Thursday, November 27, 2014
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Obamacare's Unspoken Intentions Likely to Bring Host of Unfavorable Results

We are one month into the official roll out of the Affordable Care Act (ACA). It is quickly becoming clear that the ACA has explicit policies, and the Obama Administration has unspoken intentions that will produce unforeseen consequences for our healthcare system and could have broad societal implications.

Obamacare's Unspoken Intentions Likely to Bring Host of Unfavorable Results

We are one month into the official roll out of the Affordable Care Act (ACA).  It is quickly becoming clear that the ACA has explicit policies, and the Obama Administration has unspoken intentions that will produce unforeseen consequences for our healthcare system and could have broad societal implications.

Just last week we were alerted to widespread health insurance policy cancellations despite repeated assurances by President Obama that we “could keep our health plans if we liked our health plan ‘period’.”  We now know that there was an explicit policy to eliminate a broad number of individual health policies, three million so far and projected to be as many as 15 million.  The likelihood of these cancellations was known as early as 2009. Regardless, throughout the President’s second term candidacy the ACA was sold on the basis that if you liked your plan you could keep your plan.

Consider this development a bellwether for more to come.  Another arena of likely impact is critical access hospitals (CAH’s), those under 25 beds and located in rural areas.  The Department of Health and Human Services has decided to reassess the status of these hospitals with a plan to decertify many of our CAH’s for failing to fulfill certain national location requirements (i.e., they must be 35 miles from the next hospital).  Nearly 75% of these hospitals, including many in Pennsylvania, could be affected, losing their enhanced Medicare payments and becoming economically unviable.

There is no explicit policy within the ACA to diminish the number of CAH’s.  It would have been politically impossible. Republican and Democratic representatives from rural areas would have been outraged.  Nonetheless, the Administration has decided that its view is that these hospitals are not economic and that their reduction or elimination would be beneficial.

Often these CAH’s are among the largest employers in their towns.  Therefore, an unintended consequence of downsizing or closing CAH’s will be considerable harm to local economies, the loss of well-paying jobs and the reduction of access to healthcare.  The absence of hospitals in an area may discourage new residents and businesses from locating there and drive many to leave in search of a job.

These are but two examples of the intended policies of Obamacare and the intentions of this Administration which have not been understood.  I expect that there will be many more unknown but intended consequences of the ACA with similar unfavorable results.

 


 

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Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
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