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January 15, 2014

Implications of New Insurance Coverage for Access to Care, Cost-Sharing, and Reimbursement

Author Affiliations
  • 1Health Policy Institute, Schools of the Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 2Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 3Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 4VA Pittsburgh Healthcare System and RAND Corporation, Pittsburgh, Pennsylvania
  • 5Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA. 2014;311(3):241-242. doi:10.1001/jama.2013.283150

The good news for patients is that starting in 2014 the Affordable Care Act (ACA) requires individual and group health plans to issue policies to all applicants, regardless of health status. Through the ACA’s individual mandate, insurance exchanges, and Medicaid expansion, guaranteed issue will provide new coverage for millions of citizens. Having insurance, however, does not always guarantee access to primary care.

Lost in the political rhetoric around health reform and technical glitches in the HealthCare.gov website are a set of critical decisions that many physician practices will have to make in the coming years. These decisions may very well contribute to the ultimate success or failure of the ACA.

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