Central TX doctors weigh in on pros, cons of Affordable Care Act

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by JIM BERGAMO / KVUE News and photojournalists Michael Moore and Scott Guest

Bio | Email | Follow: @JimB_KVUE

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Posted on September 16, 2013 at 12:05 PM

Updated Monday, Sep 16 at 12:05 PM

AUSTIN -- 2014 will change the face of health care in America. KVUE News looks at the pros and cons through the eyes of those Central Texas physicians who may know the Affordable Health Care Act the best.

Bruce Malone, M.D., is the past president of the Texas Medical Association. James Rohack, M.D., is the director of Scott & White's Center for Healthcare Policy.  Ari Brown, M.D., is a pediatrician with 411 Pediatrics, author and spokesperson for the American Academy of Pediatrics. They share their views on some of the positives and negatives the plan has to offer.

When it comes to health insurance, "In the United States if you don't have health insurance, you live sicker and you die younger," said Rohack.

In an effort to extend health care coverage to all Americans, Congress passed the Affordable Care Act in 2010. Some parts are already implemented, but the bulk of it becomes a reality in 2014.

"I think the person who is uninsured -- especially those who are uninsured because of preexisting conditions -- they're the big winners," said Malone.

"The person who has heart disease, or the parent that's got a child with cystic fibrosis and wants to get health insurance -- they will now be able to get that through the health insurance marketplace that will become available October 1," said Rohack.

October 1 through March 31 is an open enrollment period. It's the time when the uninsured, or those who choose to break away from their company-provided health plan, can turn to the federal exchange.

"The exchanges are going to be a new institution in medicine," said Malone. "It's going to be a mechanism where you can go online and shop for health insurance."  

Shoppers will choose between four levels of coverage. The Bronze plan means 60 percent of the healthcare costs will be covered. Silver means 70 percent, Gold means 80 pecent and Platinum means 90 percent coverage.

"To someone who has never had health insurance before, what does that mean?" said Rohack.  "What it means -- if you want the highest plan of coverage you are going to pay the highest monthly premium."

While most experts agree whether health insurance is provided by an employer or purchased over the exchange, it's going to be expensive, but depending upon your income level there may be some federal subsidies to help.

"If you have to spend more than nine-and-a-half percent of your income on a health care premium, you don't have to buy it," said Rohack. "In other words, you are considered exempt because it's unaffordable to you. If you fall between two percent and nine-and-a-half percent, you'll actually get a tax credit to lower that monthly premium."

As an orthopedic surgeon, Malone has seen and repaired his share of bad breaks. However, he says our country's leaders need to put on the brakes when it comes to the Affordable Care Act.  

"I'm concerned there are going to be some train wrecks along the way," he said.

Malone says, while the intent of the ACA to provide health insurance to all Americans is a noble idea, the plan rolled out has several flaws -- most notably the cost.

"I don't think the Affordable Care Act does anything to lower cost," said Malone. "In fact, I think it's going to increase cost, and I think that's where the crisis is going to occur."

"What my frustration is, is the misinformation that's out there," said Rohack. "October 1 is going to be here pretty soon. Right now, in Texas, we still don't know what the premiums are going to be offered and who is going to be offering it."

That affects patients as well as doctors like Brown.

"Even me trying to access the system right now, I had to call individually to the government to find out what the issues were for me as a provider," said Brown. "They weren't able to provide some specific answers, but they will, apparently, in October."

Some physicians and medical experts are already making comparisons to other countries with government-run health care, whereby doctors have one practice under the system and another private -- a cash-only practice for patients who want to be treated right away. Rohack says that already exists in the U.S. to some degree.

"As this model continues to evolve, then doctors will have to make decisions," he said. "Do I want to continue the insurance model where the insurance company is paying for me, or do I opt-out? Go to a cash-only business. There's nothing that prevents a doctor from going to a cash business. We see that popping up all the time. In fact, cosmetic surgery is not covered by insurance."

Malone is convinced the Affordable Care Act already needs a major overhaul.

"There's a new regulation coming out of Washington, D.C. every week concerning medicine. My concern is that medicine is going to become the most regulated profession in the country. I've never heard of cost efficiency coming from highly-regulated industries," he said.

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