Healthcare reform is in the news on a daily – no, make that hourly – basis. The House of Representatives passed a bill to “repeal and replace” the Affordable Care Act (ACA) recently with the American Health Care Act (AHCA). The bill is now under review by the Senate.
In its current state, the AHCA reduces the number of people with insurance compared to the ACA, to the tune of potentially 24 million without coverage within the next decade. Partly due to the lack of comprehensive coverage for Americans, in March 2017, on a previous version of the bill, the Academy of Nutrition and Dietetics noted its opposition to the AHCA. Academy President Lucille Beseler, MS, RDN, LDN, CDE, FAND, stated that the bill "fails to improve the health of all Americans" and will "worsen patient care and public health." The Academy based its decision on the idea that the proposed legislation does not meet its five tenets for analyzing healthcare reform, one of which is “…nutrition services, from pre-conception through end of life, are an essential component of comprehensive health care.”
Healthcare reform is complicated and, by the time you are reading this, new legislation may have been introduced, debated or passed - but in the meantime, the fate of the ACA is uncertain. It is important for us, as healthcare providers, to understand the implications of the current healthcare landscape and how changes may affect your private practice and your clients’ benefits.
ACA in Limbo
Will we have new healthcare legislation in place for 2018? And if so, when? In this video on Newsweek.com, House Speaker, Paul Ryan, says: “I’m not going to put a timeline on it…because we want to get it right.” The Republican Party still plans to “fix Obamacare,” but this fix remains to be seen.
Meanwhile, insurance companies are currently deciding whether they will participate in ACA (or its replacement) for 2018; they have through June to share their rates with states. And unfortunately, the outlook is not looking bright, as many insurers are departing public exchanges as of mid-April. Why? Carriers are citing uncertainty, coupled with Trump’s stance on refusing to authorize payment of ACA-required subsidies used by seven million people to cover co-pays and deductibles.
This instability will result in higher costs as insurers leave the exchanges, halt sales of individual plans, and/or raise premiums. The Trump Administration issued this rule in mid-April in an attempt to steady the marketplace, which, according to NPR, could impact our clients who purchase via exchanges this Summer in the following ways:
- Individuals who want to sign up for an ACA plan with their same insurer for next year would have to pay past-due premiums before receiving coverage
- Anticipate a shorter open enrollment period, reduced to six weeks from three months previously
- Higher deductibles for our clients may result once Trump flexes the formula that determines plans and pricing
- Patients with pre-existing conditions and gaps in coverage are at risk of being shut out of the insurance markets
How will Medicaid be Affected?
More RDNs accept private insurance over Medicaid as a form of payment, because, even with the expansion of Medicaid, nutrition counseling isn't fully covered – instead, it varies widely state by state. That said, repealing the ACA will have the biggest impact on the clients and patients who received coverage for nutrition counseling for the first time via the Medicaid expansion. Many people had access to healthcare for the first time via the ACA because their employers didn’t offer healthcare benefits or the plans were too expensive.
Without the ACA, the access to these plans goes away—without the subsidies, many people earning just above minimum wage will no longer have a viable health care option. These individuals, largely minorities and children, may no longer have access to healthcare and/or dietary counseling should the ACA be fully repealed.
Interestingly, Republicans are showing support for a universal Medicare solution. An Economist survey shows 46 percent of the party in favor of "…expanding Medicare to provide health insurance to every American." Medicare is available for adults over 65 years of age.
When Will RDNs Feel the Impact?
Amy Roberts, PhD and CEO of Healthy Bytes, noted that her company is receiving questions such as "How will new healthcare legislation affect my practice?" and "How will these changes affect my patients?"
“For private practice RDNs whose billings are via private, non-government, or employer-sponsored plans – fortunately, the impact will be limited,” Roberts noted. “We encourage RDNs to continue to be diligent about conducting eligibility checks on behalf of patients to have a full understanding of what is being covered and to protect themselves financially.”
As dietitians, we’re not likely to feel the impact of this transition for the remainder of 2017 – however, time will tell what 2018 will bring.
Bio: Krista Ulatowski, MPH, RDN, is the Seattle-based owner of KUcumber Nutrition Communications, creating and implementing marketing, communications and public relations programs for health/wellness and food companies. Connect with her on Twitter, Facebook, LinkedIn and Instagram. The author wishes to disclose that Healthy Bytes is a client.