jan. 1, 2014) have purchased a public health insurance plan through the ACA website. Many hospital administrators, however, are worried about encountering difficulties while attempting to verify an individual’s coverage. Several states are pushing their enrollment deadlines back due to the problems with the Affordable Care Act’s website, which means that many families have not yet enrolled. Some medical professionals have stated that for certain medical conditions, they will treat patients regardless of whether their health insurance coverage can be immediately verified. For more expensive tests (e.g., magnetic resonance imaging), treatment may be delayed in order to verify coverage.
Hospital performance is another concern for medical professionals, patients, and taxpayers alike. New changes in healthcare infrastructure mean that hospitals may be communicating regularly with several new health insurance providers on a daily basis. Smaller, rural hospitals that do not have access to excellent hospital networking software may encounter difficulties in establishing consistent contact with regional health insurance providers.
For patients, the Affordable Care Act contains legislation that will elicit a closer look at overall hospital performance by directly tying performance to Medicare revenue. This means that hospitals which perform better than the national average on statistics like average length of stay (LOS), readmission rates, and mortality rates will receive additional Medicare revenue. Opponents of Obamacare claim that hospitals which fall behind in hospital performance ratings will remain behind (and perhaps drop even further) by losing funding that could be used on the areas that need improvement. On the other hand, proponents of the Affordable Care Act claim that a closer watch on hospital performance will help hospitals trim overall expenses while still providing quality care to their patients. Whether one side or the other is more or less correct remains to be seen.