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Obama cites top ACA successes

tracey walker | managed healthcare executive | 21 July 2016 

PA's Bret Schroeder, healthcare expert, is quoted in an article in Managed Healthcare Executive. The article discusses President Obama's recent review of the successes of the Affordable Care Act (ACA) in the Journal of the American Medical Association (JAMA). 

Commenting on this topic, Bret states: It’s easy to show a decline in per enrollee spending when you expand the number of enrollees. Under ACA, Medicaid enrollment went from 54 million in 2010 to 70.5 million in 2015 - a 30% increase - due to a broadly expanded definition eligibility. Of course per enrollee spending goes down when the denominator is increased by 30%. However, real spending increased, about $100 billion. That $100 billion has to come from somewhere.”

Bret continues: “Higher co-pays and deductibles have left some people disenfranchised with healthcare reform. In addition, ACA has had very little impact on the cost structures of the payers and providers who continue to expand administrative, IT and compliance budgets. We are seeing significant increases in unplanned spending due to ever-changing regulations.”

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Bret expounds further, explaining: Insurers and employers are passing the increasing costs highlighted above onto their members in an effort to guide consumers to be more responsible for their care, but for the majority of the population who has seen minimal wage growth in the past five years, these increased costs take up a larger portion of household budgets. The impact is that consumers are waiting longer for care and in many instances end up requiring more care. This is more costly not only for the consumer, but also for the insurer.”

Bret concludes by highlighting some of the unintended consequences of the ACA, which includes the demise of small-practise doctors, commenting: Increased reporting and compliance requirements are difficult for small practise physician groups to manage. Combined with declining revenues imposed by changes in Medicare and insurance companies moving to ACOs and narrow networks, small practise physician groups are struggling to balance quality and business performance. Many have opted to close their practises and become hospital based employees, while others have merged into larger group practises that have the staff and infrastructure to support.”

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