After the Supreme Court: The PPACA and What It Means for PAs


The Supreme Court’s decision on the Patient Protection and Affordable Care Act (PPACA) means that the law survives largely intact. With the individual mandate upheld, the Administration will be pressing the case to move forward on implementing insurance exchanges with those states so inclined.  If states choose not to create their own exchanges the federal government has the authority to establish an exchange for the state.

However, questions remain regarding the implications of the Court’s decision to strike the enforcement mechanism of the PPACA’s Medicaid expansion. An estimated 16 million uninsured Americans were projected to be covered under the law’s Medicaid expansion. While the Court ruled that Congress can make additional Medicaid funds conditional on expanding eligibility, they cannot take away existing Medicaid funds (as the PPACA would do) if a state declines to expand eligibility. At this time, it is not clear how the states, nor the federal government, may alter course based on the decision.

The Court’s decision to uphold PPACA bolsters a number of ongoing market trends that are likely to continue regardless of future intervention by federal and state lawmakers.  These include a shift to payment for value and outcomes and away from fee for service, additional focus on prevention and coordination of care, and the increased use of information technology.

Now that the Supreme Court has ruled on the healthcare law, what does it mean for you?

  1. As an American and voter, it means that –

    • You will be hearing a lot of rhetoric both pro and con on the merits of the law throughout the 2012 congressional and presidential campaigns.
    • Depending on the outcome of the elections, you will see increased momentum in the Administration’s implementation of the law and/or attempted repeal of the law in Congress.
    • The next battleground for healthcare reform will be in the states.

  2. As a PA, it means that you will be -

    • Recognized as one of three primary healthcare professionals in the U.S. today.
    • Valued as a vital and growing component of the nation’s healthcare workforce as medical practices and healthcare systems look to become more cost efficient, while maintaining quality in the delivery of services.
    • Eligible for 10% bonus for primary care codes through Medicare.
    • Allowed to order skilled nursing facility care for Medicare beneficiaries.
    • Embraced as a favored healthcare professional in patient-centered, primary care medical homes, Independence at Home models of care, chronic care management, and other new models of care designed to better coordinate care through team-based practice and to promote value to the healthcare delivery system.

  3. As a PA student, it means that you will be –

    • Viewed as a valued professional in the nation’s future healthcare workforce.
    • Eligible for increased financial support though the National Health Service Corp’s scholarship and loan repayment programs.

  4. As a PA educator, it means that you will be –

    • Eligible for increased funding support through the Public Health Service Act’ Title VII Health Professions Program.
    • Additionally, eligible for faculty loan repayment programs through the Title VII program.

  5. As a parent, it means that you can now –

    • Extend health insurance coverage for adult children up to age 26 through your family health insurance plan.
    • Be assured that your child cannot be denied coverage based on a pre-existing condition.

  6. As healthcare consumers, it means that you and the patients you serve will continue to benefit from –

    • Selective preventive services without cost sharing.
    • High risk pools for those who are uninsured with pre-existing conditions.
    • Choice of primary care provider, OB/GYN, and pediatrician.
    • Use of the nearest emergency room, without penalty.
    • Prescription drug support for Medicare beneficiaries.

  7. In 2014, it means that you and the patients you serve will no longer be subject to –

    • Denial of health insurance coverage based on a pre-existing condition.
    • An annual limit or lifetime limits on health insurance coverage.
    • Gender discrimination in healthcare premiums.

  8. Additionally, it means that you will benefit from protections that prevent insurers from –

    • Cancelling a policy without proving fraud.
    • Denying claims without an appeal.
    • Charging premiums that build more than 20% administrative costs (and less than 80% healthcare costs) into the fee.

  9. As an AAPA member, know that the Academy will continue to advocate for you to maximize your ability to practice medicine in every setting and in all medical and surgical specialties.

Look for further details in the coming months, and watch for action alerts and ways in which you can become engaged in shaping your future, the future of the PA profession, and the future well being of the patients that you serve.

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