Individuals are not alone in making adjustments to health-care delivery under the Affordable Care Act (ACA). Providers, too, face challenges in implementing federal health-care reform.

Chris Hennessey talks about several aspects of the ACA that have an impact on providers, including potential changes to the Medicare and Medicaid reimbursement systems that help to determine doctors’ income. In addition, Congress in the 1990s passed legislation defining a “sustainable growth rate,” which set up automatic cuts to the Medicare reimbursement rate. Each year, Congress has passed a so-called “doctor fix,” overriding the mandated cut. This year, the fix is delayed, but is on Congress’ agenda.

Under health-care reform, there may be fewer doctors available for new patients due to a reduction in provider networks.

There could also be fewer doctors willing to treat Medicare and Medicaid patients.

Emergency room services could also be affected by any shortage of doctors. One of the intentions of the ACA was to reduce emergency room visits. Prior to the ACA, individuals lacking insurance would seek treatment at emergency rooms where there costs were covered. With coverage under the ACA, such individuals would not need to use the emergency room. But actually, data indicates that emergency room is increasing, because people who now have an insurance card feel they can use these services.

Changes in benefits and services are something to monitor, especially for baby boomers approaching retirement.


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