No pain, no gain with ACA

There’s an old adage in sports “no pain, no gain.” We’ve all heard it and most of us accept that hard work and a little pain pay off in athletics. The same can be said for many things in life. Yet, it appears that not everyone in Washington agrees.

Obamacare, formally known as the Patient Protection and Affordable Care Act (ACA), was designed to extend coverage to millions of Americans without insurance, reduce bankruptcies caused by burdensome medical expenses and ensure access to insurance for high-risk patients. Most of us agree that these are positive initiatives. Yet, for all of the benefits, recent delays in the rollout of the ACA may impact anticipated outcomes. Delays include the employer mandate, the smoking penalty, the verification of income, the rollback of out-of-pocket limits for exchange-based policies, and the complete repeal of the medical device tax. These unaccounted for changes will increase insurance premiums and cost billions.

How will these changes affect costs?

First, we need to understand that healthcare has an intrinsic cost. Industry workers earn top wages due to demand and training. The cost of operating hospitals and state-of-the-art medical facilities is staggering. Like other industries, healthcare businesses face inflation and rising costs in energy, litigation and employee benefits. Medical providers pass these costs directly on to patients, their employers and their insurance providers. Government payers including Medicare and Medicaid reimburse providers at or even below the actual cost of a procedure. The delta is passed on to those with private insurance in the form of higher prices. This ultimately translates to skyrocketing insurance premiums.

Regardless of your political ideology or beliefs surrounding the ACA, it’s undeniable that the Congressional Budget Office’s estimates for the cost of “Obamacare” are no longer accurate. Billions in fines and taxes will not be collected, but the promises of premium support and expansion of coverage remain in place and will undoubtedly be utilized by many. The math behind the ACA required “pain” so the “gain” could be realized. No “pain” for the intended parties means no “gain” for the 40% of us with private insurance.

At Smart Choice MRI, we’ve made a positive contribution to skyrocketing imaging costs since our inception in 2006. Realizing that imaging costs varied and had little to do with the actual cost of providing service, we founded our independent clinic on transparent flat rate pricing. We’ve charged $600 for each and every patient scan whether the patient had insurance or paid out of pocket. Our partnership with the renowned Cleveland Clinic radiologists ensures top tier quality scans. More than 30,000 patients and 4,000 physicians agree with us.

We’re concerned about the implementation of ACA. We’d like to encourage patients to take advantage of the upcoming changes on the medical care front to educate themselves. We encourage patients to shop for medical insurance and services like they do for any other out-of-pocket expense. Imaging costs alone in southeastern Wisconsin range in price from our low of $600 to nearly $3,000. Many patients who find us are amazed at the range in imaging pricing for essentially the same service. We expect that more of these educated health consumers will ultimately make a positive contribution to the cost of health care, thus benefitting us all.

Eric Haberichter is a founding member of Smart Choice MRI LLC, which has offices in West Milwaukee and Sheboygan.

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