In late March, Ruth Kevess-Cohen, M.D., noticed a change in her patients. Usually they came to her Silver Spring, Maryland, office asking about their blood sugar levels or blood pressure. Now they had a new concern: Should they be worried about the new health care reform law? Would they still be able to get in to see her? Would they still get the same treatment for their diabetes or high blood pressure? “It’s on everyone’s mind,” says Cohen, an internist who specializes in geriatric medicine.
Much has been written about how health care reform will affect patients. But very little has been written about its impact on providers—and how that will affect you. Fortunately, for people over 50, the news is mostly good. “I’m telling my patients not to worry,” says Cohen. “The changes at this point do not affect the personal relationships between patients and their doctors. Patients can see their same doctors as before, doctors will continue to refer them for tests and to specialists as before, and patients can still get their prescriptions at their local pharmacy or through mail order.”
Here are the provisions of the bill most likely to affect you and your physicians—and advice on how to ensure you get the best care possible.
1. Seeing your doctor—when you want to
One of health care reform’s greatest achievements is its guarantee of health coverage for 32 million uninsured Americans. The benefit for those 50 and older who don’t have health coverage now because of preexisting conditions or economic hardship is that you will be able to see a doctor when you need to, without fear of paying exorbitant costs for routine medical care. The new law bans private insurers from dropping people who get sick, from turning away those who have preexisting conditions, and from setting lifetime caps on benefits. It also provides subsidies for low-income Americans so they can purchase private health insurance, it expands Medicaid (state-run health insurance programs for the poor), and it allows adult children to remain on their parents’ health insurance plans until age 26.
All of these guarantees do come with a challenge, though. Whereas those who currently have a primary care physician will be able to see him or her as before, those who do not presently have access to a doctor may find themselves on a waiting list. That’s because there are parts of the country where primary care physicians are already in short supply, and the new law will bring millions of additional patients into the system. The American Academy of Family Physicians predicts a shortfall of roughly 40,000 primary care doctors over the next decade as medical students are increasingly drawn to the higher pay and better hours of specialties such as surgery or radiology.
What’s more: “The issue of access is not just about the number of patients; it’s about making our delivery system more efficient and productive,” says Michael Newman, M.D., who has an internal medicine practice in Washington, D.C. “We want to make sure everyone gets the care he or she needs, but that doesn’t mean a physician has to be the one who provides all the care. We can take the burden off physicians by using more nurse practitioners and physician assistants, and other caregivers who can better deal with the management of chronic diseases, education, compliance, prevention, etc.”
Recognizing the growing need for access, legislators included in the new law bonus payments for primary care physicians as well as expanded community-health centers and forgiveness of tuition loans as incentives to medical students to pursue primary care careers.