Implications of the ACA Ruling for Young EM Physicians

Michael Tang, MD PhD FAAEM

In the last few months, there has been much speculation on how the June 2012 Supreme Court ruling upholding the Affordable Care Act (ACA) will affect emergency departments across the U.S. The ACA, which is the most significant revision of the U.S. health care system since Medicare and Medicaid were created in 1965, is known more formally as the Patient Protection and Affordable Care Act (PPACA), and less formally as Obamacare.

Consider, for a moment, the details of how this important change in the business of U.S. health care came about. It was after three months of deliberation that a divided Supreme Court voted 5-4, with the dramatically late support of Chief Justice Roberts, in favor of upholding the ACA’s individual mandate to purchase health insurance. Individuals may choose to opt-out, but they will be charged a “tax” penalty for doing so. Additionally, the court ruling allows individual states to opt-out of expanded Medicaid coverage.

At the end of July, the Congressional Budget Office (CBO) concluded that the Supreme Court’s ruling allowing states to opt-out of Medicaid expansion would result in $84 billion in savings to the Federal Government by 2022. The CBO also predicted that the upholding of the ACA individual mandate would still result in an overall reduction of the number of uninsured individuals in the U.S., compared to the present situation. Perhaps the most positive upshot of the ACA ruling is the opportunity for patients with pre-existing medical conditions to obtain
health insurance through expanded Medicaid.

Among physicians there is a widely held expectation that, in view of the already limited number of primary care physicians, emergency departments will see their volumes go up in the future, especially on the non-acute side. At the same time, overall reimbursements to hospitals are expected to decline, which was probably inevitable anyway. What remains to be determined is how much of the shrinking pie of reimbursements will be awarded to emergency departments. This will be determined, in part, by the advocacy efforts of emergency physicians.

Much uncertainty remains. For example, it is unclear how and whether emergency departments will be  reimbursed for uninsured patients who opt-out of coverage. Furthermore, young emergency physicians who are looking forward to saving lives will continue to face the challenge of a medical education system that saddles them with crippling debt while they work in a revised health care system.

As a member of YPS I, like many others in the field, am looking forward to a busy and challenging future for emergency physicians.