More patients can seek preventive health treatments and stop using the emergency room as their primary care doctor with the benefits of two provisions of the Affordable Care Act now in effect.
As of Jan. 1, hospitals are no longer allowed to charge co-pays or costs toward insurance deductibles to insured patients for a menu of 16 preventive services for adults, 27 for children and 22 for women — paid for through state and federal Medicaid.
The act also requires states to pay primary care physicians 100 percent of Medicare payments for primary care services, an increase that is fully funded through federal dollars.
Hospital administrators, such as Carlyle Walton of Metroplex Hospital in Killeen, believe an increase in the use of services, such as blood pressure and cholesterol screenings and tobacco-use cessation counseling, will save the country money and lives.
“At the end of the day, (the law) encourages citizens to more appropriately utilize the health care system in our country,” Walton said. “Building a relationship with your primary care doctor not only saves lives but it better deploys our health care dollars and services.”
Walton said a lot of people have resisted scheduling health screenings, such as bi-annual mammograms or annual prostate exams, because of the $50 co-pay often associated with the services.
Such screenings are well known to lower the risks of dying of cancer, but Americans notoriously do not take advantage of these services, Walton said.
“If we don’t have these screenings done, we pay the cost on the back end.”
Don Daniels, chief medical officer at Metroplex, said the future of health care in the U.S. will require people to use more foresight.
“The expectation is that they can get an appointment before they are admitted into the emergency room,” Daniels said.
Small things, such as increasing fiber in diet, decreases colon cancer, or visiting with a doctor about diet and obesity helps fight the obesity epidemic in the U.S., Daniels said.
“Our country has the best medical care in the world, as far as technology, advancements and services, but we have poor health because we don’t use preventive care like they do in Great Britain and France,” Daniels said.
Pressure to insure
While many of the provisions in the Affordable Care Act have made it easier to get health care, a major tenet of the law is putting pressure on people to enroll in health insurance policies.
In order to receive many of the federally funded benefits of the new health care law, including preventive services and women’s health treatments, patients must be covered by health insurance.
“For these services, you’ve got to have some form of insurance,” Walton said.
In 2011, Texas had the highest rate of uninsured residents in the country, according to the Texas Tribune. In 2010, more than 20 percent of Bell County residents did not have health insurance.
“It is unfortunate because a lot of people use the most expensive form of health insurance,” Walton said — the emergency room.
A full list of the preventive services covered under the Affordable Care Act is available at www.healthcare.gov.