TMA Examines New Health Law’s Effect on Patients, Doctors

  The U.S. Supreme Court’s decision to uphold the constitutionality of the Patient Protection and Affordable Care Act (PPACA) means it’s now law of the land. What does this mean for Texas patients and their physicians?  

“Physicians, along with the rest of the population, face the good, the bad, and the ugly provisions of the [new health law],” said Louis J. Goodman, PhD, Texas Medical Association’s (TMA’s) executive vice president and chief executive officer.  

TMA carefully evaluated the new law to help Texas physicians understand its complexities so they can answer their patients’ questions. The September issue of TMA’s Texas Medicine magazine discusses these points and more:  

Medicaid 

Congress passed the PPACA, and the U.S. Supreme Court ruled the law constitutional  but said the law cannot force states to expand their Medicaid health insurance coverage to more people. Texas Gov. Rick Perry quickly said Texas will not expand its Medicaid rolls. 

“Medicaid plays a vital role for millions of low-income Texans,” said TMA President Michael E. Speer, MD, about the state-federal health insurance program. “But I doubt I can find many Texas physicians who would argue that our Medicaid system does a good job of providing health care for Texas’ poorest citizens.”  

“Expanding Medicaid will give a false sense to some people that they now have insurance,” said Gary Floyd, MD, immediate past chair of TMA’s Council on Legislation, pointing out that having a Medicaid card would not necessarily mean the patient could find a doctor for care. In a recent TMA physicians’ survey, just 31 percent of Texas doctors said they accept all new Medicaid patients, down from 42 percent in 2010. That’s less than half the 67 percent who reported they would take all new Medicaid patients in 2000. 

Still, Texas leads the nation in the number of people who are uninsured. TMA vows to help find a solution to this problem so patients don’t have to continue to rely on a hospital emergency department as their personal doctor’s office.  

Insurance Mandate and Penalty 

The Supreme Court ruling upheld the constitutionality of the law’s mandate forcing people to purchase health insurance.

The law imposes a penalty not only on individuals who fail to purchase insurance but also on businesses with more than 50 employees that do not provide coverage for their workers. For example, by 2016 an individual would have to pay a $695 penalty (or 2.5 percent of income) per year for opting to be uninsured.   

“My concern would be that some companies that are feeling a financial or economic pinch right now will say ‘I can’t afford paying this premium; I’m going to pay the penalty tax,’” said Dr. Floyd. “So employers are going to pay the penalty and look at the employee and say, ‘Good luck, you’re on your own.’ [In that case] I’m not sure we’ve helped the uninsured a bit.”  

Preventive Care

One particular area of the law affecting patients’ health and pocketbook is the new insurance coverage for preventive health services. The PPACA requires new individual and group health plans to cover in-network preventive health services — including immunizations, preventive care for women and children, and other preventive services given a certain classification — without paying a copayment or deductible. Now patients can be screened for aortic aneurysm, breast cancer, chlamydia, colorectal cancer, depression, gonorrhea, hypertension, lipid disorders, obesity, diabetes, and more.  

However this coverage requirement only applies to health insurance plans created after March 23, 2010. Older policies are not required to cover these preventive services without charging patients a copay or deductible, as long as the plans do not make material changes in benefit design or patient cost-sharing when they renew them. These “grandfathered” plans are permitted to impose patient cost-sharing for preventive health services. 

For more on the health law’s new regulations and their impact on Texas patients and physicians, read the September issue of Texas Medicine magazine, and visit TMA’s blog, MeAndMyDoctor.com. 

TMA is the largest state medical society in the nation, representing nearly 46,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.

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