The Affordable Care Act, like it or not, has certainly brought changes to our healthcare system. At this point, most Americans are at best curious, and at worst very anxious about what their health insurance will look like in the future. Americans all believe we should be able to receive quality care at a reasonable price – we and our lawmakers just have differing opinion on how to provide and finance that care.
This article takes no political stance, but only examines what we see at the potential impact of changes to the ACA. We also do not take into account the potential for single-payer or “Medicare for All” programs, as we do not feel they are an option for the current President and Congress.
The ACA is actually currently enjoying its highest popularity ever, with more people viewing the legislation favorably than unfavorably for the first time since its passage in 2010. It appears that the law will be at least changed if not repealed/replaced or repealed entirely.
If the ACA is repealed, or changed significantly, how will it impact your medical debt collection? My belief is that bad debt will become really bad debt. Here is how:
Coverage – This is the biggest area of impact. ACA policies are more expensive because they cover more. Will the essential health benefits (emergency services, prescription drugs, wellness and others) guaranteed by the ACA be included? Will they be included but will individual states be allowed to waive them? The worst kind of medical debt is the kind that results from uninsured events and if the requirement for essential services goes away, medical providers might see more large patient defaults.
If insurers could offer “bare bones” policies to younger healthier people, the lower premiums would be attractive, until the policy was needed, and then lack of coverage would mean patients would be on the hook for the cost of treatment. No individual mandate or not being able to stay on parental policies until age 26 might cause younger patients to forego the purchase of insurance altogether, which could cause trouble for them if they got sick or were in an accident.
Deductibles and Other Cost Sharing – The ACA did not cause high deductible policies. Deductibles were rising before the Act, as were coinsurance and co-pays. A new law could provide options with lower out of pocket expenses, which would be a good thing. Patients with less cost-sharing in their policies will be less likely to default on their portion of the bills. Of course, if the lower cost sharing means less coverage, are you simply trading dollars?
What can medical providers do to prepare for changes? The same things you should be doing now – communicating with patients at every opportunity about their insurance terms and conditions. Verify insurance coverages for new patients and review with them. Every patient should be required to sign a financial responsibility statement, and the form should be updated annually. Patients should be offered payment plans for larger debts (document these!) and discounts for prompt payment.
Medical debt collection is more about communicating with patients than anything. I find that a good deal of the “bad debts” we receive for collection are easily resolved once patients understand what their insurance paid, and when they are reminded that they agreed to take responsibility for all costs not covered by insurance.
