Obamacare: Past, Present, and the Future

Unpacking Obama’s JAMA Article

President Obama surprised the healthcare community when he unexpectedly published an article in JAMA — the first sitting President to accomplish such a feat (JAMA is notorious for its rigorous review standards, though the piece was not peer-reviewed).

Six years in, the impact of Obama’s signature legislation can be felt in all areas of healthcare. So what were the short-term outcomes of what has been called the “most comprehensive health reform legislation” in recent history? And what can we expect moving forward?

Legacy of Obamacare

The purpose of the 2010 Affordable Care Act was to fundamentally change how America receives, and pays for, its health care services. Until that law was passed, medical services were compensated on a per-visit basis, with higher volumes of patient encounters earning higher levels of compensation and many uninsured individuals paying out of pocket for their care.

Unsurprisingly, Obama cites that more people have access to insurance since Obamacare was enacted, bringing the uninsured rate to 9.1 percent in 2015. According to the article, there was also an increase in the number of non-elderly people who have a physician and access to medicine.

A more unexpected claim was the link between Obama’s law and more control over healthcare spending.This claim is likely to be debated, as it’s unclear how much the slowdown in spending is from the law itself and not other factors like the Great Recession.

Obamacare and the Private Practitioner

Without a doubt, private practices have been heavily impacted by Obamacare. The new law requires that doctors collect more comprehensive data regarding patient health and submit detailed patient reports along with their bills for services rendered.For independent physicians, this has drastically changed the way physicians provide care.

Elation user and family physician Dan Heslinga, MD found that post-ACA reimbursements were actually higher for some private practitioners like himself because of the enhanced payments that were distributed by the CMS.  

Despite this advantage, Heslinga still remains skeptical of the act.

“Regarding health exchanges and other aspects of the law, I’m taking a wait-and-see attitude,” Heslinga said.

Since the health exchanges imposed under Obamacare have increased the risk of reduced revenues, the ACA has become a double-edged sword for private physician practices.

More specifically, high deductibles, high co-pays, and high co-insurance have forced patients to delay physician visits until their illnesses are severe. Thus, many physician practices are seeing “lower volumes, higher acuity, and patient satisfaction is even more critical because patients now perceive a doctor’s visit to be a consumer encounter since more of the fees are being paid by the patient instead of the insurance company,” explains healthcare business consultant Laura S. Goodman.

Controlling Healthcare Spending

As Obama himself admits, Obamacare has not solved all that ails the healthcare system in America. Reimbursements continue to go down for physicians and inefficiencies are many, which means doctors have to see more patients, track more data, and spend less time with patients. Sandeep Jauhar, MD echoed this disillusionment in the New York Times by saying, “There is no more wasteful entity in medicine than a rushed doctor.”

To manage the health cost containment paradigm in this country, lawmakers ought to build on Obama’s existing legislation to make the system more efficient and Electronic Medical Records ought to be built with the physician in mind to ease the burden of documentation.

Pushing for the Public Option

One prominent fix that Obama prescribes for the future is a public option for government-run insurance. Offering a public option could make insurance prices more competitive in areas with few insurance options.

While primary care providers generally support this option, other specialty groups seem less receptive toward the plan. Furthermore, practice owners were less likely than nonowners to support a public option (59.7% vs. 67.1%).

Physicians’ groups have historically influenced efforts in healthcare reform, so physicians and in particular private practice physicians should continue to be the most critical playmakers of Obamacare’s ultimate success. This group must build on progress made by the Affordable Care Act if Obamacare and healthcare reform in general is destined to succeed. By serving as advocates in the health policy world, physicians are not only directly impacting the way they deliver care but also driving better care outcomes for their patients.