Policy and Regulation News

Issues Surround Health Insurance Marketplace despite ACA

By Vera Gruessner

- The health insurance marketplace underwent tremendous transformations with the passage of the Obama administration’s Patient Protection and Affordable Care Act. New regulations have required everyday citizens to purchase health insurance or else risk a tax penalty. Additionally, health payers were required to expand access to preventive screenings, allow young adults under 26 years old remain on their parents’ health insurance plans, and abolish clauses related to pre-existing conditions.

Affordable Care Act

Ever since the Affordable Care Act was passed, new economic obstacles have remained on the horizon for health payers and the coming transition to ICD-10 coding will only prove another challenge for the complex field. New policy changes will need to be developed and adopted in order to overcome the barriers found in the health insurance marketplace.

The Brookings Institution has created the Hamilton Project in an effort to address the challenges of the health insurance marketplace and the policy changes and solutions that could alleviate payers’ concerns.

On October 7, 2015, a public policy forum will be held by the Hamilton Project in Washington, D.C. to discuss the burgeoning economic obstacles taking place in the health insurance marketplace. Three different papers will be discussed revolving around medical technologies and the health insurance marketplace.

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  • Some of the speakers at the event will include former U.S. Treasury Secretary Robert E. Rubin, Jason Furman, chairman of The Council of Economic Advisers, Peter Orszag, nonresident senior fellow in Economic Studies at Brookings and vice chairman of corporate and investment banking at Citigroup, Inc., and Rick Pollack, president and CEO of the American Hospital Association.

    Research from the Congressional Budget Office shows that the Affordable Care Act will not be enough to counteract the need for affordable care coverage among the poorest in this nation. About 31 million Americans will still lack affordable health insurance in 2022, according to a news release from the American Health Lawyers Association.

    As such, free or charitable clinics found across the country will prove invaluable to patients unable to afford health insurance. The American Health Lawyers Association (AHLA) and the American Medical Association (AMA) Foundation has released a resource to guide clinic organizers on the creation of free clinics.

    “AHLA is proud to make this resource available to the public, with the helpful collaboration of AMA Foundation,” AHLA President Lois Dehls Cornell stated in the news release. “Local organizations such as medical societies, churches, and community centers often need an understanding of the numerous legal and operational issues required for the successful building and operation of any clinic. This Guide can be a big help.”

    The guidance offers key advice and solutions to address the many questions and issues surrounding credentialing, tax exemption, patient privacy, insurance, and fundraising. These free or charitable clinics will prove a key safety net for the many uninsured or underinsured individuals living in this country.

    “Ten years ago when I helped start the Grace Clinics of Delaware (Ohio), a resource such as this would have been incredibly valuable. It will certainly help lawyers like me to assist our communities and navigate the complexities of setting up free clinics,” Peter A. Pavarini, AHLA’s Immediate Past President, and contributor to the development of the Guide, said in a public statement.

    This guidance as well as the general development of free clinics could revolutionize the health payer system in a way to ensure that all American citizens receive necessary access to healthcare services.

    “There are many barriers to care access for those without insurance. Free clinics provide an important avenue to help meet the medical needs of our country’s uninsured,” stated AMA Foundation President William E. Kobler, MD. “There are also many legal issues involved in the establishment of free clinics. This document will be an invaluable resource to existing centers and will encourage and facilitate the development of new clinics. I am proud that physicians and lawyers have been able to work together to support free clinics as a part of the safety-net for these vulnerable citizens.”