• ED Manag. 2012 Sep 1;24(9):97-100.

AbstractEven though the U.S. Supreme Court has upheld the bulk of President Obama's signature health care legislation, the Accountable Care Act (ACA), the prospects for full implementation of the law remain uncertain as political opponents still vow to strike down portions of the law at the earliest opportunity. Further, the high court's decision to leave the law's Medicaid expansion provisions up to the states leaves hospitals and EDs in a particularly precarious position as they will still face mandated cuts that the law's authors anticipated would be offset by Medicaid dollars. Experts recommend that ED administrators prepare for continued stress on their departments and get involved with shaping the way emergency medicine fits into ACOs and other emerging models of care. Some experts predict that EDs will see a flood of new patients when the Medicaid expansion provisions go into effect in 2014, but this trend may be tempered by the fact that newly insured patients will be able to seek care in other settings. The health reform transition is expected to be most difficult in states with large uninsured populations, and experts agree that a shortage of primary care physicians will drive ED volume in many communities. Hospitals and health care business interests are putting pressure on states to opt in to the ACA's Medicaid expansion provisions because it will make federal dollars available to cover 100% of the cost to cover newly insured Medicaid patients for three years, and 90% of the cost after that.

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