Logo

Log In Sign Up |  An official publication of: American College of Emergency Physicians
Navigation
  • Home
  • Multimedia
    • Podcasts
    • Videos
  • Clinical
    • Airway Managment
    • Case Reports
    • Critical Care
    • Guidelines
    • Imaging & Ultrasound
    • Pain & Palliative Care
    • Pediatrics
    • Resuscitation
    • Trauma & Injury
  • Resource Centers
    • mTBI Resource Center
  • Career
    • Practice Management
      • Benchmarking
      • Reimbursement & Coding
      • Care Team
      • Legal
      • Operations
      • Quality & Safety
    • Awards
    • Certification
    • Compensation
    • Early Career
    • Education
    • Leadership
    • Profiles
    • Retirement
    • Work-Life Balance
  • Columns
    • ACEP4U
    • Airway
    • Benchmarking
    • Brief19
    • By the Numbers
    • Coding Wizard
    • EM Cases
    • End of the Rainbow
    • Equity Equation
    • FACEPs in the Crowd
    • Forensic Facts
    • From the College
    • Images in EM
    • Kids Korner
    • Medicolegal Mind
    • Opinion
      • Break Room
      • New Spin
      • Pro-Con
    • Pearls From EM Literature
    • Policy Rx
    • Practice Changers
    • Problem Solvers
    • Residency Spotlight
    • Resident Voice
    • Skeptics’ Guide to Emergency Medicine
    • Sound Advice
    • Special OPs
    • Toxicology Q&A
    • WorldTravelERs
  • Resources
    • ACEP.org
    • ACEP Knowledge Quiz
    • Issue Archives
    • CME Now
    • Annual Scientific Assembly
      • ACEP14
      • ACEP15
      • ACEP16
      • ACEP17
      • ACEP18
      • ACEP19
    • Annals of Emergency Medicine
    • JACEP Open
    • Emergency Medicine Foundation
  • About
    • Our Mission
    • Medical Editor in Chief
    • Editorial Advisory Board
    • Awards
    • Authors
    • Article Submission
    • Contact Us
    • Advertise
    • Subscribe
    • Privacy Policy
    • Copyright Information

How Will the 115th Congress Impact Emergency Medicine?

By L. Anthony Cirillo, MD, FACEP | on March 14, 2017 | 1 Comment
Features Opinion Public Policy
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version
shutterstock.com

You Might Also Like
  • Ten Ways Obamacare Could Impact Patients, Emergency Departments, and the Physician Workforce
  • States’ Expansion of Medicaid Tied to Better Care for Low-Income Adults
  • Affordable Care Act from the Emergency Medicine Perspective
Explore This Issue
ACEP Now: Vol 36 – No 03 – March 2017

shutterstock.com

Editor’s Note: This article was written before the American Health Care Act was released.

For all the philosophy imbedded in the arguments and debates around the Affordable Care Act (ACA), the reality is the program isn’t perfect. While much of the law is a win for emergency medicine, financing of the program is not. The expansion of Medicaid coverage, requirements to cover preexisting conditions, coverage of children up to age 26 on a parent’s policy, and the establishment of a minimum benefit standard including the prudent layperson standard for emergency care are great for those of us who bear the biggest burden of the uninsured population when they have no other access to care. However, the mechanisms to fund these benefits for the long-term were inadequate even on the day the ACA became law. Expecting that healthy young people would opt to pay even a 50 percent discounted health care premium (let’s say $6,000 per year) versus paying 2.5 percent of their income (which is $1,000 if they are making $40,000 per year) wasn’t going to work. Without healthy people paying into the system, the existing increase in tax revenue isn’t enough to finance the whole program. Expecting that insurance companies would continue to sell policies in regions where they are losing money despite subsidies is wishful thinking at best. Given their operating losses, and the loss of additional revenue under a risk corridor program that was defunded by Congress, insurers are leaving the ACA program. As of the beginning of this year, nearly 35 percent of potential ACA enrollees have only one insurance company to choose from in the health care exchange, and another 19 percent have only two choices.

How will President Donald Trump and Congress ensure access to health care insurance—without removing the components of the ACA that everyone likes—without individual or employer mandates? That remains to be seen. Newly confirmed Secretary of Health & Human Services (HHS) Tom Price, MD, has been an ardent opponent of the ACA and will have wide latitude to change the program based upon the large number of regulatory actions that have been taken to implement and operate the program. In his first official act after his swearing in, President Trump issued the “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal” order. This directed HHS and all departments and agencies, “to the maximum extent permitted by law,” to “delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or individual,” “provide greater flexibility to states and cooperate within them in implementing healthcare programs,” and “encourage the development of a free and open market in interstate commerce for the offering of healthcare services and health insurance.”

Pages: 1 2 3 | Single Page

Topics: AdvocacyAffordable Care ActCongressCost of Health CareEmergency MedicineEmergency PhysicianInsuranceLegislativeMedicareMedicare & MedicaidPresident TrumpPublic HealthPublic PolicyRepealReplace

Related

  • Dr. Joe Sachs and “The Pitt” Redefine Public Health Education Through Storytelling

    July 3, 2025 - 0 Comment
  • Meet the 2025 ACEP President-Elect, Board of Directors, and Council Candidates

    July 2, 2025 - 0 Comment
  • ACEP4U: The ACEP Council Shapes Policy, Advances the Mission

    June 30, 2025 - 0 Comment

Current Issue

ACEP Now: July 2025

Download PDF

Read More

About the Author

L. Anthony Cirillo, MD, FACEP

Dr. Cirillo serves on the ACEP Board of Directors. He still actively practices emergency medicine and serves as the director of government affairs for US Acute Care Solutions.

View this author's posts »

One Response to “How Will the 115th Congress Impact Emergency Medicine?”

  1. March 21, 2017

    PAUL F ROBINSON Reply

    Dr Cirillo’s article is a very thorough description of the current state of affairs regarding the PPACA(Obamacare) and the AHCA(Ryancare).

    However, he does not comment on the economic reasons driving the AHCA.
    Cutting and capping Medicaid has nothing to do with “repeal and replace.” Yet, gutting
    Medicaid seems to be the main purpose of this enterprise. As written, the AHCA will cut $880 billion of federal payments to the states, over 10 years, in order to provide huge tax breaks for the wealthy and provide corporate welfare to insurance companies and medical device manufacturers.

    Paul F. Robinson MD, PhD, FACEP
    Copello Fellow, National Physicians’ Alliance

Leave a Reply Cancel Reply

Your email address will not be published. Required fields are marked *


*
*

Wiley
  • Home
  • About Us
  • Contact Us
  • Privacy
  • Terms of Use
  • Advertise
  • Cookie Preferences
Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 2333-2603