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    The Affordable Care Act: A urologist’s survival guide

    Henry Rosevear, MDHenry Rosevear, MD

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    Dr. Rosevear is in private practice at Pikes Peak Urology, Colorado Springs, CO

    I usually start this blog by saying that residency is tough, and I still agree with that statement. But after spending the last few weeks reading about the Affordable Care Act (or Obamacare), I can honestly say that residency is straightforward compared to this law.

    Have you read: ABU certification/recertification by the numbers

    First, a brief disclaimer: I write this blog so that other young urologists can learn from my mistakes and hopefully in the process have more time for their practices, families, hobbies, and other important things. This blog is not political, and I am neither endorsing nor criticizing the new health care law. Rather, my goal is to summarize it and explain how it has already affected my practice.

    If anyone wants to read the law in its entirety, here is a link to all 906 pages: http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf. (Some friendly advice: You’ll need more than one cup of coffee [or beer] to get through it.)

    ‘Universal coverage’

    To start, it’s important to explain who in America would not get insurance under the law. And yes, while the goal was to provide "universal coverage," it is estimated by the Congressional Budget Office that even under ideal situations, over 23 million people in America would go uncovered.

    Who are they? First, anyone here illegally is not covered. Of note, if an illegal immigrant walks into an ER, they are required to be treated under the Emergency Medical Treatment and Active Labor Act (EMTALA) passed in 1986. Second, anyone who doesn't bother to enroll won't be covered. While this may seem obvious, this includes two groups of people: those who are eligible for Medicare/Medicaid but not enrolled and those who choose to pay the annual penalty rather than get coverage. Third, people who live in states who chose not to expand Medicaid and don't qualify for Medicaid under their state's current law and who also don't qualify for subsidized coverage under their state's (or the federal government’s) exchanges won't be covered. Why is there a gap? That has to do with how the law was intended to cover everyone and how the Supreme Court interpreted it, but I’ll get to that later.

    Next: The individual mandate and changes to insurance

    Henry Rosevear, MD
    Dr. Rosevear, a member of the Urology Times Clinical Practice Board, is in private practice at Pikes Peak Urology, Colorado Springs, CO.

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