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Supreme Court Upholds ACA, Individual Mandate

On June 28, the United States Supreme Court released its highly-anticipated decision on the challenge to the federal Patient Protection and Affordable Care Act (ACA). In its 5-4 decision, the Court left the ACA largely intact. In addition, the ruling upholds the controversial individual mandate under Congress’ Constitutional authority to levy taxes; but strikes down provisions of the ACA that impose sanctions on states that decline to expand their Medicaid programs.

Emergency physicians in Ohio and around the nation support several important provisions of the law. The ACA includes emergency services as an essential part of any health benefits package. In addition, the law recognizes the prudent layperson standard, which guarantees health plans base coverage on patients’ symptoms, not their final diagnoses.

However, emergency physicians remain concerned that the Affordable Care Act creates—or does not address—several important problems in the delivery of emergency care. America’s continued shortage of drugs and physicians creates serious mismatches between patient needs and available resources. The law will compound this mismatch by expanding the Medicaid rolls without increasing the number of physicians willing to treat Medicaid recipients. This leaves many Medicaid patients with little choice but to seek care at America’s emergency departments—many of which are already over capacity.

Meanwhile, emergency physicians remain concerned about the nation’s broken medical liability system, which contributes to the high cost of health care and diminishes patients’ access to lifesaving care. Unfortunately, the Affordable Care Act does not meaningfully address this dysfunctional system and continues to leave physicians vulnerable to unreasonable lawsuits.

In addition, the ACA creates the Independent Payment Advisory Board (IPAB), a fundamentally flawed panel which is unaccountable to Congress, health care providers or the public and will harm Medicare patients’ access to medical care.

Following the release of the high court’s ruling, the American College of Emergency Physicians issued a statement on the implications for emergency medicine in the United States. The statement praises several provisions of the law, including recognition of emergency services as a vital part of any health plan and inclusion of the prudent layperson standard.

However, ACEP President, Dr. David Seaberg, also raised serious concerns about the ACA. He called on the US Senate to join the House in repealing the unaccountable Independent Payment Advisory Board and again voiced his anxieties about the law’s expansion of Medicaid.

“Increasing the number of patients on Medicaid without an equivalent increase in the number of physicians willing to take that insurance will surely increase the flood of patients into our nation’s ERs,” said Dr. Seaberg. “Coverage does not equal access and critical problems facing emergency patients are not going away.”

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