There are a lot of questions arising about the future of healthcare in the United States. Read more below for insight as to what to expect in the coming years.
For patients age 26 or younger, it is highly likely that insurance coverage will not change due to the fact this age-bracket is still protected by law to be covered by the insurance policy of a parent or guardian, if the patient chooses. If you have a pre–existing condition, no insurance policy can deny you based on that fact alone. Denials based on your previous medical history will not legally take place. What might change is the structure of these exchanges in the Affordable Care Act. If parts of the ACA are repealed, there will be a smooth transition to new policies, without a gap in coverage. In the case of a patient with coverage from a commercial insurance company that will be transitioning to Congress–proposed coverage, the patient could see a shift to a Medicaid–type system where a single payer—not run by a private company but rather by the State Government—is supplemented by tax credits and with grants from the Federal Government. In cases where the patient doesn’t meet specific income thresholds, the tax credits and grants will be much more generous.
Mandates require what can be covered with credits and grants, and this can vary from state to state. The Federal Government may even have a say in what coverage requirements are needed in relation to physicals, colonoscopies, preventative care, diabetes care, flu shot, eye exam, and mental health treatments. It is imperative to review the fine lines of one’s insurance coverage options and compare plans. Do not assume that the cheaper plan is the best simply based on what your monthly payment will be, as you are going to get what you pay for. In relation to deductibles, patients must be prepared to pay them up front in cash or with a credit card in the case of a medical catastrophe, emergency medical visit, or accident.
The Medicare system will likely be shifting from public Medicare paid for by the government to a plan called a Medicare Advantage Plan, where the government pays a certain fee per enrollee to the health plan company, who then has the option to do what they want in terms of using that money to pay for the care contracted to physicians, hospitals, and pharmacies. The benefits or risks—depending on who you ask—of these types of plans include the potential to save money because the care is more managed and restricted. In other words, you might need a referral for a test or a drug, or to see a specialist, which could require a higher copay. However, the intent of it is to save the system unnecessary coverage by trying to restrict unneeded tests and further overuse. The downside of the changes includes the potential for limited or restricted access to specialists, non–generic medication, or tests for the consumer due to authorization policies of their insurance company.
The prevalence of smaller practices will continue to decline due to the increased cost of keeping up with the mandates for implementation of electronic records systems, standards for modern hardware and software, and use of consulting industries. These standards make it harder for small groups to stay abreast while still delivering quality medical care, but smaller practices will not go away completely. This will result in benefits for hospital systems, as they will own 66-75% of doctor practices, allowing for internal referrals to their own groups to generate increased revenue.
Regardless of whether there are health policy changes or executive orders for such, the cost of healthcare is going to continue to rise, especially given our aging population and ever-changing medical technologies. However, the cost of medication should lower due to pressure from the population placed on Congress. The number of medications people take, as well as tests, procedures, and surgeries given, will continue to burden the patients with increased costs that are out of proportion to their income, regardless of who is in the White House or Congress unless the government radically changes the system as a whole.