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Emergency Physicians: Save These Key Obamacare Provisions

News  |  By Gregory A. Freeman  
   January 13, 2017

Revisions to the Affordable Care Act may be inevitable, but emergency medicine providers are pushing to keep protections for pre-existing conditions, lifetime limits, and coverage for young adults.

As the Affordable Care Act is begins its path toward GOP-vowed repeal, healthcare interest groups are taking stands on which components of the law they believe should be preserved. Don't throw out the good with the bad, they say.

The American College of Emergency Physicians has outlined tenets it says are indispensable to any replacement legislation if it is to maximize access to medical care while improving quality and lowering costs:

  • Maintain emergency services as a covered benefit for any insurance plan.
     
  • Ensure that the federal Prudent Layperson Standard extends to Medicaid fee-for-service and that compliance measures are in place for all other health plans.
     
  • Require health insurance transparency of data used to determine in- and out-of-network reimbursement rates for their patients' medical care. Ensure appropriate reimbursement rates for emergency services.
     
  • Eliminate the need for prior authorization for emergency services and guarantee parity in coverage and patient co-payments for in- and out-of-network emergency care services.
     
  • Retain protections for pre-existing conditions, no lifetime limits and allowing children to remain on their parents' insurance plan until age 26.
     
  • Enact meaningful medical liability reforms, including protections for physicians who provide federally mandated EMTALA-related services, care for patients in a federally declared disaster area and who follow clinical guidelines established by national medical specialty societies.

In addition, ACEP says Congress should ensure that any continuation or expansion of Health Savings Accounts, Health Reimbursement Accounts, Association Health Plans, and Individual Health Pools provide meaningful health insurance benefits and coverage for individuals and families, including access to emergency care services.

ACEP also calls for eliminating the Independent Payment Advisory Board (IPAB) and the excise tax on high-cost employer health benefit plans, and delaying repeal of the Center for Medicare and Medicaid Innovation (CMMI) until at least 2020 or amending it to eliminate mandatory provider participation in Medicare models.

That would allow an adequate transition period for the Transforming Clinical Practice Initiative (TCPI) grants aimed at lowering costs, improving health outcomes and delivering more effective care, ACEP says.

"Although the nation's emergency departments continue to focus on our traditional mission of providing urgent and life-saving care, our role has expanded over the last several decades to encompass safety net care for uninsured and under-insured patients, public health surveillance, disaster preparedness and filling gaps in care caused by physician shortages," said ACEP's president, Rebecca Parker, MD, FACEP.

"Reimbursement reductions from public and private payers have substantially curtailed hospital capacity, which is extremely concerning for any community which might be faced with a severe disease outbreak or mass casualty event. ACEP believes all Americans must have healthcare coverage and we urge lawmakers to consider the following principles as they develop new healthcare policies."

Gregory A. Freeman is a contributing writer for HealthLeaders.


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