The Patient Protection and Affordable Care Act became law in March 2010. Since then, it has been characterized by rulings issued from the offices of state attorneys general, appellate courts, and the U.S. Supreme Court, along with executive orders promulgated by the nation’s presidents and additional guidance provided by the Department of Health and Human Services in Washington, DC. It is conceivable that efforts to stay abreast of this ever growing cascade of information would tax even the energies of the most highly gifted Talmudic scholars were they ever to shift their attention in that non-heavenly direction.
Fortunately or not, there is a veritable army of interest groups represented in the nation’s capital to maintain a close watch on all imaginable health policy developments to ensure that every T is crossed and every I is dotted correctly. As an aside, it may not be hyperbolic to assert that every major piece of legislation in both the health and education realms just as easily could be subtitled the Attorneys, Accountants, and Lobbyists Relief Act of (fill in the appropriate year) since practitioners of those trades essentially are furnished with lifetime employment opportunities once enactment occurs.
One example of how muddles can bring matters to a halt can be traced to the mid-1970s. The services of physician assistants and advance nurse practitioners were unable to be reimbursed by Medicare unless a physician was present to observe and approve what they were doing. Unfortunately, rural areas of the U.S. are geographically vast in size and also characterized by physician workforce shortages. A bill was introduced in Congress to remedy the situation by indicating that a physician did not have to be physically present when services were being provided. All was proceeding swimmingly until a bill was produced with language that referred to these other personnel as physician extenders. Opposition was fierce because representatives of other professions viewed themselves as being independent qualified operators rather than mere extensions of physicians. It subsequently took more than an extra year to resolve that predicament in order to have the bill enacted. Welcome to the ways of Washington, DC.
Cost Effects Insurance Reforms Being Considered By Congress
Plans are being formulated on Capitol Hill to make permanent the American Rescue Plan Act’s temporary boost in subsidies for marketplace plans and to fill what is known as the Medicaid coverage gap. As part of the budget process for fiscal year 2022, which begins on October 1 this year, Congress is considering a package of two reforms to the Affordable Care Act (ACA). Under what is being developed, the enhanced premium subsidies included in the American Rescue Plan Act would become permanent. Also, the so-called Medicaid coverage gap would be filled by extending eligibility for marketplace subsidies to individuals earning below 100% of the federal poverty level in 12 states that have not yet expanded Medicaid.
Presently, there are about 5.8 million uninsured adults in those states that have incomes too high for that program, but not high enough to obtain marketplace subsidies. Together, these two health insurance reforms would sharply reduce the number of Americans under age 65 who lack coverage, according to a new analysis from the Urban Institute and the Commonwealth Fund. Not only would Black Americans see the biggest decline in the ranks of the uninsured, but uninsured numbers for white and Latinx/Hispanic adults also would fall significantly as well. Researchers project the changes would result in lower financial burdens for households struggling with health care costs.
Improving Health Care For The Nation’s Older Veterans
An announcement on September 9, 2021 from the Department of Veterans Affairs (VA) describes the launching of a nationwide movement to improve emergency department (ED) care for older veterans treated in VA Medical Centers and become the nation’s largest integrated health network with specialized geriatric emergency care. The VA Geriatric Emergency Department Initiative is a public-private collaboration between the VA, the American College of Emergency Physicians (ACEP), The John A. Hartford Foundation, and the West Health Institute to establish 70 of the VA’s EDs as accredited geriatric emergency departments (GEDs). These entities are better equipped to treat older adults with complex conditions while recent studies have found that GEDs can decrease hospital admissions and lower total healthcare costs.