Last month, ACG hosted the “Health and Healthcare in America: Challenges of Living Through Reform” seminar. Moderated by Chad Magee, Vice President of Corporate Development and finance at ManTech International Corporation, the event aimed to clarify many of the provisions in the Affordable Care Act (ACA) and how they’ll impact businesses in the National Capital region.

Chad was joined by a panel of experts, including:

David Main was the first speaker to address the crowd, and described five key components he considers to be at the forefront of the national conversation:

  1. In order to increase access to health insurance, Medicaid has expanded so that the level of eligibility is higher – up 138% of the federal poverty level. States now have the opportunity and incentive to expand their Medicaid programs to this level.
  2. The establishment of health insurance exchanges will create portals where private insurance companies can sell plans to citizens. The real question is will people understand this well enough to go online and sign up?
  3. The regulation of health insurance companies will decrease the amount of citizens that lose their coverage due to preexisting conditions. Children would have to be able to stay on their parents’ plan till they’re 26, and their rates can’t change because they’re unhealthy. Some external factors like smoking may affect rates, however.
  4. Everyone in the country, with a number of exceptions due mostly to hardships in income levels, has to get insurance beginning in 2014. Many people say it’s unconstitutional, but others believe you’ll need health insurance at some point in your life, “so everyone needs to be a part of the game and pay in.”
  5. The employer mandate will force employers to provide insurance if they have more than 50 employees, but there are a lot of complicated exceptions. Employers that don’t provide insurance will have to pay a penalty. Although challenged in court, the Supreme Court ruled that it’s not unconstitutional because it’s only a tax penalty, and not a provision that forces people to purchase insurance.

According to David the ACA functions to expand the eligibility for health insurance. There are some provisions that try to improve the quality of care and address reimbursement issues and so forth, “but mostly it’s about increasing the availability of health insurance.” As to whether or not he believes the ACA is good for the country’s future, David said. “It’s a good thing for the healthcare industry and the insurance industry. It will take time to sort out, and what we’re seeing is a road map of were we want to be as a country, but maybe we’re going to have to go a little bit more slowly.”

Following David’s assessment of the ACA and its main provisions, Dr. Edward Miller discussed another impact of the ACA, the proliferation of Electronic Health Records (EHR). Dr. Miller highlighted the fact that the EHR is not a necessarily new concept, and has been around for a long time.

Dr. Miller believes that EHRs present challenges because they are more time consuming than manually filling in documents. He claims that “When you go from a paper system to an electronic system, you lose productivity …everywhere you turn, you see that physicians are required to do more and more to get data into the system, which will allow them to get paid less and less, so it doesn’t make a lot of sense.”

According to Dr. Miller, the long term benefits of EHR implementation and adoption across the healthcare industry should outweigh the costs. “In the long run though, it’s the right thing to do, because what you really would like is to be able to look at a patient longitudinally. You’d like to be able see the patient’s medical history and understand why he/she got heart failure at 45. One of the best reasons to have EHRs is to take care of a population of people,” said Dr. Miller. “We’re still in fee for service; we get paid more for doing more not for giving better patient care. But if you take care for a population of people, then you have the data to make that happen, then you’re ok.”

In our next post featuring coverage of the seminar, we’ll highlight the discussion around the  ICD-9 and ICD-10 conversion, including  why it’s important, the health insurance exchanges, and what business opportunities have emerged because of the ACA.