• Affordable Care Act Resource Center

    • TMA Takes on Marketplace Madness

      Confused by all you’ve heard about the Affordable Care Act marketplace insurance plans? Do you know whether you’re in — or out — of the narrow networks? How will you tell if a patient is on an exchange plan? What happens to you if patients don’t make their premium payments? What, if anything, can you do about all of this? TMA answers these and other tough marketplace exchange questions. MembersOnlyRed
  • Why You Need to Know About the Sunshine Act

    • Sunshine Act Review and Dispute Period Now Open
      CMS announced today that the Open Payments system is once again available for physicians and teaching hospitals to register, review and, as needed, dispute financial payment information received from health care manufacturers. The system was taken offline on August 3 to resolve a technical issue. To account for system down time, CMS is extending the time for physicians and teaching hospitals to review their records to September 8, 2014. The public website will be available on September 30, 2014.
  • Affordable Care Act in the News

    • Physicians Receive ACA Grace Period Notice Letters
      Some Texas physicians have notified TMA they have received letters from Blue Cross and Blue Shield of Texas (BCBSTX) notifying them that a patient is in the second or third month of the Affordable Care Act (ACA) 90-day grace period. The grace period is triggered once a patient with subsidized marketplace coverage misses a premium payment. Instead of immediately terminating the policy, health plans must give the patient 90 days to catch up.
    • What Do I Do If I'm Having Problems With My Marketplace Plan?
      If you are having problems with your marketplace plan—for example, you aren't getting the coverage you were promised, or the plan isn't paying your claims—you have certain rights and ways to get those problems fixed.
    • What Do I Do If I'm Having Problems With My Marketplace Plan?
      If you are having problems with your marketplace plan—for example, you aren't getting the coverage you were promised, or the plan isn't paying your claims—you have certain rights and ways to get those problems fixed.
    • The ACA Marketplace
      Physicians find themselves in a land of confusion months after the debut of the Affordable Care Act health insurance marketplace. Pervasive problems with the exchange rollout, including enrollment delays and questionable health plan networks, disrupt physicians' office operations and affect patients' access to care.
    • TMA Wants Stronger Grace Period Notification
      The Centers for Medicare & Medicaid Services (CMS) should require insurers who offer health plans on the Affordable Care Act exchanges to provide immediate notice when patients enter the first month of the 90-day grace period. That's what TMA, the American Medical Association, and more than 80 state medical societies and specialty organizations told CMS Administrator Marilyn Tavenner in a letter.
    • The Specialist I Need Is Not On My Insurance Plan's List of Doctors
      Remember that insurance plans in the marketplace must sign up enough doctors, hospitals, pharmacies, and other providers to make sure patients can get medical care. (See Who will take care of me? What are the networks?)
  • Hot Topics

    • PPACA Employer Mandate Delayed
      Physicians who have 50 or more employees have another year to comply with the "employer mandate" of the Patient Protection and Affordable Care Act (PPACA). The law requires employers with 50 or more employees to offer health insurance coverage or pay a penalty.
    • Find It, Fix It, Keep It: Patient Protection and Affordable Care Act
      Patient Protection and Affordable Care Act: Find What’s Missing. Keep What Works. Fix What’s Broken.
    • Health Insurance Exchange: Business Impact
      With the Affordable Care Act (ACA) health care exchange up and running, officials expect it to make a dent in the state’s high uninsured rate. Roughly 6 million Texans — a quarter of the population — are uninsured. The Texas Health and Human Services Commission estimates 40 percent of those people are eligible for exchange subsidies. For physicians, that could mean more patients walk in the door with health coverage. But the exchange still holds a lot of questions for doctors, especially exactly how the new marketplace health plans will play out in your practice. You need to figure out if you are participating in the plan(s) offered in your area and if they will affect your current payer contracts. You’ll need to learn how to identify patients on the exchange plans and what happens if these patients fail to keep current on their premium payments.
    • ''Hey Doc'' Gives You Answers to Patients' ACA Questions
      Americans' physicians are their most trusted source for information on the Affordable Care Act (ACA), according to a new national poll, but that's not where they're getting their news.
    • TMA: Don't Make Docs Pay For Inaccurate Plan Directories
      Calling it either "an enormously unfortunate oversight" or "a government grab at discount health care services," TMA is vehemently opposing a new federal policy regarding physician participation in the Affordable Care Act exchange marketplace health plans. 
    • Marketplace Means Decision for Doctors
      The opening of the health insurance marketplaces under the Affordable Care Act (ACA) on Jan.1 means you must be vigilant in your dealings with the health insurance companies. Or you could face major problems.
    • What Qualified Health Plans are Operating on the Marketplace in My County?
      As of Oct. 1, 2013, there were 12 insurance companies offering 96 different qualified health plans on the Affordable Care Act marketplace exchange in Texas. Each plan is offered on a county-by-county basis. Here is the list of plans, sorted by county.
    • TMA's 2013 Federal Legislative Agenda
      Here’s something Congress can do to make an immediate, positive impact on health care: Eliminate costs and hassles that don’t add value to patient care. New regulations and mandates are bombarding physician practices seemingly every day.
    • ACA: From Theory to Boots on the Ground
      New report from the Physicians Foundation examines the implementation of key provisions – in particular the health insurance exchanges – and ongoing challenges of health reform. It is the first installment in a series of reports on ACA coverage expansion and key mandates.
  • TMA Help for You to Survive and Thrive in the New Health Care Landscape

  • Congressman Mike Burgess, MD: The Case Against the ACA

    The Case Against Obamacare from texastribune on Vimeo.

    "The Case Against Obamacare" panel with U.S. Rep. Michael Burgess moderated by Scott Braddock at The Texas Tribune Festival September 24, 2011.

  • Full Text and Analysis of the Patient Protection and Affordable Care Act

    • Read the Full Text

      Read the entire bill, amendments, official summary, and legislative history at Congress.Org
    • TMA's Health Reform Bill Executive Summary

      Prepared by TMA experts, this analysis reviews what the bill does and does not do.
    • TMA Complete Summary

      Use this TMA staff summary of the bill and amendments to find which provision of the law may pertain to a particular question or issue. Then turn to the full text.
    • TMA Guiding Principles

      House of Delegates' guiding principles TMA followed as it made Texas physicians' voices heard in Washington during the debate.