NCPA - National Center for Policy Analysis

Ten Ways the Affordable Care Act Limits Patient Choice

August 9, 2012

The Affordable Care Act (ACA) limits patient choice either directly or indirectly in a variety of ways.  Below are just 10 provisions to be aware of, says Kathryn Nix, a policy analyst at the Heritage Foundation.

Medical Loss Ratio (MLR) Requirement.

  • MLR requirements -- which require insurers to use a certain percentage of premium revenue on medically related costs -- threaten popular Health Savings Account (HSAs) plans.
  • One reason is that, since HSAs often cover most or all of participants' routine medical expenses, the claims that a high-deductible health plan experiences are larger and may fluctuate significantly from year to year.

Independent Payment Advisory Board (IPAB).

  • IPAB is a board of unelected bureaucrats to implement ways to keep Medicare spending below a new cap.
  • The board is limited mostly to changing provider payment rates, but reducing reimbursement will make it more difficult for providers to continue to care for Medicare patients.
  • IPAB will also be empowered to contain costs by restricting access to certain treatments or services.

The Patient-Centered Outcomes Research Institute.

  • This entity will advance comparative-effectiveness research (CER), which compares treatment options for a disease or condition.
  • CER might be useful to doctors and patients in a purely informational role, but it should not be used to influence decisions without consideration of each patient's values, lifestyle, preferences and goals.

Medicare Value-Based Purchasing.

  • The ACA creates a Medicare value-based purchasing program to pay hospitals differentially based on their performance on federal quality measures.
  • This model has not proven effective in demonstration programs, and it could, in fact, discourage high-quality, personalized care by leading providers to focus more on care that is financially rewarding than on the needs of individual patients.

The list also includes: "Free" preventive services, "free" women's preventive services, essential health benefits package, Medicaid expansion, Medicare provider payment cuts and Medicare Advantage cuts.

Source: Kathryn Nix, "Ten Ways ObamaCare Limits Patient Choice," Heritage Foundation, July 27, 2012.


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