In Next Evolution of Healthcare, Will Quality Remain a Focus?

As the CHA points out, even supporters of the ACA agree that it has room for improvement. For example, while the law provides coverage to many without insurance, there are still coverage gaps that leave people struggling to afford necessary healthcare. Experts with the American College of Emergency Physicians (ACEP) see Trump’s promised reform as an opportunity to address insurance coverage gaps that affect emergency patients.

The ACEP points out that although emergency physicians represent only 4% of doctors, they provide care for 28% of acute care visits, 50% of Medicaid and Children’s Health Insurance Program visits, and 67% of the acute care given to uninsured patients. And for many of these patients, the high costs of their care—even with insurance—are unexpected.

“Many people don’t realize how little insurance coverage they have until they need emergency care, and then they are shocked at how little their insurance companies pay,” commented Rebecca Parker, MD, FACEP, president of the ACEP, in a statement on the election. “Health insurance companies mislead patients by selling so-called ‘affordable’ policies that cover very little, until large deductibles are met—and then blame medical providers for charges.”

The ACEP supports expanding health insurance coverage to all patients, but it also advocates for transparency and calls for insurance companies to use independent databases for calculating payments.

In laying out his healthcare reform position on DonaldJTrump.com, Trump stated that any replacement programs must demand “price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.”

That transparency could prove instrumental in helping people pursue the care they need.

“The growth of out-of-pocket costs and the reductions of in-network physicians and hospitals are leaving people with health insurance barely covered in an emergency,” Dr. Parker stated. “State and federal policymakers need to ensure that health insurance plans provide adequate rosters of physicians, affordable deductibles and co-pays and fair payment for emergency services.”

Continuing the momentum toward value over volume

While Trump’s positions have focused on creating more affordable coverage, there is less emphasis on how a replacement plan would represent an improvement in the nation’s care provision. Despite its flaws, the ACA has undoubtedly transformed healthcare quality in recent years by leading the transformation from volume-based care to value-based care.