Abstract and Introduction
Abstract
The Health Care Reform (HCR) legislation passed by Congress in 2010 will have significant impact on transplant centers, patients and health care professionals. The Act seeks to expand coverage, limit the growth in health care costs and reform the delivery and insurance systems. In Part I of this two part series, we provide an overview and perspective of changes in private health insurance resulting from HCR. Under the plan, all Americans will be required to purchase coverage through their employer or via an improved individual/small group market. This legislation limits abusive practices such as limitations on preexisting conditions, lifetime and annual coverage limitations and dropping of beneficiaries if they become sick. The legislation will also limit high-cost plans and regulate premium increases. Private sector reforms are likely to benefit our patients by increasing the number of patients with access to transplant services, since the use of 'preexisting' conditions will be eliminated. However without a concomitant increase in the organ supply, longer waiting times and greater use of marginal organs are likely to increase the cost of transplant. Furthermore, transplant providers will receive reduced reimbursement as a result of market consolidation and the growing power of large transplant networks.
Introduction
On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act into law, ushering in a series of changes in the organization and financing of the American health care system. The measure seeks to expand access to private health insurance for the majority of Americans who can afford it and significantly increase in access to Medicaid for those who cannot. To finance this expansion, the law limits Medicare spending, increases taxes on high priced insurance plans and creates penalties for individuals and businesses who fail to purchase coverage.
The 'federalization' of insurance regulation will almost certainly impact all participating providers, including transplant centers. Transplant centers may get benefited from the expansion of private insurance coverage as key provisions such as the restrictions on coverage limitations for those patients with preexisting conditions and state insurance exchanges for the individual and small business markets are implemented in 2014. However, restrictions on the overall cost of insurance plans and restrictions on high cost, high-benefit plans are likely to put significant downward pressure on reimbursement and choice. The full impact of improved access to transplantation may depend on the ultimate payer mix within each transplant center's 'book of business', the expanded role of national transplant networks, specific benefit language for transplantation services included in some of the leaner insurance policies and the changes in public programs (Table 1).
In this article and the companion piece, we will provide an overview of the provisions of the health care reform legislation with particular attention to the potential impact on transplant patients, centers and providers. Our perspective in Part I will focus primarily on the private sector regulations including the changes in access to insurance, private sector financing of health care and strategies to improve the quality and efficiency of services as these changes may impact the care of transplant and prospective transplant patients.