PracticeLink Magazine

SUMMER 2014

The career development quarterly for physicians of all specialties, PracticeLink Magazine provides readers with feature articles, compensation stats, helpful job search tips—as well as recruitment ads from organizations across the U.S.

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SUMMER 2014 PracticeLink.com | 19 E NROLLMENT OF PATIENTS under the Affordable Care Act (ACA) grows, but some parts of the program have been postponed. When the period of open enroll- ment closed earlier this year, more than 8 million people had signed up for private health care insurance under the act. The ACA also increased cover- age for uninsured Americans by expanding the Medicaid program, making eligible anyone with income less than 138 percent of the federal poverty level. (In 2014 in the 48 contiguous states, 138 percent of the poverty level is $16,105 for one person and $32,913 for a family of four.) The Rand Corporation estimates that Medicaid enrollment increased by 5.9 million since enrollment expanded under the ACA. The number of persons covered by expanded Medicaid would have been larger had it not been for the U.S. Supreme Court deci- sion, which although upheld most of the ACA, gave states the right to opt out of Medicaid expansion (National Federation of Independent Business et al v. Sebelius, 2012). Approximately 24 states have opted out. The cost of not expanding Medicaid Researchers at Harvard University Medical School and City University of New York, writing in the Health Affairs Blog, estimated that between 7,115 and 17,104 will die each year because of the lack of Medicaid expansion in opt-out states. The deaths occur because many patients without insurance will forego screenings and treat- ments, including medications. The decision by some states to not expand their Medicaid programs was made even though the federal government will pay 100 percent of the costs of expan- sion in the f rst three years of the program and 90 percent of the costs thereafter. The ACA has reduced the number of people without insur- ance, but 32 million are estimated to still be without insurance. According to Gallup, those most likely to be without insurance are Hispanic (37 percent) or Black (18 percent). Eleven percent of Whites are uninsured. The Obama administration has acted to prohibit discrimination against same-sex married couples under the ACA. Insurance compa- nies issuing policies through insur- ance exchanges will be obliged to offer coverage to same-sex married By JEFF ATKINSON The Affordable Care Act in progress More people signed up for health insurance, but there will be delays for ICD-10, a permanent "doc fix," the Two-Midnights Rule and the employer mandate. Reform Recap How health care reform affects your life and practice Continued 2 4 3 - S u m 1 4 . i n d d 1 9 243-Sum14.indd 19 6 / 1 3 / 1 4 1 1 : 2 9 A M 6/13/14 11:29 AM

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