What the ACA replacement means for radiology

The ACA replacement bill appears to leave intact pieces of the Affordable Care Act (ACA) beneficial to radiologists, namely the expansion of preventative cancer screening. While it’s an encouraging sign, the tri-part repeal-and-replace process means radiologists should keep their ears to the ground, according to Chris Sherin, Director of Congressional Affairs at the American College of Radiology (ACR).

“The section relating to U.S. Preventative Task Force Screening-approved exams wasn’t repealed, which was a pleasant surprise,” said Sherin. “It appears that preventive screens that have grades of 'B' or above must continue to be provided by private insurance companies to patients without any form of cost sharing.

“However, plenty of questions remain."

According to Speaker Paul Ryan and other Republican leaders, the American Health Care Act’s reforms will come in three stages. The first stage—which is currently underway—uses the budget reconciliation process to repeal and replace as much of the ACA as possible. The second stage will utilize the regulatory process to unwind other parts of the ACA, which could include Essential Health Benefits packages. The third stage will attempt to pass any remaining changes through the normal legislative process, due to restrictions on what can be pushed through budget reconciliation.

The uncertainty of this process could make both insurers and patients wary, according to Sherin.

A chief concern for advocacy groups such as the ACR is how insurance companies react when they see large portions of the ACA being repealed but select provisions retained, said Sherin. A trade group of large health insurers criticized elements of the Republican plan in a letter to House GOP leaders, citing the age-based tax credits and changes to Medicaid expansion funding.

In addition, confusion among the patient population about the specifics of an ACA repeal could negatively impact screening utilization. Educating patients about the specifics of the ACA repeal will help ensure they’re aware of the coverage that remains. which means radiologists letting patients know they can still get certain preventative screenings without a co-pay.

As the repeal and replace process proceeds down it’s deeply partisan path, radiologists should also be aware of its effects on US healthcare industry as a whole. While radiology is primarily a referral-based specialty, it’s not immune from the deleterious effects of millions of Americans losing coverage.

“Obviously, the American Health Care Act appears to be negatively impacting the ability of individuals to access health insurance coverage, which will have a downstream effect on radiologists,” said Sherin. “If patients aren’t capable of seeing an ordering physician, they won’t be referred for important medical imaging procedures.”

However, repeal and replace is not yet a foregone conclusion. A report from CNN on Friday said the White House is privately backing calls to roll back the ACA Medicaid expansion earlier than the 2020 date put forward in Speaker Ryan’s bill, upsetting the already fragile efforts to pass the legislation through the Senate.

“We’re eager to see how the politics play out,” said Sherin.