

Affordable Care Act provisions spark a tech and app gold rush - closedbracket
http://www.marketwatch.com/story/health-care-startups-see-an-obama-bump-2013-05-30

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will_brown
Great read.

I am a co-founder of a health care start up, offering patients primary care
for $20/month ($15/month corporate plan) and a $20 copay to see the Dr. or $10
copay to see a ARNP or PA. _All out of pocket, we do not accept insurance or
medicare, as it would drive up our cost_.

Unfortunately, the future of our start-up is uncertain because of Patient
Protection and Affordable Health Care Act ("ObamaCare"). Specifically, when
the new law goes into full effect, patients will no longer be able to pay out
of pocket for medical care. Obviously our start-up is geared towards
underinsured and uninsured patients, so in the future our business model will
likely be unlawful. Of course it is great these patients will have health
insurance coverage, but their access to and quality of primary care will
likely go down and their costs will go up.

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dragonwriter
> Specifically, when the new law goes into full effect, patients will no
> longer be able to pay out of pocket for medical care.

I am pretty sure that the new law requires most people to purchase medical
insurance (with some exceptions that are covered by existing/expanded safety
net systems like Medicaid), and subsidizes some medical insurance purchases,
but I'd be very interested in a citation to the supposed prohibition on
patients purchasing medical care directly. (Now, there are certainly
deductible limits which may limit the amount patients may be _required_ by
insurers to pay out of pocket for things which are otherwise within the scope
of the coverage of the insurance they have, but that's a very different thing
than being prohibited to pay out of pocket.)

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will_brown
>I'd be very interested in a citation to the supposed prohibition on patients
purchasing medical care directly.

This is the whole idea of the penalty/tax. If a patient does not purchase
insurance, and for example needs to go to the ER, then that patient will
receive the penalty/tax from the IRS for not having a gov. approved health
insurance plan and they will receive a bill for the actual government
healthcare plan (premium payments and co-pays). The same will be true of walk-
in clinics, or offices with membership plans - they will be required to report
the uninsured, so the effect will be deterring the uninsured from availing
themselves to affordable care, because it will no longer be affordable but any
care will result in the government penalty and the actual bill (premium) for
the government healthcare plan.

If you are sincere here is the a cite to the Supreme Court Case:
<http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf> (See page 7-8
regarding the individual mandate and IRS "penalty") here is an excerpt:

"Beginning in 2014, those who do not comply with the mandate must make a
“[s]hared responsibility payment” to the Federal Government. §5000A(b)(1).
That payment,which the Act describes as a “penalty,” is calculated as a
percentage of household income, subject to a floor based on a specified dollar
amount and a ceiling based on the average annual premium the individual would
have to pay for qualifying private health insurance. §5000A(c). In 2016, for
example, the penalty will be 2.5 percent of an individual’s household
income..."

Do they come out and say uninsured are bared from simply paying out of pocket
for medical care? No, but they do not need to say it, because on a practical
level, the only way this is enforceable is requiring medical providers to
report uninsured patients and disallow them to simply pay out of pocket - in
my opinion this will put an end to walk-in clinics, membership based
practices, and care such as CVS minute clinics. The one way these practices
will stay around is if they get in bed with the insurance companies, but: 1.
it will limit patient access to care (you can no longer choose your provider
and pay out of pocket, but you will be mandated who you can see by your
insurance plan) and 2. drive up the cost of care (the only reason we can offer
$20/month $10-$20 copay is because the cost of billing insurance/medicare is
removed from the equation).

