This week’s Cavalcade of Risk is up at the Notwithstanding Blog. One of my favorite posts in this edition also comes from the Notwithstanding Blog, in a discussion about how the PPACA could both enhance consumer protections and also take them away, thanks to some currently in-force consumer protections that may have to be swept aside to allow ACOs to operate.
The specific consumer protections contained in the PPACA are generally well-known. Things like requiring health insurance carriers to accept applicants with pre-existing conditions (as of 2014), allowing young adults to remain on their parents’ health insurance policies until age 26, and removing lifetime limits on coverage are frequently mentioned in news stories about the health care reform law, and tend to be relatively popular provisions.
That some existing regulations may have to be removed in order to allow ACOs to function is much less understood. Regulations like the ban on Medicare balance billing and various anti-kickback laws that were designed to limit fraud and abuse in the health care system are no doubt consumer protections. But the fact that they may be waived in order to implement ACOs has received far less commentary than the direct consumer protections explicitly created by the PPACA.
In reality, I think that it’s possible for ACOs to operate ethically and responsibly – with more up-to-date regulations and oversight – even if some older regulations have to be suspended in the process. I doubt that regulators will simply throw out the existing rules and allow ACOs to operate without consumer protections to place to guard against fraud and abuse. Instead, I see them coming up with new regulations that take into account the changing landscape of health care delivery, including ACOs. But either way, the creation of new consumer protections while suspending others does make for an interesting discussion.