For the past month, there has been a tremendous interest in the Supreme Court’s decision regarding the constitutionality of the Affordable Care Act (ACA). As it turned out, the Supreme court upheld the law as constitutional, and we are now moving forward in shaping healthcare to uphold the law and its mandates.
To be perfectly honest, I am not sure how the ACA will affect the everyday practice of medicine- I do not think anyone can say exactly how this is going to play out. I am hardly a legal professional, but what I can do is offer my perspective as a physician in solo private practice in trying to understand what the ACA is going to do for my practice and for my patients.
The Good: The ACA gets rid of health insurer’s practices of denying patients coverage based on pre-existing conditions. Thank goodness for that! It never made sense to me that the people who needed healthcare the most were denied coverage because they were sick. The law also brings forward provisions that will allow most people to obtain health insurance coverage at (what we hope) will be reasonable rates. As we are all too aware of in medicine, disaster can strike anyone at any time- indiscriminately. For all of the griping that everyone is doing about the mandate to purchase insurance, having everyone have access to healthcare is not a bad thing.
The ACA will increase the number of insured patients in our population, which in turn will necessitate that we have physicians that can take care of these patients. My concerns about the ACA are almost entirely centered on the lack of medical liability reform built into the law. Without serious attention paid to federal liability reform laws, we in Illinois will never be able to hang on to the physicians we train here, and will lose them to other states where the cost of practicing medicine is cheaper. According to ISMIE, half of physicians who train here leave after residency; of those, two-thirds cite Illinois' liability climate as a chief reason for leaving. National projections suggest we will soon have an inadequate number of doctors to meet patient needs. Those of us who choose to stay (because this is home, for goodness’ sake!) are left paying huge sums of cash to obtain medical liability insurance.
Take my little practice, for example. My biggest monthly expense is my liability insurance- more than rent, more than payroll. And because practicing obstetrics is so expensive (to the tune of over $100,000/year just in malpractice insurance costs!), I have limited my practice to gynecology only in an effort to keep afloat. So here you have a physician who has trained for years to practice the art and science of delivering babies and who loves doing it. To make her small business run, she cannot continue in this practice- not because she is incapable or unwilling- but because she cannot come up with the thousands required to purchase the insurance necessary to protect herself from a legal environment that is hostile to physicians. It is a sad commentary on healthcare in America, and why I often wish that doctors instead of lawyers were the leaders of healthcare law.
The ACA will undoubtedly bring about some good, but I think that we physicians are watching fearfully to see where it will land us in terms of our ability to practice medicine. That is the reality of our situation, and that is where we have some real work ahead of us.
