Exchange coverage, Medicaid expansion begin this month
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While much of physicians’ attention related to the Affordable Care Act (ACA) has been on provisions related to care delivery, such as the law’s push for accountable care organizations (ACOs), the law is also intended to expand health insurance coverage to many of the country’s more than 50 million uninsured. It does so, in large part, through a state-by-state expansion of the Medicaid program for people with incomes below 138 percent of the federal poverty line and the creation of health insurance exchanges that allow people with incomes between 100 and 400 percent of the poverty line to shop for insurance plans and potentially receive subsidies to help pay for them. (The Medicaid expansion was originally mandatory but the Supreme Court ruled, in upholding the bulk of the ACA, that the federal government could not penalize states that did not expand coverage, so some patients with incomes too high for their state Medicaid thresholds but too low for the exchanges will not be eligible for any assistance in obtaining insurance.) Some of the uninsured will also be covered through the Children’s Health Insurance Program.

How many newly insured patients will there be? Look below for estimates from a July 2012 Congressional Budget Office report. See article in this issue for more on how dermatologists can prepare their practices for the Medicaid expansion.