Health Law Expert David Trueman '97 Explores Impact of Affordable Care Act

Trueman, Who Teaches Health Law at Columbia Law School, Says Obamacare Will Expand Coverage But May Not Lower Costs.
New York, October 23, 2013—The Patient Protection and Affordable Care Act (ACA) will help millions of people purchase health insurance and will lower costs of premiums for many, but not all individuals, said lecturer-in-law David Trueman ’97 in an Oct. 17 presentation at Columbia Law School. Trueman also predicted that the future of medical practice may be dramatically altered as new mechanisms of health care payments, already contained in the ACA, become a standard means of paying health care providers.
Trueman, a practicing attorney and licensed psychologist who teaches Health Law and Access to Health Care, explained that the health reform package known as Obamacare is an attempt to expand coverage ideally to all U.S. citizens and legal immigrants, improve consumer protections and quality of care, and alter the core economics of health care.
“The rationale is that more people buying insurance means cheaper rates per person, and we can lower premiums by incentivizing everyone, including healthy people, to buy insurance,” he said.
Trueman described the ACA’s several interlocking changes to the health care system intended to encourage more Americans to sign up for health insurance: an originally mandatory expansion of Medicaid on a state-by-state basis, modified to a state-by-state elective change by the U.S. Supreme Court; the creation of government-provided marketplaces, or exchanges, where consumers can purchase insurance; the availability of subsidies for lower income individuals purchasing coverage on the exchanges, making insurance more affordable; the individual mandate requiring all adults to obtain coverage or pay fines; penalties for larger employers who do not provide health insurance to their workers; and various consumer protections and insurance mandates increasing the accessibility and comprehensiveness of insurance options.
Trueman said the biggest insurance changes are that beginning January 1, 2014, insurers in the individual and group markets will be prohibited from imposing pre-existing condition exclusions under the Affordable Care Act, will not be able to charge different rates based on gender or health history, are prohibited from imposing annual or lifetime limits on coverage, and are mandated to offer coverage to everyone who wishes to purchase insurance. While optimistic that the ACA will enable many more people to obtain health insurance, Trueman raised concerns about whether the system will be able to attract enough healthy participants to cover the costs of sicker people in the system, and, thereby, lower premiums or rein in the rapid growth of national spending on health care in recent years.
“The individual mandate is not going to compel people to buy insurance. The ACA has no way to collect penalties except by limiting refunds on tax returns,” he said. “The rate amounts we are seeing now are just projections, and coverage may well become more expensive. My guess is that premiums will go up.”
Trueman added, however, that separate from the individual mandate, the opportunity for individuals to purchase health care insurance is compelling and we can expect significant numbers to purchase insurance from the exchanges.
Trueman indicated that the ACA is utilizing a different mechanism of payment for Medicare patients whose treatment will be increasingly provided by Accountable Care Organizations (ACOs), large groups of physicians and hospitals who voluntarily band together to provide coordinated care for a single fee per patient, as opposed to paying customized bills from multiple specialists. Although the development of ACOs and medical homes will likely lead to more cost-effective care provided by integrated groups of providers, potentially increasing the quality of care, individuals in the future may not have continuity of care from any particular physician. He predicted that in coming years there will be systemic changes in the provision of medical care from individual physician practice to integrated groups of health care professionals providing integrated care, particularly to individuals with chronic illnesses. 
“The days of individual medical care and practice are winding down,” Trueman said. 
Currently, however, he stated that individuals on Medicare or with insurance remain free to see the same physician.
Trueman’s talk was sponsored by the Columbia Health Law Association.