Affordable Care Act provisions spark a tech and app gold rush

http://www.marketwatch.com/story/health-care-startups-see-an-obama-bump-2013-05-30

by closedbracket • 13 years ago

6 9 13 years ago

will_brown5• 13 years ago

Great read.

I am a co-founder of a health care start up, offering patients primary care for $20/month ($15/month corporate plan) and a $20 copay to see the Dr. or $10 copay to see a ARNP or PA. All out of pocket, we do not accept insurance or medicare, as it would drive up our cost.

Unfortunately, the future of our start-up is uncertain because of Patient Protection and Affordable Health Care Act ("ObamaCare"). Specifically, when the new law goes into full effect, patients will no longer be able to pay out of pocket for medical care. Obviously our start-up is geared towards underinsured and uninsured patients, so in the future our business model will likely be unlawful. Of course it is great these patients will have health insurance coverage, but their access to and quality of primary care will likely go down and their costs will go up.

lifeguard3• 13 years ago

>> patients will no longer be able to pay out of pocket for medical care

Untrue. Patients can still buy supplemental care in addition to Obamacare if they desire it.

will_brown5• 13 years ago

Well of course my statement becomes untrue when you qualify it by saying "in addition to Obamacare if they desire it." I am talking about uninsured, the majority of our patients. Perhaps I could have added the word "uninsured" to my sentence:

uninsured patients will no longer be able to pay out of pocket for medical care

That said your statement is very optimistic that the uninsured/underinsured patients who we cater to will not only be able to afford insurance in the future but be able to pay out of pocket for healthcare "if they desire". It is more like if they can afford it, which they cannot which is why they are uninsured now. Keep in mind many primary care copays are $50-$100 under existing insurance plans, which is going to be very difficult for these patients to pay under any circumstance, but especially in light of their new found insurance expense (maybe even an additional government penalty expense). At least now an uninsured can come to us and get antibiotics for $30 ($20 1st month payment and $10 to see the ARNP or PA).

dragonwriter• 13 years ago

> Specifically, when the new law goes into full effect, patients will no longer be able to pay out of pocket for medical care.

I am pretty sure that the new law requires most people to purchase medical insurance (with some exceptions that are covered by existing/expanded safety net systems like Medicaid), and subsidizes some medical insurance purchases, but I'd be very interested in a citation to the supposed prohibition on patients purchasing medical care directly. (Now, there are certainly deductible limits which may limit the amount patients may be required by insurers to pay out of pocket for things which are otherwise within the scope of the coverage of the insurance they have, but that's a very different thing than being prohibited to pay out of pocket.)

will_brown5• 13 years ago

>I'd be very interested in a citation to the supposed prohibition on patients purchasing medical care directly.

This is the whole idea of the penalty/tax. If a patient does not purchase insurance, and for example needs to go to the ER, then that patient will receive the penalty/tax from the IRS for not having a gov. approved health insurance plan and they will receive a bill for the actual government healthcare plan (premium payments and co-pays). The same will be true of walk-in clinics, or offices with membership plans - they will be required to report the uninsured, so the effect will be deterring the uninsured from availing themselves to affordable care, because it will no longer be affordable but any care will result in the government penalty and the actual bill (premium) for the government healthcare plan.

If you are sincere here is the a cite to the Supreme Court Case: http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf (See page 7-8 regarding the individual mandate and IRS "penalty") here is an excerpt:

"Beginning in 2014, those who do not comply with the mandate must make a “[s]hared responsibility payment” to the Federal Government. §5000A(b)(1). That payment,which the Act describes as a “penalty,” is calculated as a percentage of household income, subject to a floor based on a specified dollar amount and a ceiling based on the average annual premium the individual would have to pay for qualifying private health insurance. §5000A(c). In 2016, for example, the penalty will be 2.5 percent of an individual’s household income..."

Do they come out and say uninsured are bared from simply paying out of pocket for medical care? No, but they do not need to say it, because on a practical level, the only way this is enforceable is requiring medical providers to report uninsured patients and disallow them to simply pay out of pocket - in my opinion this will put an end to walk-in clinics, membership based practices, and care such as CVS minute clinics. The one way these practices will stay around is if they get in bed with the insurance companies, but: 1. it will limit patient access to care (you can no longer choose your provider and pay out of pocket, but you will be mandated who you can see by your insurance plan) and 2. drive up the cost of care (the only reason we can offer $20/month $10-$20 copay is because the cost of billing insurance/medicare is removed from the equation).

Affordable Care Act provisions spark a tech and app gold rush

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