22
COM Outlook . Fall 2012
physicians who will take their insurance.
Additionally, some high-quality physicians
have chosen not to accept Medicaid, but
will accept patients with Medicare due to a
greater reimbursement. Under the Afford-
able Care Act, Medicaid will reimburse
health care providers at a rate of no less
than 100 percent of the Medicare rate. This
is projected to increase access to quality
care for Medicaid recipients.
Extends the Children’s Health
Insurance Program
The Children’s Health Insurance Program
(
CHIP) was created in 1997 to provide health
insurance access to children who don’t
qualify for Medicaid and whose families find
available insurance unaffordable. The Afford-
able Care Act extends the program to 2015.
Creation of an Insurance Exchange
The Affordable Care Act provides for
the creation of an insurance marketplace.
Americans will be able to shop for health in-
surance in a competitive environment. Mem-
bers of the U.S. Congress will be required
to obtain their health insurance through this
marketplace starting in 2014.
Mandate Individual Coverage
When Affordable
The most controversial provision of the
new law is the individual mandate. By 2014,
Americans will be required to obtain basic in-
surance that meets minimum standards. If an
individual can afford to pay for insurance, but
chooses not to, he or she will be assessed a
fee. In most cases, this money will be used
to offset the cost of insuring Americans who
cannot afford insurance. This provision of the
law will have the greatest impact by opening
access to 32 million of the 46 million Ameri-
cans without health insurance.
Increase Medicaid Eligibility
The law also provides the ability of
states to expand access to Americans who
live slightly above the poverty line and were
previously ineligible for Medicaid. The fed-
eral government will now fund 100 percent
of this cost for the first three years and then
90
percent after the initial phase-in period.
In Florida, Governor Rick Scott has declared
he won’t expand access to health care to
Floridians who would otherwise qualify for
this new provision.
It is clear that the Affordable Care Act,
in its entirety, will create a paradigm shift in
how patients will access health care, improve
the quality of health care, and eventually
stabilize the cost of health care in the United
States. At NSU-COM, we are training caring
and competent physicians who will serve the
health care needs of Americans and beyond
in this new frontier of medicine.
-
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young adults are allowed to be covered by
their parents’ plan until they turn 26.
Reduce Administrative Costs or Profits
for Insurance Companies
The Affordable Care Act provides provi-
sions to limit administrative costs and profits
to 15-20 percent.
Establishment of Accountable
Care Organizations
A major provision of the law is the
establishment of Accountable Care Organiza-
tions (ACOs). Under the law, organizations
may form a coordinated group of health care
providers, and their reimbursement for health
care services will be tied to quality outcome
measures as well as total health costs to the
population of patients they care for. The idea
behind ACOs is to align the interests of the
patients and society with the financial inter-
ests of a health care organization to foster
improved outcomes. A consequence of the
creation of ACOs is a greater trend toward
an employed model that aligns well with the
desires of current graduates to be employees
rather than the traditional solo-practice model
that previously dominated medicine.
Increasing Medicaid Payments for
Primary Care Doctors
Patients who are insured under Medic-
aid frequently are challenged with finding
