Managed Care


Some Aspects of ACA Might Be Hard To Swallow

MANAGED CARE June 2013. © MediMedia USA
Editor’s Memo

Some Aspects of ACA Might Be Hard To Swallow

Open wide. When one is reaching for a metaphor to describe the Affordable Care Act’s effect on health care, that’s a good start, lending itself to an image of a python about to swallow something bigger than its esophagus, or a dentist with instruments of torture.

Insurers should be very concerned, as our cover story by Michael D. Dalzell on page 22 points out. It looks at five ACA trouble spots, but note the sidebar that cites five more that are not quite so dire, but still irksome. Lack of space made us focus on the main problems, and leave many others for later discussion. How many? Hard to say when you’re talking about a monster law that is 907 pages long, with regulations that go on for 70,000 more.

Health care lawyer Kathrin Kudner, displaying a talent for understatement, points out that “it’s not organized in a user-friendly way.”

The ACA reaches into all our lives, and inevitably it reaches into a few corners of this issue. For instance, accountable care organizations (ACOs) are a bulwark of health reform, and insurers need to be careful here, as well. Our story on page 48 explains the four basic elements every ACO contract should contain.

Meanwhile, the U.S. Preventive Services Task Force calls for nearly universal screening for HIV (page 38). It’s a grade A recommendation, meaning that plans must cover the service and patients need not pay anything out of pocket — another ACA provision.

Lest I be accused of being a noodge or even someone with a political ax to grind, let me quickly point out that everybody — and I mean everybody — agreed that something needed to be done to fix the system, and the ACA was a true compromise plan. In the end, the ACA might very well succeed, but not without some discomfort.

Do pythons ever gag?


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