ACA’s ‘grace period’ shows physician-led reform must be grassroots

Professional organizations including the AACU empower individual urologists with resources that support grassroots engagement in vital campaigns to re-assert the physician's role in health reform.

Based on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or info@aacuweb.org for more information.

As policymakers pieced together what would become the Patient Protection and Affordable Care Act ("Obamacare") in 2009, a Gallup poll asked Americans who they trusted to recommend the right reforms for the U.S. health system.

More than anyone else, those polled declared that physicians could be counted on to guide health reform.

Five years later, we know that physicians' recommendations were mostly ignored, while insurance company executives, bureaucrats, and academics re-engineered the health care system in a way that fails to consider the realities of medical practice.

Case in point: The 90-day "grace period" for patients who fail to pay their ACA-supported insurance premiums in full.

Throughout the construction and early rollout of the ACA, health insurers were responsible for unpaid claims incurred throughout the entire grace period. The Centers for Medicare & Medicaid Services (CMS), however, slyly shifted insurers' exposure for the full 3 months in regulations. As of today, issuers must pay claims incurred during the first month of the grace period only, and they're not obligated to inform providers of patients' nonpayment status until months two and three.

More than 80 physician organizations representing physicians and medical practices voiced indignation in a March 2014 letter to CMS Administrator Marilyn Tavenner.

"The timing and manner of such notice is left to the discretion of the issuers," the letter noted. "We believe these current notice requirements are inadequate and will lead to administrative confusion for physicians and practices."

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Physicians pushed back in state legislatures, as well (see “How four states responded to 90-day grace period,” below). In the first few months of 2014, at least four states considered legislation requiring immediate disclosure of premium payment status and/or specifying that the insurer or patient is responsible for all claims. Only Washington state's version requiring both provisions has been signed into law.

How is it that physician input has been largely disregarded? Were the ACA and subsequent regulations developed without consideration of the practice of medicine?

A generally respected health policy blog, noting far more physicians serve in Congress today compared to 1968 when Medicare and Medicaid were conceived, heralded an era of physician-led health reform.

The authors fail to understand that unless and until physicians make up the entire Congress, health reform will be led by insurers. Physician-led reform will only happen from the bottom up. Professional organizations including the AACU empower individual urologists with resources that support grassroots engagement in vital campaigns to re-assert the physician's role in health reform. Join us and make your voice heard.