The U.S. Supreme Court on Thursday did not render an opinion on the Affordable Care Act, the federal health care reform bill. A ruling is expected to be announced next week.
The Affordable Care Act was passed by Congress and signed into law by President Barack Obama in March 2010. Twenty-six states have challenged the constitutionality of the law’s mandate for all U.S. citizens to purchase health insurance by 2014.
“The hot-button issue, of course, is the provision for mandatory coverage, including the obligation for citizens who can afford it to buy health insurance and access to taxpayer-subsidized insurance by about 35 million uninsured Americans,” John B. Pinto, OSN Practice Management Section Editor, told Ocular Surgery News.
“If this provision stands, then at least theoretically, U.S. ophthalmologists stand to gain, with more total dollars being pumped into the health care delivery system,” Pinto said. “However, this will only exacerbate the pace of health care cost inflation — 13% of the gross domestic product in the ‘Clinton reform’ years and 18% today — and drive down payments allowed per unit service. Under a best-case scenario, eye surgeons would be doing more work for the same total payments.”
Pinto noted that unit fees will decline, regardless of the court’s ruling on the law. However, ophthalmology will likely fare better than other medical specialties because the aggregate demand for ophthalmic care is rising 3% to 5% annually, while the number of ophthalmologists is growing at a rate of less than 1%, he said.
“The average ophthalmologist will have a greater demand for his or her services in the years ahead. The market is growing, not shrinking,” Pinto said.
In addition, ophthalmologists stand to gain because senior patients are largely willing and able to pay out of pocket for premium technology and advanced care. Medicare payments are also a factor, Pinto said.
“Ophthalmologists, who receive about 60% of their total revenue stream from Medicare, have long ago accommodated to a reduced-fee environment,” he said.
Urban providers stand to be the most adversely affected under any health care reform scenario, Pinto said. They face higher operating, payroll and living expenses and hospital and clinic mergers, which may adversely affect those who are unwilling to forfeit their independence and join large groups, he said.
Rural providers would be least affected because of low patient-provider ratios, penetration of managed care, operating costs and cost of living, Pinto said.