Orthopedic surgeons are weighing the potential impact of proposed cuts to ACA subsidies, which could lead to coverage losses and shifts in payer mix across the specialty.
Here, three surgeons shared how reduced subsidies could affect orthopedic care and patient access.
Question: What impact will cutting ACA subsidies have on orthopedics?
Editor’s note: Responses have been lightly edited for clarity and length.
Douglas Dirschl, MD. Professor and Chairman of the Joseph Barnhart Department of Orthopedic Surgery at Baylor College of Medicine (Houston): For patients, higher out-of-pocket costs for care will likely lead many to delay or defer medically necessary elective orthopedic care. For practices, reduced volume and revenue could result — that perhaps cannot be replaced in its entirety. A recent analysis in our practice plan revealed that 15% of our managed care revenue was from Marketplace plans; if this volume were to suddenly disappear, it would be hard to immediately replace it with other managed care patients.
Mitchel Harris, MD. Chair of Orthopaedic Surgery at Mass General Brigham; Professor of Orthopaedic Surgery at Harvard Medical School (Boston): If the ACA subsidies are cut, and our local government estimates are correct; 2-300,000 people will lose their insurance status. Remember, before it was termed ACA, it was Obamacare; before it was Obamacare, it was Governor Mitt Romney’s healthcare plan for the state of Massachusetts. This cut will significantly affect the payor mix of all healthcare providers and systems. It will also likely subject many individuals to new hardships finding appropriate care within the state.
Mark Vrahas, MD. Professor and Chair of the Department of Orthopedics at Cedars-Sinai (Los Angeles): The cutting ACA subsidies along with cuts in Medicaid will result in fewer insured patients supporting our health care system. This will be especially difficult for rural hospitals that run on low margins and depend on Medicaid. It is also likely to lead to hospital closures, cuts in services and job losses. The burden of uninsured at academic institutions is likely to increase, compounding financial headwinds. Typically, the care of uninsured and underinsured patients at these institutions is subsidized by income from commercial insurance. To offset losses from uninsured patients, hospitals will be pressured to advocate for higher reimbursements from commercial plans, which will lead to increased premiums.
