3) The offer of health insurance “coverage” in the HIE marketplace at the 60 percent bronze level or even 90 percent platinum level in the marketplace is essentially false advertising. What really matters is what the out-of-pocket maximum is under the plan and how much “real money” individuals and families are going to have to come up with when you add up premiums, deductibles, co-pays, and coinsurances.
Explore This IssueACEP Now: Vol 33 – No 01 – January 2014
4) The PPACA did nothing to address the “hidden” costs of defensive medicine or create any improvement in the medical malpractice arena.
5) Eventually, the IPAB will become the most important aspect of the law. The one critical “itch” that needed to be “scratched” for the U.S. government was the doubling of Medicare expenditures that was projected to occur from 2011 to 2021 due to the aging of the Baby Boomer generation (from $569 billion to $980billion) and that 23 percent of the federal budget already pays for health care. PPACA will not change that aging demographics, so we know that there will be more people getting older and eventually needing more care. (Last I checked, the one statistic that you can’t manipulate is that there is still a 100 percent mortality rate for all individuals.) Eventually, Medicare spending will need to be decreased; the IPAB would just be the most expedient way to do that (although all of the 1 percent and 2 percent bonuses that few will achieve will help).
Dr. Taylor: The Affordable Care Act (perhaps more aptly named the “Health Insurance Reform Act”) is the biggest economic and social sciences experiment in American history, eclipsing Medicare and Medicaid combined. The ACA’s fundamental flaw is that it assumes health insurance coverage will (necessarily) result in access to health care. While ACA may increase the number with insurance coverage, it will functionally decrease health care access, largely due to high out-of-pocket cost (premiums plus deductibles plus coinsurance plus special fees) and due to limited network-provider panels.
The second (perhaps fatal) fundamental flaw of the ACA relates to human behavior by assuming the American public will a) be able to figure it out, b) have the patience to do so, and c) have sufficient incentive to care at all. So while perhaps well-intentioned, the ACA is the illusion of health insurance coverage, resulting in less actual health care, and at a cost of $2 trillion plus increasing individual costs (also in the trillions). In total, this makes the ACA the biggest boondoggle in America history.