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Monday Memo
Monday Memo
Monday, November 14, 2016
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If the Affordable Care Act is repealed, will Case Managers be prepared to deal with an increase in the "uninsured"?

With the surprising outcome of the presidential election, all of us in the healthcare industry are left wondering, "Now what?" The entire industry has barely accommodated to the provisions of the Affordable Care Act (ACA) and now we have a president-elect who has vowed to repeal and replace the ACA and implement more major changes to American healthcare. Many of us are left to wonder what will happen to value and quality initiatives in healthcare if this happens?

On November 9th, an article in Modern Healthcare postulates a number of possible changes if the ACA is successfully repealed, such as:

  • An end to the expansion of Medicaid
  • Medicare restructuring (though Mr. Trump promised to leave Medicare unchanged)
  • Possible rollback in abortion rights for women.
  • An end to the individual and employer insurance mandates
  • Elimination of ACA insurance reforms such as minimum essential benefit packages
  • Paring back and restructuring the premium subsidies

Unraveling of the ACA system could lead to millions of elderly and low-income people losing coverage. As Case Managers, we have always been tasked with supporting the uninsured and under-insured by helping them to locate resources and services. Athena Forum supports case managers by addressing the issue in several courses, such as Revenue Cycle Management, Utilization Management and Discharge Planning. Read on for excerpts addressing this topic.

["Trump upset will force healthcare leaders to rethink the future," Modern Healthcare, November 9, 2016]

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Tips from our featured course

Case Managers: Discharge Planners

Discharge planners need to be aware of expanding opportunities to gain Medicaid coverage and will have to work harder and become more creative to locate funding for necessary services and durable medical equipment (DME) that uninsured patients need upon discharge.

While it used to be that having a job equated to having health care coverage, more than 65% of the individuals without coverage were employed workers and their families.

[Discharge Planning, Module A, Core Elements]


Looking Back: The Affordable Care Act (ACA) and the Uninsured

The ACA:

  • Offers many opportunities for almost all Americans to have health insurance coverage
  • Eliminates "preexisting medical conditions" as an obstacle to health insurance access

Despite several reforms, there are still numerous limitations and challenges:

  • More than 26 million Americans remain uninsured in 2016
  • Those who can purchase insurance may still have a high deductible
  • Many hospitals with limited resources are competing in a new marketplace, yet still caring for the uninsured

The ACA provides important opportunities to redirect and improve healthcare services. With a focus on options available, the ACA assists CMs in the implementation of a methodical assessment process.

[Utilization Management, Module E, Key Quality Measures]

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Thomas A. Rasmussen
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