Although the Affordable Care Act – popularly referred to as Obamacare – was recently upheld by the United States Supreme Court, many questions remain about its long-term impact, particularly how it will affect patients with chronic conditions. I asked Douglas Hough, an expert in behavioral economics in health care and health care economics and professor at the Johns Hopkins Carey Business School, to explain what it means.
What does the Affordable Care Act mean for patients with chronic conditions?
The obvious change is with regard to pre-existing conditions. The ACA is, in a sense, made for chronic care. Before the ACA, insurers were able to deny coverage to those who were deemed too risky by having a pre-existing condition; now those with chronic illnesses will have a way to get into the system. Those who previously had either no health care or inadequate care will be better off.
There will also be increased financial incentives for hospitals, physicians and rehabilitation centers to treat patients with chronic conditions. On the margin, those delivering the care will now be encouraged to devote time and energy to chronic care.
The other big change is with regard to Accountable Care Organizations. In every wave of health care reform starting decades ago, there is always hope this will facilitate integrated care. Providing for the totality of care – beyond just addressing a singular disease through a short-term action - has been the bugaboo for decades. Every time there is new legislation for health care reform, we think it's going to work. When managed care first came up, we thought that this would be the impetus for a true continuum of care. Now the ACA is another opportunity, though I am much more optimistic than previously.
What is the benefit to the individual patient with a chronic condition?
This is what chronic patients have been waiting for. In the past, many patients have to explain their condition, medications and prior treatment to every single provider with no coordination in medications and therapies. This can be incredibly frustrating for both patients and families. On top of the frustration, disjointed care doesn’t make sense from a clinical or economic standpoint. The most positive outcome, for the patients, will be the development of ACOs, where there will be coordinated care. If the big providers of care can get on board, things will be dramatically better for patients moving forward.
How is the cost of health care going to change for everyone?
Cost is going to be community-based, not experienced-based. What I mean by this is that cost will be spread more evenly across the entire community, rather than those who have had a history of medical needs paying exponentially more. If more care is delivered to chronic patients, costs will increase for all of those paying for the system; however, this will be spread across premiums of everybody. This is part of being a member of society; we must uphold the public good.