From the Editor

  As you have undoubtedly heard, the Supreme Court recently upheld the constitutionality of the Affordable Care Act (ACA) by a vote of 5-4. While the 193-page opinion written by Chief Justice John Roberts is full of surprises, one glaring revelation is that individual states can opt out of the law’s sweeping expansion of Medicaid. Ironically, this will significantly reduce the number of Americans who gain healthcare insurance. If you’re wondering what the impact on wound care will be, the Medicaid ruling may play a big role in determining that. Expansion of Medicaid within the ACA was expected to extend health insurance coverage to about 17 million Americans. By 2019, the program was expected to cover everyone below 133 percent of the federal poverty line (an annual income of $14,500 for an individual).

Rightly Stated

  The ACA provides financial incentives to entice states into the Medicaid expansion. The federal government will cover the entire cost of all these new patients for the first three years. (Usually states have to contribute something to the cost.) However, the match starts to decrease in 2017, with the feds paying 90 percent of the bill. That may still sound like a high percentage, but it may not be enough to entice states that are already struggling under the weight of growing Medicaid bills. The financial burden would be higher on the states that have traditionally had less expansive Medicaid programs. In my state of Texas, for example, which only covers parents up to 26 percent of the federal poverty level, the state would spend an estimated $2.6 billion on the coverage expansion between 2014 and 2019. The expansion would cover an additional 1.8 million people in Texas who do not currently have insurance. Under the original wording of the ACA, if a state would have failed to implement the expansion, it stood to lose all Medicaid funding. This component of the ACA has been viewed by Roberts as “coercive” and was struck down by a 7-2 decision. Meanwhile, those states that opt into the expansion could create an insurmountable deficit in each respective budget, possibly causing bankruptcy. If a state opts out, some of the poorest Americans could end up in a “no man’s land” and not be covered by federal entitlement programs and not be eligible for subsidized insurance. No matter your personal political views, the fundamental question is: Can this country, which is struggling under the weight of a multi-trillion dollar deficit, afford the ACA? More people than ever before are going to have healthcare coverage, but the money to pay for that coverage is limited. Efforts at controlling healthcare reimbursement will be redoubled under a variety of programs. This will effectively be “rationing” under other names. The effect on wound care is not yet known.

Focus on Fraud

  We can now expect the government’s anti-fraud enforcement to take center stage. The ACA contains amendments to the federal False Claims Act, the government’s principal enforcement statute. The US Department of Justice and the US Department of Health and Human Services will be under pressure to expand their civil and criminal fraud enforcement activities, as this will have a profound effect on wound care practice. I think you’ll find this issue of Today’s Wound Clinic, which reviews what clinicians need to know about the numerous recoupment programs that exist to be one of the most important and timely we’ve published. Caroline Fife, co-editor of TWC, chief medical officer at Intellicure Inc., cfife@intellicure.com.