Even If You Don’t Get A Subsidy, Obamacare Affects You
Open enrollment season is coming to an end. People all of the country are tucking away their insurance cards as dreams of government subsidies dance through their heads. And as the Obama administration touts the success of the program, many Americans who get more traditional coverage through their employer are turning an apathetic ear.
Those Americans who have insurance through an employer are under the impression the Affordable Care Act (also known as Obamacare) doesn’t affect them because they are not getting a subsidy. As a result they have tuned out the debate over health care coverage.
If you are one of those people that think that the Obamacare law doesn’t affect you, this post will give you a few reason to think again.
Stifling Patient Choice
Lost in all the noise about mandated health insurance coverage is the fact the Affordable Care Act completely changed the way Hospital systems and physicians are reimbursed.
At the Hospital level, the reimbursement system changed to a focus on individual outcomes rather than the number of patients and the time in which they are treated. Now insurances are looking for whether or not hospitals are evaluating patients for all possible health issues that could cause a readmission. That includes anticipating medical needs the patient might have after discharge form the hospital.
In general, if a patient is readmitted within 30 days the hospital system receives a penalty imposed on future reimbursement. The system includes the hospital and all of the doctors that work within it.
This change in focus has resulted in massive changes in healthcare systems. Because Hospitals are forced to anticipate future healthcare needs of patients, they have been expanding into other services like home care, hospice and even nursing homes.
By doing this hospitals hope to avoid readmission by controlling where patients are referred after discharge. This can stifle patient choice if patients lack knowledge about the services to which they are being referred.
Restricted Hospital Admissions
In order to be Re-admitted to the Hospital you have to be admitted in the first place. That is why now more than ever Hospitals are careful about who they actually admit to the hospital. Many people don’t know that when a patient goes to the emergency room they are not actually admitted to the Hospital. Emergency falls into a type of outpatient care where admission to the hospital is not necessary.
Because of the focus on outcomes, Hospitals are now increasingly careful which patients they actually admit for inpatient care. If there isn’t a clear positive outcome, hospitals may resist admitting a patient in order to avoid a re-admission later on.
The difference between admission and outpatient treatment is a key distinction for insurance companies. Some tests and treatments aren’t covered if given on an outpatient basis. Hospital admission is also trigger for insurance coverage of other services like Sub-Acute Rehab. If a visit to the ER turns into an overnight stay, don’t assume you have been admitted, ask the attending physician.
We Are All Stakeholders
Even if you don’t receive a direct subsidy for your healthcare coverage, Affordable Care Act regulations have most definitely effected your company’s health care insurance policies. Whether it be an increase in premium or change in enrollment procedures this law effects everyone.
It is silly to think that universal healthcare coverage will be repealed, no matter who wins the white house in 2016. That is why it is important to be aware of the changes in our healthcare system and they effect the average American. If the country is going to get universal healthcare coverage right, we need the input from every American.