VOLUME 27, ISSUE 1

This past year the Patient Protection and Affordable Care Act (ACA), aka Obamacare swung into full effect. It is a disservice to an American icon to refer to this law as a massive turkey, but somehow it fits. The current law was never intended to pass. The House version was the intended legislation. Secondly, due to the reconciliation mechanism, the legislation passed without meaningful amendments. Since passage the Republican Base has strongly opposed any efforts to fix the legislation and the Democrats have blocked all efforts to repeal it. This is an example of our political system at its worst; leaving us with a turkey that we can neither shoot, pluck, nor clean up. We are left with an almost unworkable statutory and regulatory nightmare of the first order.

The ACA is over 2,000 pages of law which has resulted in hundreds of thousands of pages of regulations. Over the next several Bulletin issues I will try to break down the legislation and discuss some of the issues of particular significance to Anesthesiologists.

So where do we stand today? First and foremost the ACA was to reform and expand healthcare insurance coverage to all Americans by a combination of an expansion of Medicaid and private insurance. Both mechanisms have considerable Federal financial support in Obamacare. The ACA includes payments for 100% (decreasing to 90%) of the additional direct costs of Medicaid and subsidies for moderate income citizens to purchase commercial healthcare insurance. These additional Federal expenditures were partially offset by an elimination of the “Disproportionate Funding Program” which was designed to reimburse hospitals for uncompensated care.

The best estimate among several studies is that the number of insured has increased by 3.5% nationally and less than 1.66% in Texas, leaving us with greater than 25% uninsured in Texas. Even in states with an expanded Medicaid, health insurance enrollment has fallen well short of the goals. Medicaid is perhaps one of the more expensive options for healthcare coverage. A Kaiser Healthcare study stated it would cost $7,300 a year per patient through 2022 to insure 21.3 million people under Medicaid. This is more than all but the most expensive private insurance policies and this does not include the billions of indirect administrative costs. The lack of real expansion in the insured population and an elimination of the Disproportionate Funding Program have left many the hospitals in the State with tight budgets.