Understanding What the ACA Means for Ophthalmology

American Academy of Ophthalmology 2013

Roger F. Steinert, MD; Nancey K. McCann; Brock K. Bakewell, MD


November 22, 2013

In This Article

Clearing Up ACA Confusion

Ms. McCann: There is a lot of confusion about the ACA. We had our government-relations committee meeting the other day and everybody is talking about the ACA. The ACA is not Medicare. The ACA is about covering the uninsured and eliminating preexisting conditions and other things that the insurance companies have been getting away with, and lining the pockets of their executives. Not that I am a proponent of the ACA -- ASCRS actually opposed it. It didn't fix the Sustainable Growth Rate and so on and so forth. But basically the concept is that if you get the young and healthy uninsured population into the system in these different areas of the country, then you share the risk, and so then the insurance company can afford it. That is how they adjust it. We have all of these healthy younger people who are not using the services and who offset the costs of care for those who are sicker. That is the concept of the exchanges.

It remains to be seen what will happen in the future, but many of these proposals were actually based on Republican ideas; the exchanges, the individual mandate, and preserving the insurance companies in the marketplace were all actually Republican ideas. Some of the proposals before this were Republican ideas. It will be interesting to see what happens, but for ophthalmology, because about 70% of our patient population is on Medicare, Medicare is what we should focus on, and Medicare often drives the market. A lot of the plans base their fee schedules on the Medicare fee schedule. They negotiate from it, and often Medicare is the higher payer. It will be interesting to see what happens in the next couple of years.

Dr. Steinert: I appreciate both of you giving your time to try to lend some clarity to the issue. A year ago, even 6 months ago, none of this was even remotely understood -- maybe by you, but certainly not by the rest of us. Now it is at least starting to become a little clearer -- not less threatening, but at least clearer. Of course, as we sit here at the Academy, we are in the midst of all of this noise about the failure of the Website for signing up. That is the uninsured buying insurance, which is separate from the ACO issue, correct?

Ms. McCann: Correct.

Dr. Steinert: These are different components of the plan that we are all going to be learning about the hard way. I would like to thank you both for joining us. This is Dr. Roger Steinert, with Nancey McCann and Dr. Brock Bakewell, on behalf of Medscape Ophthalmology.


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