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Implications of New Insurance Coverage for Access to Care, Cost-Sharing, and Reimbursement

A. Everette James III, JD1,2; Walid F. Gellad, MD3,4; Brian A. Primack, MD5
[+] Author Affiliations
1Health Policy Institute, Schools of the Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
2Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
3Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
4VA Pittsburgh Healthcare System and RAND Corporation, Pittsburgh, Pennsylvania
5Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA. 2014;311(3):241-242. doi:10.1001/jama.2013.283150.
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The good news for patients is that starting in 2014 the Affordable Care Act (ACA) requires individual and group health plans to issue policies to all applicants, regardless of health status. Through the ACA’s individual mandate, insurance exchanges, and Medicaid expansion, guaranteed issue will provide new coverage for millions of citizens. Having insurance, however, does not always guarantee access to primary care.

Lost in the political rhetoric around health reform and technical glitches in the HealthCare.gov website are a set of critical decisions that many physician practices will have to make in the coming years. These decisions may very well contribute to the ultimate success or failure of the ACA.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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